December 2025

ORTHOPAEDICS

CASE REPORT: FAILED HIP ARTHROSCOPY WITH MILD ACETABULAR RETROVERSION

Featuring: ​​Ryan S. Selley, MD
Introduction
Hip pain in competitive swimmers can significantly impair performance and quality of life. Femoroacetabular impingement (FAI) is a recognized contributor to hip dysfunction, often managed initially with arthroscopy. However, failure of primary arthroscopy necessitates reevaluation of underlying structural abnormalities. This report details the management of a collegiate butterfly swimmer with persistent bilateral hip pain after failed arthroscopic surgery.

Case presentation
The patient, a 22-year-old female collegiate swimmer, presented with chronic bilateral hip pain exacerbated by sitting and prolonged walking. She previously underwent bilateral hip arthroscopy at an outside institution after unsuccessful conservative management, including physical therapy and intra-articular injections. Postoperatively, symptoms persisted despite additional injections providing only transient relief.

Diagnostic work up
Advanced imaging was obtained, including MRI and CT scans. Findings included:
  • Mild acetabular retroversion (posteriorly oriented socket)
  • Possible sub spine impingement
  • Femoral anteversion, typically protective against impingement

No significant cartilage wear was noted, but intra-articular adhesions were suspected.

Surgical strategy
Given the failure of prior arthroscopy and identified bony abnormalities, two options were discussed:
  • Repeat arthroscopy to address intra articular pathology and sub spine impingement without correcting acetabular retroversion
  • Combined hip arthroscopy and periacetabular osteotomy (PAO) to address both intra-articular and structural issues

The patient elected for the combined approach in a single operative session.

Procedure
  • Hip Arthroscopy: Removal of scar tissue and a prominent suture stack from prior surgery; assessment of labrum and cartilage integrity.
  • PAO: Reorientation of the acetabulum to correct retroversion while preserving femoral anteversion balance. Residual sub spine impingement was also addressed.

Both interventions were completed in one surgery to minimize recovery time.
Postoperative
  • Weight-bearing: Protected for six weeks
  • Return to school: Approximately two to three weeks post-op, with full readiness for clinical rotations at three months
  • Outcome: At nearly one-year post-op, the patient reported excellent functional recovery and resolution of pain with daily activities. She is scheduled for elective screw removal and considering contralateral hip surgery after completing her academic program.

Key findings:
  • Failed arthroscopy: Repeating the same procedure without addressing underlying biomechanical issues is unlikely to succeed.
  • Comprehensive imaging: CT-based assessment is essential for detecting subtle deformities such as acetabular retroversion and sub spine impingement.
  • Combined approach: Performing arthroscopy and PAO in one session can optimize outcomes and reduce overall rehabilitation time.
  • Technical nuance: Correction must balance acetabular and femoral version to avoid overcorrection and secondary instability.
  • Patient-centered planning: Academic and lifestyle considerations should guide surgical timing and staging.

Conclusion
Persistent hip pain after failed arthroscopy warrants thorough biomechanical evaluation. Combined arthroscopy and PAO can provide durable symptom relief in young athletes with complex hip morphology, enabling return to high-level function.
 
Ryan S. Selley, MD, presented this case at the recent Chicago Hip Summit.
Ryan S. Selley, MD, Assistant Professor of Orthopaedic Surgery at Northwestern Medicine

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