Abstract
Purpose
As many as 10% of primary hip arthroscopies end up with a revision arthroscopy procedure when treating patients suffering from femoroacetabular im**ement syndrome (FAIS). In general, revision procedures are indicated because of residual im**ement, but only a few studies present outcome data from revision hip arthroscopy after failed FAIS surgical treatment. The purpose of this study was to evaluate clinical outcomes after revision hip arthroscopy in a FAIS cohort and compare outcomes with a primary FAIS hip arthroscopy cohort and describe potential causes of failure after the primary hip arthroscopy. It was hypothesized that subjective outcomes improve after revision hip arthroscopy although outcomes were expected to be inferior to primary hip arthroscopic outcomes.
Methods
Three-hundred and thirty-one arthroscopic revision hip FAIS patients were included from the Danish Hip Arthroscopy Registry (DHAR). Patient-related outcome measures (PROM’s), Copenhagen Hip and Groin Outcome Scores (HAGOS), Hip Sports Activity Scale (HSAS), EQ-5D and Numeric Rating Scale (NRS) pain, were assessed in the study cohort prior to the primary procedure and at revision and at follow-up one year after the revision procedure. These data were compared with 4154 primary hip arthroscopic FAIS patients.
Results
One-year after revision surgery, mean follow-up (in months ± SD): 12.3 ± 1.6, significant improvements (p < 0.05) in all PROMs was demonstrated, but FAIS patients in the primary hip arthroscopic cohort demonstrated significantly higher outcomes, in all PROMs, when compared at one-year follow-up. Scar tissue, residual osseous im**ement and insufficient healing of the labral repair were reported as the main reasons for revision surgery. The conversion to total hip arthroplasty was low (6.4%).
Conclusion
Revision hip arthroscopy in FAIS patients improves subjective outcomes significantly, although they are poorer than after primary FAIS hip arthroscopy. Main reasons for revision arthroscopy was scar tissue, residual femoroacetabular im**ement and insufficient healing of labral repair.
Level of evidence
Level III.
Similar content being viewed by others
References
Beck M, Leunig M, Parvizi J et al (2004) Anterior femoroacetabular im**ement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73
Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular im**ement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012–1018
Domb BG, Gui C, Hutchinson MR, Nho SJ, Terry MA, Lodhia P (2016) Clinical outcomes of hip arthroscopic surgery: a prospective survival analysis of primary and revision surgeries in a large mixed cohort. Am J Sports Med 44:2505–2517
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular im**ement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120
Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M et al (2016) The Warwick Agreement on femoroacetabular im**ement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50:1169–1176
Gupta A, Redmond JM, Stake CE, Dunne KF, Hammarstedt JE, Domb BG (2016) Outcomes of revision hip arthroscopy: 2-Year clinical follow-up. Arthroscopy 32:788–797
Harris JD, McCormick FM, Abrams GD, Gupta AK, Ellis TJ, Bach BR Jr et al (2013) Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy 29:589–595
Heyworth BE, Dolan MM, Nguyen JT, Chen NC, Kelly BT (2012) Preoperative three-dimensional CT predicts intraoperative findings in hip arthroscopy. Clin Orthop Relat Res 470:1950–1957
Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT (2007) Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy 23:1295–1302
Kester BS, Capogna B, Mahure SA, Ryan MK, Mollon B, Youm T (2018) Independent risk factors for revision surgery or conversion to total hip arthroplasty after hip arthroscopy: a review of a large statewide database from 2011 to 2012. Arthroscopy 34:464–470
Konan S, Rayan F, Meermans G, Witt J, Haddad FS (2011) Validation of the classification system for acetabular chondral lesions identified at arthroscopy in patients with femoroacetabular im**ement. J Bone Joint Surg Br 93:332–336
Larson CM, Giveans MR, Samuelson KM, Stone RM, Bedi A (2014) Arthroscopic hip revision surgery for residual femoroacetabular im**ement (FAI): surgical outcomes compared with a matched cohort after primary arthroscopic FAI correction. Am J Sports Med 42(1785–1790):2
Leunig M, Beaule PE, Ganz R (2009) The concept of femoroacetabular im**ement: current status and future perspectives. Clin Orthop Relat Res 467:616–622
Locks R, Bolia IK, Utsunomiya H, Briggs KK, Philippon MJ (2018) Revision hip arthroscopy after labral reconstruction using iliotibial band autograft: surgical findings and comparison of outcomes with labral reconstructions not requiring revision. Arthroscopy 34(4):1244–1250
