Capsular Management at the Time of Hip Arthroscopy for Femoroacetabular Impingement Syndrome Varies With Geography and Surgeon Subspecialty Training: A Cross-Sectional, Multinational Surgeon Survey

Abstract

PurposeTo perform a multi-national survey and identify patterns in capsular management at the time of hip arthroscopy. MethodsAn anonymous, non-validated survey was distributed by the American Orthopedic Society for Sports Medicine, Arthroscopy Association of North America, European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, International Society for Hip Arthroscopy, and Turkish Society of Sports Traumatology, Arthroscopy, and Knee Surgery. Questions were broken down into 6 categories: demographics, capsulotomy preference, traction stitches, capsular closure, postoperative rehabilitation, and postoperative complications. ResultsThe survey was completed by 157 surgeons. Surgeons who used a half or full T-type capsulotomy had 2.4 higher odds of using traction sutures for managing both the peripheral and central compartment during hip arthroscopy for femoroacetabular impingement (FAIS) (p=0.024). Surgeons who felt that there was sufficient literature regarding the importance of hip capsule closure had 1.9 higher odds of routinely performing complete closure of the capsule (p=0.044). Additionally, surgeons who practiced in the United States had 8.1 higher odds of routinely closing the capsule relative to international surgeons (p<0.001). Moreover, those who received hip arthroscopy training in residency or fellowship had 2.4 higher odds of closing the capsule completely compared to surgeons who did not have exposure to hip arthroscopy during their training (p=0.009). ConclusionGeographic and surgeon-related variables correlate to capsular management preferences during hip arthroscopy. Surgeons who utilized a half or full T-capsulotomy more often utilized traction stitches for managing both the peripheral and central compartment. Surgeons performing routine capsular closure are more likely to believe that sufficient evidence is available to support the practice, with surgeons in the United States more likely to perform routine capsular closure in comparison to their international colleagues.