Issue: October 2014
Perspective from Asheesh Bedi, MD
October 01, 2014
2 min read
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Improved outcomes found for revision arthroscopic hip surgery

Issue: October 2014
Perspective from Asheesh Bedi, MD
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One of the first studies on outcomes of revision hip arthroscopy indicates most patients who struggle after an initial hip arthroscopy or subsequently have recurrent pain improve with repeat arthroscopy.

“[We found a] wide range of how well people did, but overall more than 90% of our patients did experience some improvement,” F. Winston Gwathmey Jr., MD, said during a presentation at a recent meeting.

To determine the outcomes of revision hip arthroscopy, Gwathmey and his colleagues evaluated prospectively collected data on 192 revision hip arthroscopy cases performed between 1995 and 2013 by the senior author, J.W. Thomas Byrd, MD, with at least 1 year follow-up. This cohort included 192 hips of 188 patients and was comprised of 70 men and 118 women. The average age of the patients was 33 years. The average time from original hip surgery to revision procedure was 24 months.

Byrd had performed the index procedure in 112 cases, and 80 cases were performed by another surgeon. The investigators discovered 139 patients (72%) experienced intermittent relief of symptoms after the index arthroscopy while 49 patients reported no improvement.

Byrd met with and indicated revision surgery for all patients included in the study. All surgeries were performed with patients positioned in standard supine position, and patients underwent a standard rehabilitation protocol. The investigators evaluated patients preoperatively and postoperatively using the modified Harris Hip Score (mHHS) at standard intervals. The patients had an average follow-up of 39 months.

“The mean number of diagnoses of revision hip arthroscopy was about four,” Gwathmey said. “The mean documented number of procedures was about 3.4.”

The cases included several pathologies: 55% of cases presented with acetabular chondral lesions the majority of which were high grade; 14% of cases involved femoral chondral lesions; 53% of cases had labral tears; and 26.6% had labral calcification. Additional findings during revision hip arthroscopy included adhesions, bone fragments, loose sutures, cam and pincer impingement, and recurrent synovial chondromatosis.

Pathology consistent with femoroacetabular impingement was seen in 42% of revision cases. In these cases, 61% of the cam and 84% of the pincer deformities were unaddressed at the index procedure. High grade acetabular cartilage damage was more common in cases of residual cam impingement.

Most of the repeat arthroscopic surgeries performed were chondroplasty and labral debridement. Other arthroscopic procedures included femoroplasty, debridement, acetabuloplasty, labral repair, microfracture and trochanteric bursectomy.

The investigators found a mean improvement in mHHS of 24.6 points, and measurable symptomatic improvement was seen in 92% of cases. The complication rate was low.

“There has been a proliferation of hip arthroscopies over the last couple decades,” Gwathmey said. As these procedures continue to increase — some studies suggest that the number of cases increased by 18 times between 1999 and 2009 — revision surgeries will rise as well, he noted calling for a need to better understand the potential outcomes. – by Katie Pfaff

Reference:

Gwathmey FW. Paper SS-41. Presented at: Arthroscopy Association of North America Annual Meeting; May 1-3, 2014; Hollywood, Fla.

For more information:

F. Winston Gwathmey Jr., MD, can be reached at the Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA; email: fwg7d@virgina.edu.

Disclosure: Gwathmey has no relevant financial disclosures.