Lund B, Mygind-Klavsen B, Nielsen TG et al (2017) Danish Hip Arthroscopy Registry (DHAR): the outcome of patients with femoroacetabular im**ement (FAI). J Hip Preserv Surg. 4(2):170–177
Lund B, Kraemer O, Hölmich P, Winge S, Maagaard N, Mygind-Klavsen B (2019) Danish Hip Arthroscopy Registry 2018 Annual Report. https://saks.ortopaedi.dk/wp-content/uploads/2019/10/DHAR_2018_Annual_report.pdf. Accessed 2 February 2020
McCarthy JC, Jarrett BT, Ojeifo O, Lee JA, Bragdon CR (2011) What factors influence long-term survivorship after hip arthroscopy? Clin Orthop Relat Res 469:362–371
Minkara AA, Westermann RW, Rosneck J, Lynch TS (2019) Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular im**ement. Am J Sports Med 47(2):488–500
Mehta N, Chamberlin P, Marx RG et al (2018) Defining the learning curve for hip arthroscopy: a threshold analysis of the volume-outcomes relationship. Am J Sports Med 46(6):1284–1293
Mygind-Klavsen B, Gronbech Nielsen T, Maagaard N, Kraemer O, Holmich P, Winge S et al (2016) Danish hip arthroscopy registry: an epidemiologic and perioperative description of the first 2000 procedures. J Hip Preserv Surg 3:138–145
Naal FD, Miozzari HH, Kelly BT, Magennis EM, Leunig M, Noetzli HP (2013) The hip sports activity scale (HSAS) for patients with femoroacetabular im**ement. HIP Int 23(2):204–211
O´Connor M, Steinl GK, Padaki AS et al (2020) Outcomes of revision hip arthroscopic surgery a systematic review and meta-analysis. Am J Sports Med 48(5):1254–1262
Rogers MJ, Adeyemi TF, Kim J et al (2019) Understanding preoperative demographics and risk factors for early revision surgery in patients undergoing hip arthroscopic surgery: a large database study. Orthop J Sports Med. https://doi.org/10.1177/2325967119849579
Ricciardi BF, Fields K, Kelly BT, Ranawat AS, Coleman SH, Sink EL (2014) Causes and risk factors for revision hip preservation surgery. Am J Sports Med 42(11):2627–2633
Sogbein OA, Shah A, Kay J et al (2019) Predictors of outcome after hip arthroscopic surgery for femoroacetabular im**ement: a systematic review. Orthop J Sports Med. https://doi.org/10.1177/2325967119848982
Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular im**ement: a radiographic diagnosis - what the radiologist should know. AJR Am J Roentgenol 188(6):1540–1552
Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM (2011) The copenhagen hip and groin outcome score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45(6):478–491
Thorborg K, Tijssen M, Habets B et al (2015) Patient-reported outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence. Br J Sport Med 49(12):812
Thorborg K, Kraemer O, Madsen AD et al (2018) Patient-reported outcomes within the first year after hip arthroscopy and rehabilitation for femoroacetabular im**ement and/or labral Injury. The difference. Am J Sports Med. 46(11):2607–2614
Van den Borne MP, Raijmakers NJ, Vanlauwe J, Victor J, de Jong SN, Bellemans J et al (2007) International cartilage repair society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage 15:1397–1402
West CR, Bedard NA, Duchmann KR et al (2019) Rates and risk factors for revision hip arthroscopy. Iowa Orthop J 39(1):95–99
Zampelis V, Ornstein E, Franzén H, Atroshi I (2014) A simple visual analog scale for pain is as responsive as the WOMAC, the SF-36, and the EQ-5D in measuring outcomes of revision hip arthroplasty. Acta Orthop 85(2):128–132
Acknowledgements
The authors of this work would like to thank Andreas Chatterton (MD) for his hard work making an initial draft for this manuscript and presentation of this matter held at Aarhus University.
Funding
No funding was accepted for the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author declares to have no conflicts of interest.
Ethical approval
Ethical approval was not needed for the present study. Handling of data from DHAR was approved by the Danish Data Protection Agency under case number 1-16-02-184-18. DHAR is approved by the Danish Health Authority.
Informed consent
Formal consent was not required for this registry study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mygind-Klavsen, B., Nielsen, T.G., Lund, B. et al. Clinical outcomes after revision hip arthroscopy in patients with femoroacetabular im**ement syndrome (FAIS) are inferior compared to primary procedures. Results from the Danish Hip Arthroscopy Registry (DHAR). Knee Surg Sports Traumatol Arthrosc 29, 1340–1348 (2021). https://doi.org/10.1007/s00167-020-06135-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-020-06135-w