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Revision Hip Arthroscopy Yields Inferior Patient Reported Outcome Measures and Patient Acceptable Symptomatic State
Juan Bernardo Villarreal-Espinosa1, Fernando Gómez-Verdejo1, Michael J Murray1
1Rush University Medical College, Chicago, Illinois, U.S.A.
Purpose:
To compare functional and patient-reported outcomes between primary and revision hip arthroscopy.
Methods:
A systematic search was conducted using 3 databases (PubMed, EMBASE, CINAHL) from inception to October 2024, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Only comparative clinical studies evaluating primary versus revision hip arthroscopy with minimum 2-year follow-up were included. Evaluated outcomes included patient-reported outcome measures, reoperation/total hip arthroplasty conversion rates, and patient-acceptable symptomatic state (PASS)/minimal clinically important difference (MCID) achievement rates.
Results:
Nine studies were retrieved for analysis. In total, 2,128 and 723 patients (2,230 and 737 hips) were included in the primary and revision setting, respectively. Femoroacetabular impingement and labral-related procedures were reported in all patients. At a minimum 2-year follow-up, Hip Outcome Score Activities of Daily Living and Sports Subsection scores ranged from 77 to 87.4 and 57 to 91.7 in the primary and from 77.6 to 80.4 and 54.4 to 65.3 in the revision groups, respectively. Moreover, modified Hip Harris Score and International Hip Outcome Tool 12 scores presented lower ranges in the revision setting, upon comparison with the primary cohort (72.2-81 vs 80-96 and 59.4-63.7 vs 71.9-91.5, respectively). Furthermore, revision/repeat revision ranged from 0-12.5% in the primary and 0-14.2% in the revision cohort. Conversion to total hip arthroplasty varied from 0 to 12.6% in the primary and from 0 to 27.5% in the revision arm. PASS threshold achievement rates were higher in the primary hip arthroscopy group in 3 of the 4 studies that reported them (55.8-71.1% vs 29.4-80.6%).
Conclusions:
Patients undergoing revision hip arthroscopy achieve inferior functional outcomes, reflected in patient reported outcome measures and PASS achievement rates, compared to the primary setting. No apparent revision or repeat revision arthroscopy differences were observed; however, the revision cohort trended toward higher total hip arthroplasty conversions. These results support our hypothesis regarding inferior outcomes and higher conversion rates in revision cases.
Level Of Evidence:
III, systematic review of Level II-III studies.
