Thursday, May 1, 2008

Failed Hip Arthroscopy and Revision Hip Arthroscopy Articles

Radiologic and Intraoperative Findings in Revision Hip Arthroscopy
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth, M.D., Michael K. Shindle, M.D., James E. Voos, M.D., Jonas R. Rudzki, M.D., Bryan T. Kelly, M.D.
Arthroscopy. 2007 Dec;23(12):1295-302.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.

Revision Hip ArthroscopyMarc J. Philippon, MD*, Mara L. Schenker, Karen K. Briggs, MPH, MBA, David A. Kuppersmith, R. Brian Maxwell and Allston J. Stubbs, MD
Am J Sports Med. 2007 Nov;35(11):1918-21. Epub 2007 Aug 16
Background: Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy.
Hypothesis: Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes.
Results: All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16–53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9–84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22–99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6–19 months). Outcomes showed patients regained some of their lost function within the first year.
Conclusion: Patients commonly required revision hip arthroscopy because of persistent impingement.

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