AANA Lab Course 905 - 2nd Annual Fellows Course-Approach to the Failed Hip-Joshua D. Harris, M.D.

Approach to the Failed Hip-Joshua D. Harris, M.D.

Pdf Summary

This document by Dr. Joshua Harris addresses the approach to managing failed hip arthroscopy, emphasizing prevention, accurate diagnosis, and comprehensive revision strategies. The cornerstone message is to “get it right the first time” in primary hip arthroscopy, as residual femoroacetabular impingement (FAI)—particularly residual cam morphology—is the leading cause (90%) of failure resulting in revision surgery or total hip arthroplasty (THA). Reported revision rates range from 1.1% to 12% over 15-28 months.<br /><br />Key technical recommendations include using proper T capsulotomy for visualization, employing multiple arthroscopic views and dynamic exams, and utilizing radiographic imaging (especially Dunn 45 views and CT) to precisely characterize pathology preoperatively. Surgeons must be cautious to avoid over-correction of bone resections, as this can worsen outcomes and increase THA conversion rates.<br /><br />On the acetabular side, the article illustrates common pitfalls and stresses careful correction including subspine decompression when needed. Labral preservation is vital; primary cases should prioritize repair, whereas revision scenarios may involve reconstruction—typically via peroneus longus allograft—if the labrum is deficient. Selective debridement with preservation can also yield excellent patient outcomes.<br /><br />Capsule management is critical as under- or over-tightening can cause stiffness or instability. Adhesions in three main areas (capsulolabral, peripheral compartment, capsule-rectus/psoas) are common post-op problems, with early range of motion, continuous passive motion (CPM), and pharmacologic strategies (e.g., losartan) recommended to prevent scarring.<br /><br />Finally, Dr. Harris highlights the importance of mental health and wellness assessment in patient care, advocating for thorough preoperative evaluation and caution against repeat procedures without strong indications.<br /><br />In conclusion, success in hip arthroscopy requires meticulous osseous correction, preservation of soft tissues, scar prevention, and recognition of mental health factors, aligning with the principle that “an ounce of prevention is worth a pound of cure.”

Keywords

failed hip arthroscopy

residual femoroacetabular impingement

cam morphology

revision surgery

total hip arthroplasty

T capsulotomy

radiographic imaging

labral preservation

capsule management

mental health assessment