Contemporary Arthroscopic Techniques May Improve the Outcomes of Revision Hip Arthroscopy: A Propensity-Matched Cohort Study

Abstract

Background:

Patient outcomes after revision hip arthroscopy are less favorable than those after primary procedures. Advancements in arthroscopic techniques including labral reconstruction and capsular plication have improved anatomic restoration of the suction seal and capsule. The effect of these techniques on outcomes remains unclear when compared with earlier techniques.

Purpose:

To compare postoperative outcomes between patients undergoing modern revision (MR) hip arthroscopy techniques and those treated with older methods.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A prospectively collected surgical database was reviewed for patients undergoing revision hip arthroscopy with a minimum 2-year follow-up. Patients were categorized into an older revision (OR) cohort or MR cohort based on available surgical techniques. Patients in the OR cohort did not have a capsular repair or labral reconstruction with the knotless pull-through technique, while all patients in the MR cohort had capsular closure or plication as well as labral restoration with either repair or modern reconstruction. A 1:1 age, sex, and body mass index propensity match was performed, and patient demographics along with pre- and postoperative radiographic data and outcomes were analyzed. The primary outcome was the rate of conversion to arthroplasty or revision arthroscopy at the 2-year time point. Secondary outcomes included patient-reported outcome scores (PROs) and achievement of clinically relevant outcome thresholds.

Results:

A total of 53 patients in the MR cohort were matched with 53 patients in the OR cohort. There were no significant preoperative demographic or radiographic differences between the 2 groups. Patients in the MR cohort had higher levels of acetabular chondral damage identified intraoperatively according to the Outerbridge and acetabular labrum articular disruption classifications (P < .01 for both). Patients in the MR cohort had significantly greater postoperative Hip Outcome Score Sports-Specific Subscale scores (62.8 ± 29.9 vs 53.0 ± 31.4; P = .03).

Conclusion:

Patients undergoing revision hip arthroscopy with modern techniques had greater postoperative PRO scores compared with revisions with older techniques. Notably, this improvement in outcomes was observed despite higher rates of cartilage damage identified intraoperatively in the modern group.