Residual Structural Disease and New Labral Tears Are the Most Common Indications for Revision Hip Arthroscopy: A...

To provide a summary of the available literature on the most common indications for revision hip arthroscopy (RHA).

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines by searching PubMed, Embase, and the Cochrane Library to identify English-language clinical studies reporting on indications for patients undergoing RHA from January 1, 2000, to April 1, 2025. The search terms used were as follows: hip AND arthroscopy AND (revision OR failure OR reoperation). The primary outcomes assessed were reasons for revision reported by each study. Other outcomes included revision procedures, radiographic measures, patient-reported outcomes, rates of conversion to total hip arthroplasty, and rates of subsequent RHA; additional data extracted included number of patients, sex or gender distribution, follow-up period, and time from index procedure.

Eleven studies (1 Level I, 1 Level II, 6 Level III, and 3 Level IV) met the inclusion criteria, with a total of 1,242 hips. Patient age ranged from 24.2 to 38.0 years, with 12.3- to 63.9-month follow-up reported. The most common revision indications were unaddressed femoroacetabular impingement (744 hips), labral tears (667 hips), and capsulolabral adhesions (401 hips). Common revision procedures included femoroplasty (704 hips), acetabuloplasty (526 hips), labral repair (365 hips), and lysis of adhesions (321 hips). Among studies presenting preoperative and postoperative patient-reported outcomes, patients showed significant improvements in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, and Hip Outcome Score-Sports Subscale. Two studies reported achievement of the minimal clinically important difference in 65.5% to 69.8% of patients for the modified Harris Hip Score and 61.9% to 63.6% of patients for the Hip Outcome Score-Sports Subscale. Rates of subsequent RHA ranged from 3.9% to 13.1%, and rates of conversion to total hip arthroplasty ranged from 3.9% to 11.9%.

The most common indications for RHA include unaddressed femoroacetabular impingement and new labral tears. There are differing opinions on reporting capsulolabral adhesions as an indication. These findings suggest that revision is often necessitated by a combination of structural and soft-tissue abnormalities that may be under-recognized or inadequately addressed at the time of the primary procedure.

Level IV, systematic review of Level I to IV studies.