Key result
Arthroscopic FAI revision is linked to ~22% fewer good or excellent outcomes versus primary correction.
Why the study?
There is very limited data reporting outcomes after revision arthroscopy for residual femoroacetabular impingement (FAI).
Does arthroscopic hip revision surgery improve patient-reported outcomes in patients with residual FAI compared to primary arthroscopic FAI correction?
Cohort (n=202)
Does arthroscopic hip revision surgery improve patient-reported outcomes in patients with residual FAI compared to primary arthroscopic FAI correction?
Absolute Event Rate: 63.3% vs 81%
p-value: p=.012
Arthroscopic hip revision surgery for residual FAI leads to significant improvements in patient-reported outcomes, though these improvements are inferior to those seen after primary FAI correction.
Revision for residual FAI linked to inferior results; leaves open optimal patient selection and technique refinement.
Objectives: There is a steep surgical learning curve when managing femoroacetabular impingement (FAI) and residual FAI can lead to continued pain and disability. There is very limited data reporting outcomes after revision arthroscopy for residual FAI. Methods: The records of patients that underwent arthroscopic hip revision surgery for residual FAI based on plain radiographs and 3D CT scans were reviewed. Pre and post-operative structural pathomorphology, intra-operative findings, and pre and post-operative outcomes measures using Modified Harris Hip Scoring (MHHS), SF-12 scoring, and pain on a visual analogue scale (VAS) were evaluated. Outcomes after revision arthroscopic FAI correction were compared to a cohort that underwent primary arthroscopic FAI correction. Results: 48 patients (53 hips) underwent arthroscopic revision FAI correction (mean 20.0 months follow-up). There were 62 previous arthroscopic surgeries and 4 previous surgical dislocations. There were 23 males and 25 females with a mean age of 29.9 years (range 18 - 59). 48 hips had residual cam-type FAI, and 40 hips had residual pincer-type FAI and underwent femoral and rim resections, respectively. The labrum was debrided in 27 hips, repaired in 24 hips and reconstructed with allograft in 2 hips. Adhesions were excised for 35 hips. The results of revision arthroscopic FAI correction were compared to 154 patients (169 hips) that underwent primary arthroscopic FAI correction (mean 25.2 months follow-up). The mean improvement for outcomes scores after revision FAI correction was 13.7 points (MHHS, p<.01), 8.6 points (SF-12, p<.01), and 2.6 points (VAS, p<.01) compared to 23.7 points (MHHS, p<.01), 22.3 points (SF-12, p<.01), and 4.6 points (VAS, p<.01) after primary arthroscopic FAI correction. Most recent outcomes scores and mean improvement in outcome scores were significantly better after primary (81% good/ excellent results) compared to revision (63.3% good/excellent results) FAI correction (MHS (p=.012), SF-12 (p<.01), VAS (p<.01). Conclusion: With appropriate indications and expectations, arthroscopic hip revision surgery for residual FAI led to significantly improved outcome measures. Outcomes, however, were inferior to those after primary arthroscopic FAI corrective surgery.
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Larson et al. (2013) conducted a cohort in Residual femoroacetabular impingement (FAI) (n=202). Arthroscopic hip revision surgery vs. Primary arthroscopic FAI correction was evaluated on Good/excellent results (p=p=.012). Arthroscopic hip revision surgery for residual FAI yielded significantly fewer good or excellent results compared to primary arthroscopic correction (63.3% vs 81%).
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