Strategies in revision hip arthroscopy

With the recent increase in the use of hip arthroscopy, revision hip arthroscopy has also become more prevalent. Managing patients with residual and/or recurrent symptoms following hip arthroscopy is diagnostically and technically challenging. It is important to be aware of the most common reasons for failure, such as bony under-resection, labral tear or re-tear, progression of degenerative joint disease, and missed concurrent disorders such as subspine impingement, snapping hip syndrome, and athletic pubalgia. It is also important to rule out extra-articular causes of hip pain, such as referred pain from the spine or trochanteric bursitis. Pre-operative planning is of paramount importance if revision surgery is being considered, and three-dimensional modalities [such as magnetic resonance imaging and computed tomography (CT) with 3D reconstruction] are often required. Appropriate patient selection, honest discussions about potential outcomes, and management of patient expectations are important before proceeding with revision surgery. Intra-operatively, there are specific techniques and assistive technologies (e.g., fluoroscopy, navigation) that can aid in achieving a successful revision. Specific techniques have been developed for use in revision settings, such as labral and/or capsular reconstruction/grafting, remplissage for bony under-resection, and chondral implantation.