title: Defining modes of failure after joint-preserving surgery of the hip.
abstract: OBJECTIVE
  Joint-preserving surgery of the hip (JPSH) has evolved considerably and now includes a number of procedures, including arthroscopy, surgical dislocation, and redirectional osteotomies of the femur and acetabulum. There are a number of different factors which lead to failure of JPSH. Consequently, it is of interest to assess the various modes of failure in order to continue to identify best practice and the indications for these procedures.
  
  
  METHODS
  Using a retrospective observational study design, we reviewed 1013 patients who had undergone JPSH by a single surgeon between 2005 and 2015. There were 509 men and 504 women with a mean age of 39 years (16 to 78). Of the 1013 operations, 783 were arthroscopies, 122 surgical dislocations, and 108 peri-acetabular osteotomies (PAO). We analysed the overall failure rates and modes of failure. Re-operations were categorised into four groups: Mode 1 was arthritis progression or organ failure leading to total hip arthroplasty (THA); Mode 2 was an Incorrect diagnosis/procedure; Mode 3 resulted from malcorrection of femur (type A), acetabulum (type B), or labrum (type C) and Mode 4 resulted from an unintended consequence of the initial surgical intervention.
  
  
  RESULTS
  At a mean follow-up of 2.5 years, there had been 104 re-operations (10.2%) with a mean patient age of 35.5 years (17 to 64). There were 64 Mode 1 failures (6.3%) at a mean of 3.2 years following JPSH with a mean patient age of 46.8 years (18 to 64). There were 17 Mode 2 failures (1.7%) at a mean of 2.2 years post-JPSH with a mean patient age of 28.9 years (17 to 42) (2% scopes; 1% surgical dislocations). There were 19 Mode 3 failures (1.9%) at a mean of 2.0 years post-JPSH, with a mean patient age of 29.9 years (18 to 51) (2% scopes; 2% surgical dislocations; 5% PAO). There were 4 Mode 4 failures (0.4%) at a mean of 1.8 years post-JPSH with a mean patient age of 31.5 years (15 to 43). Using the modified Dindo-Clavien classification system, the overall complication rate among JPSHs was 4.2%.
  
  
  CONCLUSIONS
  While defining the overall re-operation and complication rates, it is important to define the safety and effectiveness of JPSH. Standardisation of the modes of failure may help identify the best practice. Application of these modes to large clinical series, such as registries, will assist in further establishing how to improve the efficacy of JPSH. Cite this article:Bone Joint J2017;99-B:303-9.
authors.affiliation: The Ottawa Hospital, General Campus, 501 Smyth Road CCW 1640, Ottawa ON, K1H 8L6, Canada.
authors.forename: P E
authors.initials: PE
authors.lastname: Beaulé
authors.affiliation: The Ottawa Hospital, General Campus, 501 Smyth Road CCW 1640, Ottawa ON, K1H 8L6, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Bleeker
authors.affiliation: The Ottawa Hospital, General Campus, 501 Smyth Road CCW 1640, Ottawa ON, K1H 8L6, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Singh
authors.affiliation: The Ottawa Hospital, General Campus, 501 Smyth Road CCW 1640, Ottawa ON, K1H 8L6, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Dobransky
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D018450:Disease Progression; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D012086:Reoperation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: Arthroscopy; Hip; Joint preservation; Modes of failure; Periacetabular osteotomy; Surgical dislocation