What are the reasons you would perform a revision hip arthroscopy?
There are multiple reasons that patients may need a revision surgery:
Not enough bony resection during the initial surgery
- This is the most common reason for a revision.
- Part of the labral repair surgery is to shave excessive bone around the hip that may be causing a labral tear. Sometimes, a surgeon may not remove enough bone, meaning that the cause of your labral tear was not adequately addressed.
- If this is the case, the bony lesions would be properly removed during the revision surgery. This may also require a labral re-repair, labral repair with an augmentation or a labral reconstruction.
Re-injury to the labrum
- Sometimes, repeat injury can occur. This may be caused by a surgeon mistake, by a patient being extremely active, by another accident or for an unknown reason.
- This may require a labral re-repair, labral repair with an augmentation or a labral reconstruction.
Prior labral debridement
- Hip arthroscopy, specifically labral repairs, did not become popular until about 10-15 years ago. Prior to that, if patients had a labral tear, it was more common to debride the damaged labrum rather than fix it. This can cause significant problems for patients, because you are removing a significant force redistributor.
- This may also require a labral repair with an augmentation or a labral reconstruction.
Failed labral repair
- Even if a surgeon performs a surgery 100% perfectly, there is still a chance that the surgery itself may not provide the patient with enough symptom relief. A failed labral repair can happen for many reasons:
- Surgeon error – one of the labrum repair stitches can come loose, or not enough bone was shaved off.
- Physical therapist error – not following the protocol and advancing the patient before they are ready
- This may require a labral re-repair, labral repair with an augmentation or a labral reconstruction.
Hip joint capsule did not heal
- Because arthroscopic hip labral repairs are relatively new, techniques for the surgery are improving all the time. In order to perform the surgery, the surgeon must make an incision on your hip joint capsule, as this is the only way to gain access to the hip joint. There is evidence to show that the surgeon should repair the incision that they made on the capsule once the labral repair is complete. Some hip arthroscopists do not fix the incision they made on the capsule, which can cause residual symptoms for patient.
- This may also require a capsule reconstruction with allograft.
Post-operative stiffness
- One of the most common complications from a hip arthroscopic surgery is stiffness. Some patients are simply more prone than others to develop adhesions around the hip joint.
- This could also be due to lack of compliance with the post-op protocol. The physical therapy following the initial labral repair surgery is designed to prevent stiffness. If a patient fails to adhere to this, then
- This may also require more extensive physical therapy, lysis of adhesions (LOA) or a combination of both.
- LOA is simply a clean up of scar tissue and adhesions in the joint
Psoas (hip flexor) contracture
- This is another common complication following hip arthroscopy. This is the reason that you are flat foot weight bearing with crutches rather than the traditional way you use crutches, and why you were restricted from performing too much hip flexion exercises during the initial phases of rehab.
- This may require more extensive physical therapy, or a surgery called an arthroscopic psoas release.
