Three or More Revision Hip Arthroscopy Surgeries Is More Common in Female Patients and High-Grade Acetabular Chondral Lesions Lead to Increased Risk of Failure.

PURPOSE: To characterize risk factors for patients who underwent multiple-revision hip arthroscopies and report survivorship at a minimum 2 years after hip arthroscopy.

METHODS

Patients aged 18-65 years who underwent revision hip arthroscopy between January 2011 and September 2018 with ≥2-year follow-up were included. Exclusion criteria were age <18 or >65 years at time of surgery, center-edge angle <20°, previous ipsilateral periacetabular osteotomy, or refusal to participate. Procedures were categorized as first (R1), second (R2), or third or more (R3+) revisions. Demographics, preoperative radiographic measurements, baseline patient-reported outcomes (PROs), intraoperative findings, and survivorship were compared across groups and between those requiring further surgery or total hip arthroplasty (THA) and those who did not. Survivorship was defined as re-revision and arthroplasty-free survival. PROs included modified Harris Hip Score, Hip Outcome Score - Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form Physical and Mental Component Scores (12-Item Short Form Physical Component Score/Mental Component Score).

RESULTS

A total of 284 hips (246 patients) met inclusion criteria, with mean follow-up of 4.3 ± 2.1 years. Female sex (52% vs 63% vs 78%, P = .03), primary hip arthroscopy at an outside institution (62% vs 78% vs 96%, P < .001), smaller alpha angle (64° vs 56° vs 50°, P < .001), and worse baseline PROs (modified Harris Hip Score, Hip Outcome Score - Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index; P = .05, P = .01, P < .001, P = .01) were associated with more previous revisions. Failure incidence did not differ between groups (P = .29), but the hazard ratio for further surgery or THA was greater for R3+ versus R1 (hazard ratio 2.4, 95% confidence interval 1.04-5.38, P = .04).

CONCLUSIONS

At a minimum 2-year follow-up, more prior revisions were associated with female sex, lower baseline PROs, capsular deficiency, and greater failure risk. Patients with lower nondysplastic lateral center-edge angles, severe acetabular cartilage damage, or ≥3 revisions had elevated risk for re-revision or THA.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.