Hip Arthroscopy After Total Hip Arthroplasty: A Current Review of Indications, Techniques, and Outcomes

Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications.

The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.