Summary

Revision hip arthroscopy was beneficial for the improvement of patient reported outcomes in high-level athletes at a 5-year follow-up, and those who returned to sports were able to continue practicing after 5-year follow-up at the same rate as the control group.

Abstract

Purpose

Mid-term outcomes of revision hip arthroscopy in the athletic population have not been well established. We aim to evaluate the mid-term outcomes for high-level athletes who underwent revision hip arthroscopy, focusing on cases involving femoroacetabular impingement syndrome (FAIS) or labral tears. Additionally, we compared these results with those of a matched-pair group of high-level athletes who underwent primary hip arthroscopy.

Methods

Data were retrospectively collected between November 2008 and February 2019 from professional, college, and high-school athletes. We matched athletes who underwent revision hip arthroscopy in a 1 to 3 ratio to control athletes who underwent primary arthroscopy according to age, sex, BMI, follow-up time, labral treatment, capsular treatment, and Tönnis grade. Included patients received treatment for labral pathology and had a minimum 5-year follow-up for at least one of the following patient-reported outcome (PRO) scores: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), visual analog scale (VAS) pain, iHOT-12, or satisfaction. Patients who converted to arthroplasty or required other revision surgeries were accounted for. We excluded patients with prior hip conditions, Tönnis grade greater than 1, or were Worker’s compensation. PRO and return-to-sport (RTS) analyses were performed. Any patients who did not attempt to return to sport were excluded from the sub-analysis.

Results

A total of 41 athletes (42 hips) undergoing revision hip arthroscopy were successfully matched to 115 primary hip arthroscopy athletes (126 hips). Both groups showed similar improvement in PROs, while the pre-op scores were lower in the revision group. Of the 41 patients who underwent revision hip arthroscopy, 37 attempted to return to sport, 21 successfully returned to sport at some point, and 14 of them could continue playing at 5 years or more. Of the 115 patients who underwent primary hip arthroscopy, 101 attempted to return to sport, 86 successfully returned to sport at some point, and 62 of them could continue playing at 5 years or more. Conversion rate to hip arthroplasty was higher in the revision group but not statistically significant (P = 0.12). complication rate was similar in both groups (2.38%).

Conclusion

Revision hip arthroscopy was beneficial for the improvement of PROs in high-level athletes at a 5-year follow-up. The study group showed significant improvement like the control group but reached lower 5-year scores due to a lower baseline. The return to sport rate was lower in the study group, however, those who returned to sports were able to continue practicing after 5-year follow-up at the same rate as the control group. In addition, the complication rate was similar in both groups.