James D Wylie1, James T Beckmann2, Travis G Maak1, Stephen K Aoki3. 1. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA. 2. Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA. 3. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA stephen.aoki@hsc.utah.edu.
Abstract
BACKGROUND: Management of the hip capsule has been a topic of recent debate in hip arthroscopic surgery. Postoperative instability after hip arthroscopic surgery has been reported and can lead to poor outcomes. PURPOSE: To determine the outcome of patients diagnosed with symptomatic instability after hip arthroscopic surgery at a minimum of 12 months and 24 months after revision surgery for capsular repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In a cohort of approximately 1100 patients who underwent hip arthroscopic surgery, 33 patients (33 hips) developed symptomatic instability requiring a revision surgery. Two patients suffered anterior dislocations following their initial surgery. Radiographs were reviewed to evaluate for acetabular dysplasia. Three patients were lost to follow-up and 10 patients were excluded as they were <1 year out from the revision surgery. A total of 20 patients (18 female, 2 male) completed a preoperative and postoperative modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) at a minimum of 12 months. Eleven of these patients had a minimum follow-up of 24 months. All patients filled out a Likert scale of perceived improvement in physical ability at final follow-up. RESULTS: The mean age of the patients was 29.7 years (range, 15.2-55.5 years). The mean lateral center-edge angle was 25°, and the mean acetabular index was 7° before revision. All patients underwent interportal capsulotomy during the index arthroscopic procedure. After their index arthroscopic procedures, patients had minimal improvement at a mean of 19.1 months postoperatively on the mHHS (from 57.1 to 57.6; P = .423), HOS-Activities of Daily Living (ADL) (from 62.7 to 66.4; P = .260), and HOS-Sports (from 42.0 to 39.1; P = .800). For the patients with a minimum 1-year follow-up after revision surgery (n = 20; mean follow-up, 21.3 months), the mean mHHS (from 57.6 preoperatively to 85.8 at final follow-up; P < .001), HOS-ADL (from 66.4 to 85.7; P < .001), and HOS-Sports (from 39.1 to 79.8; P < .001) all improved significantly. The results were similar when looking at only the patients with a minimum 2-year follow-up after revision surgery (n = 11; mean follow-up, 26.1 months); the mean mHHS (from 56.0 preoperatively to 91.5 at final follow-up; P = .001), HOS-ADL (from 68.3 to 89.9; P = .009), and HOS-Sports (from 35.7 to 87.9; P = .001) all improved significantly. When comparing patients with isolated capsular repair to those with additional procedures performed, there were no differences between the groups (all P > .05). At final follow-up, all but 1 patient had improved overall physical ability levels. CONCLUSION: Revision hip arthroscopic surgery for capsular repair in patients with symptomatic instability after hip arthroscopic surgery provides good functional outcomes at a minimum of 1 and 2 years postoperatively.
BACKGROUND: Management of the hip capsule has been a topic of recent debate in hip arthroscopic surgery. Postoperative instability after hip arthroscopic surgery has been reported and can lead to poor outcomes. PURPOSE: To determine the outcome of patients diagnosed with symptomatic instability after hip arthroscopic surgery at a minimum of 12 months and 24 months after revision surgery for capsular repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In a cohort of approximately 1100 patients who underwent hip arthroscopic surgery, 33 patients (33 hips) developed symptomatic instability requiring a revision surgery. Two patients suffered anterior dislocations following their initial surgery. Radiographs were reviewed to evaluate for acetabular dysplasia. Three patients were lost to follow-up and 10 patients were excluded as they were <1 year out from the revision surgery. A total of 20 patients (18 female, 2 male) completed a preoperative and postoperative modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) at a minimum of 12 months. Eleven of these patients had a minimum follow-up of 24 months. All patients filled out a Likert scale of perceived improvement in physical ability at final follow-up. RESULTS: The mean age of the patients was 29.7 years (range, 15.2-55.5 years). The mean lateral center-edge angle was 25°, and the mean acetabular index was 7° before revision. All patients underwent interportal capsulotomy during the index arthroscopic procedure. After their index arthroscopic procedures, patients had minimal improvement at a mean of 19.1 months postoperatively on the mHHS (from 57.1 to 57.6; P = .423), HOS-Activities of Daily Living (ADL) (from 62.7 to 66.4; P = .260), and HOS-Sports (from 42.0 to 39.1; P = .800). For the patients with a minimum 1-year follow-up after revision surgery (n = 20; mean follow-up, 21.3 months), the mean mHHS (from 57.6 preoperatively to 85.8 at final follow-up; P < .001), HOS-ADL (from 66.4 to 85.7; P < .001), and HOS-Sports (from 39.1 to 79.8; P < .001) all improved significantly. The results were similar when looking at only the patients with a minimum 2-year follow-up after revision surgery (n = 11; mean follow-up, 26.1 months); the mean mHHS (from 56.0 preoperatively to 91.5 at final follow-up; P = .001), HOS-ADL (from 68.3 to 89.9; P = .009), and HOS-Sports (from 35.7 to 87.9; P = .001) all improved significantly. When comparing patients with isolated capsular repair to those with additional procedures performed, there were no differences between the groups (all P > .05). At final follow-up, all but 1 patient had improved overall physical ability levels. CONCLUSION: Revision hip arthroscopic surgery for capsular repair in patients with symptomatic instability after hip arthroscopic surgery provides good functional outcomes at a minimum of 1 and 2 years postoperatively.
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
Authors: Kelly M Tomasevich; Megan K Mills; Hailey Allen; Amanda M Crawford; Alexander J Mortensen; Angela P Presson; Chong Zhang; Stephen K Aoki Journal: Arthrosc Sports Med Rehabil Date: 2021-12-27
Authors: Benjamin D Kuhns; Alexander E Weber; David M Levy; Asheesh Bedi; Richard C Mather; Michael J Salata; Shane J Nho Journal: Front Surg Date: 2016-03-04