AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Revision Hip Preservation Surgery – Arthroscopy_ Open_-J.W. Thomas Byrd, MD, Tania Ferguson, MD

Revision Hip Preservation Surgery – Arthroscopy_ Open_-J.W. Thomas Byrd, MD, Tania Ferguson, MD

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This presentation by Dr. J. W. Thomas Byrd at the 2019 AANA/ISHA meeting discusses revision hip preservation surgery via arthroscopy following previous hip arthroscopy procedures. Postoperative issues are common, even with expert physical therapy, often triggered by increased activity after symptom relief. About 80% of postoperative problems can be addressed by adjusting rehabilitation protocols, which must be tailored to individual hip tolerance rather than following rigid guidelines.<br /><br />Patients with postoperative difficulties are generally managed initially with physical therapy strategies before considering further surgery. A key caution is avoiding unnecessary iliopsoas tendon lengthening, as this can complicate recovery without clear indications. Many past revisions included such procedures for unclear reasons, but unnecessary intervention there is discouraged.<br /><br />Imaging such as MRI is less reliable for hips than for shoulder or knee, especially after surgery; surgeons must interpret scans carefully. Decisions for repeat arthroscopy rely on both objective measures and subjective clinical judgment.<br /><br />The two primary reasons for revision arthroscopy are capsulolabral adhesions and incomplete correction of femoroacetabular impingement (FAI). However, these findings may also be present in patients doing well postoperatively, indicating complexity in determining who truly needs revision. When these factors are carefully evaluated, there is an approximate 83.6% chance of meaningful improvement with revision surgery.<br /><br />Multiple factors contribute to postoperative symptoms, including hip dysplasia, labral hypoplasia, ligamentum teres damage, capsular issues, conditioning level, and excessive forces. The presenter emphasizes understanding the patient thoroughly, including circumstances leading to the initial surgery, and having clear, definable problems before attempting revision. Postoperative problems are often multifactorial and require a multidisciplinary approach rather than simple surgical fixes.

Keywords

revision hip preservation surgery

arthroscopy

postoperative hip problems

rehabilitation protocols

physical therapy

iliopsoas tendon lengthening

MRI imaging limitations

capsulolabral adhesions

femoroacetabular impingement (FAI)

multifactorial postoperative symptoms