Failed Hip Arthroscopy

FAI is a recognized cause of hip pain due to anatomic abnormalities that damage the labrum and it is a major factor in development of degenerative arthritis of the hip. Hip arthroscopy is the gold standard surgical procedure to restore labral anatomy and function. The goal is to correct anatomic abnormalities that lead to symptoms, and repair or refix the labrum, to prevent the development of osteoarthritis secondary to FAI.

Hip arthroscopy generally yields favorable outcomes, both in the short and long term, in the treatment of FAI, but there is a group of patients who have residual or recurrent symptoms. Studies report that about 4% of patients require revision arthroscopy. The average time between primary and revision hip arthroscopic surgery has been reported to be 18 – 25 months.

Management of failed hip arthroscopy is a complex problem that should be addressed by hip preservation experts. All consultations require a thorough history, focused physical exam and review of pertinent imaging (X-Ray, MRI, CT) to establish the cause of hip pain or discomfort.

First-line management in diagnosed, recurrent hip pain always begins with conservative measures such as activity modification and focused physical therapy. When indicated, after exhaustion of conservative measures, revision hip arthroscopy has been clinically proven to significantly improve patient-reported outcomes.

The most common indication for revision hip arthroscopy is persistent pain following an index surgical procedure. Reasons for pain following hip arthroscopy include residual hip impingement (FAI), residual or recurrent damage to the hip labrum, damage to articular cartilage, capsular deficiency leading to persistent hip instability and adhesions (scar tissue).

Revision arthroscopic hip surgery may involve re-shaping of the femoral head (femoroplasty) or socket (acetabuloplasty), revision labral repair, circumferential labral reconstruction, or labral augmentation. Persistent instability may require capsular plication, capsular reconstruction or augmentation, ligamentum teres reconstruction with internal brace. Cartilage injury may require marrow stimulation techniques such as microfracture or cartilage resurfacing.

Surgeons at LALL Orthopedics ⁺ utilize world-class expertise to perform portions, or all, of the above procedures during the same, one-time, minimally invasive surgical setting. Of note, many of the above procedures were developed in-part by our team of surgical experts and have been published in the peer-reviewed orthopedic literature, presented at national / international meetings, and taught to surgeons worldwide.

A full clinical evaluation is vital to identifying the cause of failure. Repeat MRI or CT imaging is essential to understand the cause of failure. Diagnostic hip joint injections may be needed for confirmation of pain generators prior to a surgical procedure, to ensure the hip is indeed the source of pain. Sources of pain outside of the hip joint must be considered and may include tendinitis, lumbar spine disease, and pelvic floor pain.

The diagnosis of the cause of failure will determine which procedures may be involved.

• Labral repair is indicated when the patient presents with pain and MRI evidence reveals the need for additional surgery to repair, augment or reconstruct the labrum with a graft.
• Bone and cartilage repair may be implicated in certain types of FAI when symptoms recur and there is evidence of bone and cartilage defects.

All revision surgery is based upon the source of the problems. Every patient is unique. Revision procedures are individualized for the patient’s needs. There is no one size fits all. Current available peer-reviewed information, with much contribution by the clinicians at LALL Orthopedics ⁺, is that patients who undergo revision hip arthroscopy can achieve favorable outcomes when the source of the problem is identified, and the surgical procedures chosen are executed successfully.