Kostas J Economopoulos1, Anikar Chhabra1, Christopher Kweon2. 1. Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA. 2. Department of Orthopaedics, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. PURPOSE/HYPOTHESIS: The purpose was to perform a prospective randomized trial to comparatively assess 3 commonly performed capsular management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes when compared with unclosed capsulotomy management techniques. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS:Patients (N = 150) who had hip arthroscopy with labral repairs and femoral osteoplasties performed by the senior author were randomly assigned into 3 groups at the time of their surgery: T-capsulotomy without closure (TC), interportal capsulotomy without closure (IC), and interportal capsulotomy with closure (CC). All patients underwent labral repair and femoral osteoplasty. Patient-reported outcomes were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Other outcomes obtained included the need for future hip surgery. RESULTS: Patient demographics, preoperative patient-reported outcomes, and radiographic measurements were similar among all 3 groups. Revision hip arthroscopy was performed in 5 TC cases, 2 IC cases, and 1 CC case (P = .17). Conversion to hip arthroplasty occurred in 4 patients in the TC group and none in the IC and CC groups (P = .02). The CC group showed higher modified Harris Hip Score (mHHS) and Hip Outcome Score-Activities of Daily Living (HOS-ADL) at the 2-year follow-up when compared with the IC group (P = .003 and P < .001, respectively). When compared with the TC group, the CC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (Hip Outcome Score-Sports-Specific Subscale; 74.4 vs 65.3) at the final 2-year follow-up (P < .001). At the 2-year follow-up, the IC group had a higher mHHS (81.7 vs 76), HOS-ADL (82 vs 76.8), and HOS-SSS (71.4 vs 65.3; P > .001) as compared with the TC group. CONCLUSION: Patients undergoing complete capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes when compared with those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsular management technique.
RCT Entities:
BACKGROUND: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. PURPOSE/HYPOTHESIS: The purpose was to perform a prospective randomized trial to comparatively assess 3 commonly performed capsular management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes when compared with unclosed capsulotomy management techniques. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS:Patients (N = 150) who had hip arthroscopy with labral repairs and femoral osteoplasties performed by the senior author were randomly assigned into 3 groups at the time of their surgery: T-capsulotomy without closure (TC), interportal capsulotomy without closure (IC), and interportal capsulotomy with closure (CC). All patients underwent labral repair and femoral osteoplasty. Patient-reported outcomes were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Other outcomes obtained included the need for future hip surgery. RESULTS:Patient demographics, preoperative patient-reported outcomes, and radiographic measurements were similar among all 3 groups. Revision hip arthroscopy was performed in 5 TC cases, 2 IC cases, and 1 CC case (P = .17). Conversion to hip arthroplasty occurred in 4 patients in the TC group and none in the IC and CC groups (P = .02). The CC group showed higher modified Harris Hip Score (mHHS) and Hip Outcome Score-Activities of Daily Living (HOS-ADL) at the 2-year follow-up when compared with the IC group (P = .003 and P < .001, respectively). When compared with the TC group, the CC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (Hip Outcome Score-Sports-Specific Subscale; 74.4 vs 65.3) at the final 2-year follow-up (P < .001). At the 2-year follow-up, the IC group had a higher mHHS (81.7 vs 76), HOS-ADL (82 vs 76.8), and HOS-SSS (71.4 vs 65.3; P > .001) as compared with the TC group. CONCLUSION:Patients undergoing complete capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes when compared with those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsular management technique.
Entities:
Keywords:
capsular closure; hip arthroscopy; hip instability; labral tear
Authors: Allison K Perry; Steven F DeFroda; Safa Gursoy; Iain R Murray; Amar S Vadhera; Shane J Nho; Jorge Chahla Journal: Arthrosc Tech Date: 2021-07-21
Authors: Niels H Bech; Lode A van Dijk; Sheryl de Waard; Gwendolyn Vuurberg; Inger N Sierevelt; Gino Mmj Kerkhoffs; Daniël Haverkamp Journal: World J Orthop Date: 2022-04-18