Early Outcomes After Arthroscopic Hip Capsular Reconstruction Using Iliotibial Band Allograft Versus Dermal Allograft

Abstract

To compare the clinical outcomes between 2 groups of patients who underwent arthroscopic hip capsular reconstruction with the same surgical technique with an iliotibial band (ITB) allograft versus dermal allograft tissue. From March 2013 to October 2015, patients who were 18years of age or older and who underwent revision arthroscopic hip surgery with capsular reconstruction by the senior author were identified. Patients who were younger than 18years old, had a lateral center-edge angle <20° or Tonnis osteoarthritis grade 2 or 3, or refused to participate were excluded. Patients were assigned to 2 groups based on whether an ITB (ITB group) or a dermal allograft (dermal group) was used to reconstruct the capsule. The ITB graft was used initially, then the dermal graft was used when it was available. The dimensions were based on the intraoperative measurement of the capsular defect, and the thickness was 3mm. Other treatments included labral debridement, repair, or reconstruction; treatment of residual femoroacetabular impingement; and treatment of cartilage damage. Clinical outcome scores including the Hip Outcome Score (HOS)-Activity of Daily Living scale (primary outcome measure), modified Harris Hip Score, HOS-Sports scale, SF-12, and Western Ontario & McMaster Universities Osteoarthritis Index were compared between the groups in addition to the failure rate (conversion to total hip arthroplasty, revision hip arthroscopy) and patient satisfaction rate with the outcome (range, 1-10). Thirty-six patients (9 men and 27 women) met the inclusion criteria. Each group consisted of 18 patients (18hips) with a mean age of 30.9 ± 9.4years in the ITB group and a mean age of 29.8 ± 9.4years in the dermal group (P= .718). There were no differences in patient demographics, physical examination findings, or imaging characteristics. The procedure failed for 8 patients (4 in the ITB group and 4 in the dermal group), and another surgery was required (P=1.0). Additional surgeries included 3 total hip arthroplasties, 1 periarticular osteotomy, and 4 revision arthroscopies. The mean follow-up time was 25months (range, 18-38months) in both groups (P= .881). At follow-up, the HOS-Activity of Daily Living scale, SF-12, modified Harris Hip Score, and HOS-Sports scale measures were significantly higher in the ITB group than in the dermal group (P < .05). A greater percentage of patients reached minimum clinically important difference in the ITB group for Western Ontario & McMaster Universities Osteoarthritis Index and HOS scales with the minimum clinically important difference for HOS-Sports scale being significantly higher in the ITB group (P=.04). Patient satisfaction scores were 8 and 6 in the ITB and dermal groups, respectively. At a mean follow-up time of 25months, hip capsular reconstruction with an ITB allograft results in improved clinical outcomes compared with the dermal allograft. A similar failure rate was noted in both groups, but a greater percentage of patients in the ITB group achieved clinical improvement.