AANA Lab Course 914 - Advanced Hip Arthroscopy-Revision Hip Arthroscopy, Benjamin Domb, MD

Revision Hip Arthroscopy, Benjamin Domb, MD

Pdf Summary

Dr. Benjamin G. Domb, Chair of the American Hip Institute Research Foundation and Fellowship Director, presents an overview on managing "Failed Hip Arthroscopy Syndrome." Common causes of failed hip arthroscopy include femoroacetabular impingement (FAI), instability, arthritis, intraarticular pathologies, and extraarticular factors.<br /><br />FAI, particularly residual cam deformity, is the leading cause for revision surgery. Over-resection during initial surgery can be more challenging and typically results in worse outcomes than residual cam. Instability arises from ligamentous laxity (measured by Beighton score), bony abnormalities such as dysplasia, or iatrogenic causes. Greater Trochanteric Pain Syndrome (GTPS) involving tendinopathy, bursitis, or partial/full-thickness tears also contributes to persistent pain, alongside iliopsoas impingement and femoral rotational deformities (retroversion linked to FAI, anteversion to instability). Chondral damage and arthritis further complicate management.<br /><br />Surgical decision-making balances factors such as the severity of arthritis (via imaging and dGEMRIC), patient age, number of prior preservation surgeries, and mechanical issues like labral tears or iliopsoas impingement. Cases discussed highlight varied presentations: athletes with borderline dysplasia and persistent pain, and older patients with insidious symptoms and functional weakness.<br /><br />Treatment options include technically demanding revision arthroscopy, anterior hip resurfacing, and robotic total hip replacement—especially for patients with arthritis or multiple prior procedures.<br /><br />Dr. Domb concludes that managing failed hip arthroscopy involves complex decisions and advanced surgical techniques. While good outcomes are achievable, they may be less favorable compared to primary interventions. Emerging technologies and tailored surgical approaches offer promising alternatives for addressing these challenging cases.

Keywords

Failed Hip Arthroscopy Syndrome

Femoroacetabular Impingement (FAI)

Residual Cam Deformity

Hip Instability

Greater Trochanteric Pain Syndrome (GTPS)

Iliopsoas Impingement

Chondral Damage and Arthritis

Revision Hip Arthroscopy

Anterior Hip Resurfacing

Robotic Total Hip Replacement