Revision Hip Arthroscopy Terrible Triad: Capsular Deficiency, Labral Deficiency, and Femoral Over-Resection

Abstract

Revision hip arthroscopy is increasingly common and most often performed to treat residual femoroacetabular impingement caused by cam under-resection. Unfortunately, other pathologies encountered during revision hip arthroscopy are more difficult to treat, including capsular deficiency, labral deficiency, adhesion formation, and/or cam over-resection. When encountered, these various pathologies should be comprehensibly corrected with the goals of restoring anatomy, re-establishing the hip fluid seal, and ensuring impingement-free motion. Labral deficiency can successfully be treated with labral augmentation or reconstruction. Capsular deficiency is best managed with primary repair or capsular reconstruction. Cam over-resection is a difficult problem, but there is growing evidence for a soft-tissue remplissage used to fill the defect with soft tissue. The combination of these problems can be considered a salvage scenario but can be treated comprehensively with these techniques with improved outcomes and acceptable survivorship.