Poster 92: Revision Hip Arthroscopic Remplissage using an Iliotibial Band Allograft for Cam Over-Resection Improves Patient Outcomes at 2-year and 5-year Follow-up

Objectives: Due to the expanding indications and increasing number of arthroscopic hip surgeries performed each year, there has been a subsequent increase in the number of revision hip arthroscopies. Cam over-resection can lead to the loss of the hip suction seal, resulting in instability and pain. After failure of non-operative treatment, hip remplissage can be utilized to fill the defect and restore the hip suction seal. There remains limited data in the literature regarding patient outcomes following hip remplissage. The purpose of this study was to evaluate minimum 2- and 5 -year patient-reported outcomes after arthroscopic hip remplissage with an iliotibial band (ITB) allograft for cam over-resection. Methods: Patients who underwent arthroscopic ITB hip remplissage from 2015 to 2022 were included in the study. Pre- and at short- (minimum 2 years) as well as at mid-term (minimum 5 years) follow-up, postoperative patient-reported outcomes, including the 12-Item Short Form Survey (SF12) Physical Health Composite Score (PCS), SF12 Mental Health Composite Score (MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport), were compared. Results: Forty-six patients (sex: 57% female, age at the time of surgery: 36±11 years) were included at short-term follow-up (median 2.3 years (range, 2.0-7.0 years; 86% follow-up) (Table 1). Eleven of these patients (sex: 81.8% female, age at surgery: 42±10 years) were additionally followed up at mid-term (median 5.6 years [range, 5.0-7.2 years]). At short-term follow-up, SF-12 PCS, WOMAC pain, WOMAC function, WOMAC total, mHHS, HOS-ADL and HOS-Sport all statistically significantly improved post-operatively (Figure 1, Table 2). SF-12 MCS (P=0.06) and WOMAC stiffness (p=0.661) scores did not statistically significantly improve at short-term follow-up compared to preoperative scores. Four patients went on to revision hip arthroscopy (8.7%) and 2 patients converted to total hip arthroplasty (4.3%). In the mid-term follow-up analysis, similar patient-reported outcomes were identified. There was a significant improvement in all patient reported outcomes with the exception of SF-12 MCS (p=0.07) and WOMAC stiffness (p=0.34) (Table 3). No additional patients required revision hip arthroscopy and the two previously mentioned patients that converted to total hip arthroplasty were included in this cohort. Conclusions: Arthroscopic hip remplissage using an ITB allograft improves patient reported outcomes at short-term follow-up. Subgroup analysis at mid-term follow-up demonstrated that the clinical improvements are maintained without any additional conversions to total hip arthroplasty or need for revision hip arthroscopy. Remplissage is a reasonable and successful treatment for cam over-resection. Surgeons must remain diligent and careful to avoid cam over-resection in the primary and revision setting.

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