Rachel M Frank1, Simon Lee2, Charles A Bush-Joseph2, Bryan T Kelly3, Michael J Salata4, Shane J Nho2. 1. Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA rmfrank3@gmail.com. 2. Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. 3. Hospital for Special Surgery, New York, New York, USA. 4. University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Abstract
BACKGROUND: Hip capsular management after hip arthroscopic surgery for femoroacetabular impingement (FAI) is controversial. PURPOSE/HYPOTHESIS: To compare the clinical outcomes of patients undergoing hip arthroscopic surgery for FAI with T-capsulotomy with partial capsular repair (PR; closed vertical incision, open interportal incision) versus complete capsular repair (CR; full closure of both incisions). The hypothesis was that there would be improved clinical outcomes in patients undergoing CR compared with those undergoing PR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Consecutive patients undergoing hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2011 to January 2012 were prospectively collected and analyzed. Inclusion criteria included all patients between ages 16 and 65 years with physical examination and radiographic findings consistent with symptomatic FAI, with a minimum 2-year follow-up. For analysis, patients were matched according to sex and age ±2 years. Primary clinical outcomes were measured via the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales, the modified Harris Hip Score (mHHS), patient satisfaction (measured on a visual analog scale), and clinical improvement at baseline, 6 months, 1 year, and 2 years. Statistical analysis was performed utilizing Student paired and unpaired t tests, with P < .05 considered significant. RESULTS: A total of 64 patients were included in the study, with 32 patients (12 male, 20 female) in each group. The average follow-up was 29.9 ± 2.6 months. There were no significant demographic differences between the groups. The CR group demonstrated significantly superior outcomes in the HOS-SS at 6 months (PR: 63.8 ± 31.1 vs CR: 72.2 ± 16.1; P = .039), 1 year (PR: 72.7 ± 14.7 vs CR: 82.5 ± 10.7; P = .006), and 2.5 years (PR: 83.6 ± 9.6 vs CR: 87.3 ± 8.3; P < .0001) after surgery. Patient satisfaction at final follow-up was significantly better in the CR group (PR: 8.4 ± 1.0 vs CR: 8.6 ± 1.1; P = .025). Both groups demonstrated significant improvements in the HOS-ADL (PR: 64.6 ± 17.0 to 90.7 ± 8.4 [P < .0001]; CR: 66.1 ± 15.7 to 92.1 ± 7.9 [P < .0001]) and HOS-SS (PR: 39.4 ± 23.9 to 83.6 ± 9.6 [P < .0001]; CR: 39.1 ± 24.2 to 87.3 ± 8.3 [P < .0001]) at final follow-up. There were no significant differences between the groups in the HOS-ADL at any time point. There were no significant differences in the mHHS between the groups at final follow-up (PR: 82.5 ± 5.0 vs CR: 83.0 ± 4.4; P = .364). The overall revision rate was 6.25%; all patients (n = 4) who required revision arthroscopic surgery were in the PR group (13% of 32 patients), while no patients in the CR group required revision surgery. CONCLUSION: While significant improvements were seen at 6 months, 1 year, and 2.5 years of follow-up regardless of the closure technique, patients who underwent CR of the hip capsule demonstrated superior sport-specific outcomes compared with those undergoing PR. There was a 13% revision rate in the PR group, but no patients in the CR group required revision surgery. While longer term outcome studies are needed to determine if these results are maintained over time, these data suggest improved outcomes after CR compared with PR at 2.5 years after hip arthroscopic surgery for FAI.
BACKGROUND: Hip capsular management after hip arthroscopic surgery for femoroacetabular impingement (FAI) is controversial. PURPOSE/HYPOTHESIS: To compare the clinical outcomes of patients undergoing hip arthroscopic surgery for FAI with T-capsulotomy with partial capsular repair (PR; closed vertical incision, open interportal incision) versus complete capsular repair (CR; full closure of both incisions). The hypothesis was that there would be improved clinical outcomes in patients undergoing CR compared with those undergoing PR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Consecutive patients undergoing hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2011 to January 2012 were prospectively collected and analyzed. Inclusion criteria included all patients between ages 16 and 65 years with physical examination and radiographic findings consistent with symptomatic FAI, with a minimum 2-year follow-up. For analysis, patients were matched according to sex and age ±2 years. Primary clinical outcomes were measured via the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales, the modified Harris Hip Score (mHHS), patient satisfaction (measured on a visual analog scale), and clinical improvement at baseline, 6 months, 1 year, and 2 years. Statistical analysis was performed utilizing Student paired and unpaired t tests, with P < .05 considered significant. RESULTS: A total of 64 patients were included in the study, with 32 patients (12 male, 20 female) in each group. The average follow-up was 29.9 ± 2.6 months. There were no significant demographic differences between the groups. The CR group demonstrated significantly superior outcomes in the HOS-SS at 6 months (PR: 63.8 ± 31.1 vs CR: 72.2 ± 16.1; P = .039), 1 year (PR: 72.7 ± 14.7 vs CR: 82.5 ± 10.7; P = .006), and 2.5 years (PR: 83.6 ± 9.6 vs CR: 87.3 ± 8.3; P < .0001) after surgery. Patient satisfaction at final follow-up was significantly better in the CR group (PR: 8.4 ± 1.0 vs CR: 8.6 ± 1.1; P = .025). Both groups demonstrated significant improvements in the HOS-ADL (PR: 64.6 ± 17.0 to 90.7 ± 8.4 [P < .0001]; CR: 66.1 ± 15.7 to 92.1 ± 7.9 [P < .0001]) and HOS-SS (PR: 39.4 ± 23.9 to 83.6 ± 9.6 [P < .0001]; CR: 39.1 ± 24.2 to 87.3 ± 8.3 [P < .0001]) at final follow-up. There were no significant differences between the groups in the HOS-ADL at any time point. There were no significant differences in the mHHS between the groups at final follow-up (PR: 82.5 ± 5.0 vs CR: 83.0 ± 4.4; P = .364). The overall revision rate was 6.25%; all patients (n = 4) who required revision arthroscopic surgery were in the PR group (13% of 32 patients), while no patients in the CR group required revision surgery. CONCLUSION: While significant improvements were seen at 6 months, 1 year, and 2.5 years of follow-up regardless of the closure technique, patients who underwent CR of the hip capsule demonstrated superior sport-specific outcomes compared with those undergoing PR. There was a 13% revision rate in the PR group, but no patients in the CR group required revision surgery. While longer term outcome studies are needed to determine if these results are maintained over time, these data suggest improved outcomes after CR compared with PR at 2.5 years after hip arthroscopic surgery for FAI.
Authors: Edward C Beck; Gregory L Cvetanovich; David M Levy; Alexander E Weber; Benjamin D Kuhns; Mahmoud M Khair; Jonathan Rasio; Shane J Nho Journal: J Hip Preserv Surg Date: 2019-11-23