Approach to Revision Hip Arthroscopy: Tips and Tricks

As the number of hip arthroscopies continues to rise, revision procedures have become increasingly common, with reported rates as high as 13.2%. Persistent functional limitation after primary hip arthroscopy is most often related to unresolved bony impingement, capsular insufficiency, or recurrent labral pathology.

Revision hip arthroscopy is indicated when symptoms persist after primary surgery and an intra-articular source of the symptoms-such as inadequate or excessive bony resection, capsular mismanagement, or iatrogenic cartilage or labral injury-has been identified. Surgeons should also consider the potential need for the different open hip surgeries at this time and rule them out before proceeding with revision hip arthroscopy surgery.

Revision hip arthroscopy starts with reviewing the previous operative note, obtaining standing anterior-posterior pelvis, 45° Dunn, and false profile radiographs, and, in our practice, performing a 3-dimensional (3D) computed tomography (CT) scan to assess for remaining bony impingement, as well as femoral version and tibial torsion. Magnetic resonance imaging arthrogram helps differentiate postoperative changes from new pathology. Intraoperatively, new portals are created as needed. Diagnostic arthroscopy assesses synovitis, adhesions, labral quality, capsular integrity, and any iatrogenic cartilage injury. Residual cam, pincer, or subspine impingement is addressed with the aid of 3D CT planning and intraoperative fluoroscopy to prevent over- and under-resection of bony pathology. Labral pathology is managed with a re-repair or tibialis anterior allograft reconstruction using the pull-through technique. Capsular insufficiency is addressed through imbrication in a figure-of-8 suture configuration or augmentation with suture anchors when the capsule cannot support additional sutures. Postoperative rehabilitation is similar to that of primary hip arthroscopy protocols with protected weightbearing and early motion precautions.

Revision hip arthroscopy is a safe and reliable procedure that improves pain and function in patients, although postoperative gains may be less than after primary arthroscopy. Complication rates are similar to primary arthroscopy, but the risk of conversion to total hip arthroplasty remains higher in the revision population.

When revision hip arthroscopy is appropriately indicated and performed, particularly with attention to residual bony impingement, labral pathology, and capsular integrity, it is a reliable option for patients with failed primary surgeries.

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