Failed Hip Arthroscopy Treatment Options

Can a failed hip arthroscopy be treated without surgery?

In cases with a mild to moderate re-injury to the labrum or capsule, a failed hip arthroscopy can be treated without surgery.

Non-operative treatment of a failed hip arthroscopy involves a change in activities to avoid movements that cause hip pain, including taking time off from activities that cause hip pain, using over-the-counter anti-inflammatory medications to reduce pain and inflammation, and physical therapy. Typically, symptoms will resolve within several weeks of conservative, non-surgical treatment. A steroid injection can also help relieve hip pain. If your hip pain is resolved with non-operative treatment and you can return to your desired level of activity, then no FAI revision surgery is needed.

What are the surgical options for FAI?

When nonsurgical FAI treatments do not relieve hip pain and imaging confirms re-injury to the hip labrum or hip capsule, then hip surgery is a reasonable option. FAI revision surgery can be performed in a minimally invasive procedure called hip arthroscopy. FAI revision surgery is usually an outpatient procedure, and you will go home the same day. During your FAI revision surgery, Dr. Chahla will remove any remaining abnormal bone growth causing the hip impingement and repair any re-injury to the labrum or capsule. In some revision cases, a labral or capsular reconstruction may be indicated. Surgery typically lasts about 1-2 hours. Revision hip surgery is customized for each patient based off of each patient’s unique hip anatomy, hip condition, and previous hip surgery.

Labrum Reconstruction

Hip labral reconstruction surgery is a procedure that replaces the damaged part of the labrum with a graft (typically a donor graft, otherwise known as an allograft) in order to regain stability and normal function of the hip joint. The major difference between labral repair and reconstruction is that repair consists of reattaching the torn labrum to the hip socket, whereas reconstruction involves replacing a segment or the entire native labrum. Labral reconstruction can be performed as a partial or full labrum reconstruction. A partial reconstruction preserves the healthy part of the labrum and replaces only the damaged segment. A full reconstruction involves replacing the entire native labrum with a graft. The decision to perform one over the other is based on the patient’s unique characteristics, past hip surgical history, and the quality of the labral tissue itself.

Labrum Augmentation

A labral augmentation surgery consists of using tissue from another part of the body (autograft) or a donor (allograft) and attaching it to the top of the native labrum to restore the suction seal. This is indicated in a subset of patients in which the labral tissue near the rim is healthy, but there is not enough of it to maintain the suction seal, leading to micro instability of the hip and hip pain. A labral augmentation is a relatively new alternative to reconstruction that is used to restore the stability of the joint. It is thought that the blood supply of the native labrum helps the graft heal postoperatively.

Capsular Reconstruction

Capsular reconstruction surgery is a procedure that replaces the damaged capsule with a graft from another part of the body (autograft) or a donor (allograft). The goal of this procedure is to restore stability and the biomechanical properties of the hip joint. The difference between capsular repair and reconstruction is that repair consists of cleaning the frayed capsular tissue and reattaching the torn edges together, whereas reconstruction involves removing the deficient capsule segment and replacing it with a graft. Capsular reconstruction is indicated for patients who have symptoms of hip instability, weakness, or pain due to a deficient joint capsule, have failed conservative management, and who are not candidates for repair. Most commonly, patients will present with micro instability after previous arthroscopic hip surgery when the capsule was not restored. During hip capsular reconstruction surgery, the defect in the hip capsule is measured and an appropriately sized graft is prepared. The new graft is laid over the defect and attached to the rim of the hip socket and the healthy segment of the native capsule, therefore restoring the dynamic stability of the hip joint.