Influence of capsular repair versus unrepaired capsulotomy on 2-year clinical outcomes after arthroscopic hip preservation surgery

Benjamin G Domb, Christine E Stake, Zachary J Finley, Tian Chen, Brian D Giordano
Arthroscopy 2015, 31 (4): 643-50

PURPOSE: The primary objective of this study was to determine whether capsular management technique influences clinical outcomes at a minimum of 2 years after arthroscopic hip preservation surgery.

METHODS: A retrospective review of prospectively collected data was conducted to determine the relative influence of 2 capsular management strategies on clinical outcomes: unrepaired capsulotomy (group A) and capsular repair (group B). Four hundred three patients who had undergone arthroscopic hip preservation surgery met the inclusion criteria and had 2-year outcome data available. All patients completed 4 patient-reported outcome (PRO) questionnaires preoperatively and at a minimum of 2 years' follow-up. These included the Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) subsets, Non-Arthritic Hip Score (NAHS), and modified Harris Hip Score (mHHS).

RESULTS: Group A included 235 patients and group B, 168. The mean age of all patients at final follow-up was 36.9 years. Patients in group A were significantly older (42.3 years v 29.4 years, P < .0001) and had a significantly higher body mass index (26.8 kg/m(2)v 22.9 kg/m(2), P < .0001) compared with group B. In addition, female patients were more likely than male patients to undergo capsular repair (136 female patients v 32 male patients, P < .0001). Patients in group A also showed greater chondral damage by acetabular labrum articular disruption classification (P = .0081) and reduced preoperative PROs (HOS-ADL of 60.5 v 66.0, P = .087; HOS-SSS of 37.0 v 46.4, P = .0002; NAHS of 54.6 v 62.2, P < .0001; mHHS of 58.7 v 64.4, P = .0009; and visual analog scale score of 6.3 v 5.84, P = .028). All PROs showed statistically significant improvements for both groups at a minimum follow-up of 2 years (HOS-ADL, 60.5 to 82.2 in group A and 66 to 86.1 in group B; HOS-SSS, 36.9 to 67.3 and 46.4 to 71.2, respectively; NAHS, 54.6 to 79 and 62.2 to 82.8, respectively; visual analog scale score, 6.3 to 3.1 and 5.8 to 2.9, respectively; and mHHS, 58.7 to 81 and 64.4 to 83.8, respectively; P < .0001 for all differences). Furthermore, group B showed greater overall improvements than group A for the HOS-ADL (P = .03) and NAHS (P = .03) on uncorrected univariate analysis, but significance was lost once we controlled for confounding variables.

CONCLUSIONS: Arthroscopic capsular repair, used in conjunction with arthroscopic hip preservation surgery, appears to be safe and did not negatively influence clinical outcomes in this study. When confounding variables were controlled for, the use of capsular repair did not show clinically relevant superiority over the use of unrepaired capsulotomy.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.

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