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Revision Hip Arthroscopy Terrible Triad: Capsular Deficiency, Labral Deficiency, and Femoral Over-Resection
Joseph J Ruzbarsky1, Ali Noorzad1, Nicholas A Felan2
1The Steadman Clinic, Vail, Colorado, U.S.A.; The Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Insights
Revision hip arthroscopy addresses complex issues like labral and capsular deficiency, and cam over-resection. Comprehensive correction of these pathologies can restore hip anatomy and function, leading to improved outcomes.
Area of Science:
- Orthopedic Surgery
- Arthroscopy
- Hip Preservation
Background:
- Revision hip arthroscopy is frequently performed for residual femoroacetabular impingement.
- Pathologies like capsular deficiency, labral deficiency, and cam over-resection present challenges during revision surgery.
Purpose of the Study:
- To outline comprehensive management strategies for complex pathologies encountered during revision hip arthroscopy.
- To emphasize restoring hip anatomy, fluid seal, and impingement-free motion.
Main Methods:
- Labral deficiency treated with augmentation or reconstruction.
- Capsular deficiency managed with primary repair or reconstruction.
- Cam over-resection addressed with soft-tissue remplissage techniques.
Main Results:
- These techniques aim to comprehensively correct combined pathologies, even in salvage scenarios.
- Improved patient outcomes and acceptable survivorship are achievable with these reconstructive methods.
Conclusions:
- Revision hip arthroscopy requires addressing multiple complex pathologies.
- Comprehensive surgical correction of labral deficiency, capsular deficiency, and cam over-resection can restore hip function and improve long-term results.
Abstract:
Revision hip arthroscopy is increasingly common and most often performed to treat residual femoroacetabular impingement caused by cam under-resection. Unfortunately, other pathologies encountered during revision hip arthroscopy are more difficult to treat, including capsular deficiency, labral deficiency, adhesion formation, and/or cam over-resection. When encountered, these various pathologies should be comprehensibly corrected with the goals of restoring anatomy, re-establishing the hip fluid seal, and ensuring impingement-free motion. Labral deficiency can successfully be treated with labral augmentation or reconstruction. Capsular deficiency is best managed with primary repair or capsular reconstruction. Cam over-resection is a difficult problem, but there is growing evidence for a soft-tissue remplissage used to fill the defect with soft tissue. The combination of these problems can be considered a salvage scenario but can be treated comprehensively with these techniques with improved outcomes and acceptable survivorship.
