Arthroscopic hip remplissage may improve outcomes after cam over-resection
Click Here to Manage Email Alerts
Published results showed patients with hip instability caused by previous cam over-resection may have improved patient-reported outcomes after arthroscopic hip remplissage.
Joseph J. Ruzbarsky, MD, and colleagues compared preoperative and postoperative patient-reported outcome scores among 13 patients with hip instability from cam over-resection who underwent arthroscopic iliotibial band hip remplissage from May 2013 to April 2018. Patient-reported outcome scores included SF-12 physical health composite score, SF-12 mental health composite score, WOMAC score, modified Harris Hip Score, hip outcome score activities of daily living and sport subscale. Researchers also evaluated postoperative Tegner Activity Scale score and patient satisfaction.
Researchers found patients had an average of 1.38 previous surgeries and one patient underwent total hip arthroplasty 2 years after remplissage. Results showed improved patient-reported outcomes after remplissage among the 12 patients who did not undergo THA. Besides the mental component of the SF-12, researchers noted all improvements met statistical significance. Patients had a median postoperative Tegner score of 2.9 and a median postoperative patient satisfaction of seven out of 10, according to results.
“Iatrogenic microinstability caused by cam over-resection during hip arthroscopy can be treated with an iliotibial band allograft to fill and recontour the defect with the goal of restoring proximal femoral anatomy and the hip fluid seal. At a mean 3-year follow-up, patients undergoing this defect filling or ‘remplissage’ procedure reported improved patient-reported outcomes from preoperatively to postoperatively while only one of the 13 patients included in the study converted to a hip arthroplasty procedure at final follow-up,” Ruzbarsky told Healio Orthopedics. “Although these early results are promising, the mean patient reported outcomes are not commensurate with those achieved following primary hip arthroscopy. This emphasizes the importance of avoidance of over-resection at the time of primary cam decompression. However, appropriate treatment is essential as under resection leading to continued impingement is a common reason for revision hip arthroscopy.”
Perspective
Back to Top
I read with interest the article “Salvage revision hip arthroscopy including remplissage improves patient-reported outcomes after cam over-resection” by Marc Philippon, MD, and colleagues. I commend the authors on describing their surgical technique and review of patient-reported outcomes.
Important takeaways include a well-cited study by Yosif Mansor, MD, and colleagues which showed how cam over-resection of greater than 5% can lead to inferior outcomes and higher rate of conversion to arthroplasty following revision hip arthroscopy. Iatrogenic cam over-resection therefore can and should be avoided via well described intraoperative techniques, such as dynamic impingement testing, fluoroscopic guidance, preoperative 3D planning and navigated femoroplasty.
Indications for possible salvage arthroscopic hip remplissage include thorough femoral head concavity mapping when preparing for allograft implantation. However, although this technique seems of common sense – fill the void – the question of should the void be filled remains paramount. Can a larger labral reconstruction graft provide maintenance of the suction seal throughout hip range of motion? Is capsular reconstruction instead what is needed to provide dynamic stability? Will filling a cavernous femoral void ever be the only reason for improved patient outcomes in revision arthroscopy? The answer likely lies in the years ahead by those found managing complex revision cases of potentially avoidable pathology.
Collapse
Read more about
Click Here to Manage Email Alerts