Paper 08: Long Term Survivorship and Outcomes of Patients Undergoing Capsular Repair and Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Abstract

Objectives: The purpose of this study is to report minimum 10-year survivorship and patient-reported outcomes (PROs) following primary hip arthroscopy with capsular repair for FAIS and to compare outcomes of patients undergoing capsular repair to capsular release. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Survivorship was defined as a non-conversion to total hip arthroplasty (THA). Patients with minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Visual Analog Scale for pain (VAS). If available, preoperative and minimum 10-year follow-up for the Hip Outcome Score—Sports Specific Subscale (HOS-SSS) were reported. Patients with ipsilateral hip surgery, worker’s compensation, Tönnis osteoarthritis grade > 1, and hip dysplasia (lateral center-edge angle < 25°) were excluded. Survivorship defined by non-conversion to THA, PROS, and clinical benefit (minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS)) were reported. An additional propensity-matched sub-analysis comparing patients undergoing capsular repair with patients undergoing capsular release over the age of 40 with acetabular labrum articular disruption ≥ 2 was performed. Results: 145 (130 patients) out of 180 eligible hips (165 patients) had minimum 10-year follow-up (80.6%). 126 hips (86.9%) were female, and 19 hips (13.1%) were male. The average patient age was 30.3 ± 12.9 years. The survivorship rate was 91.0% at minimum 10-year follow-up. The cohort experienced significant improvement (P < 0.001) in the mHHS, NAHS, HOS-SSS, and VAS for pain. Additionally, the cohort achieved high rates of PASS for the mHHS (89.8%), and high rates of the MCID for the mHHS (82.4%) and VAS for pain (80.6%). 29 capsular repair hips were matched to 81 capsular release hips. Both groups experienced significant improvement in all PROs, but there was a higher conversion to THA rate in the release group (P < 0.05). Conclusions: Patients undergoing primary hip arthroscopy with capsular repair experienced a high rate of survivorship of 91.0% at minimum 10-year follow-up. Patients that did not convert to THA saw favorable improvements in PROs and achieved high rates of clinical benefit. In the subanalysis, patients undergoing capsular repair demonstrated higher rates of survivorship.