Patient Reported Outcomes of Capsular Repair versus Capsulotomy in Patients Undergoing Hip Arthroscopy: Minimum 5-Year Follow-Up. A Matched Cohort Study

Abstract

This study aimed to elucidate what effect various capsular management strategies during hip arthroscopy might have on patient outcomes over the mid-term. Between February 2008 and February 2011, data were prospectively collected on patients undergoing hip arthroscopy. Patients were matched for age ± 5 years, gender, BMI ± 5, Workman's Compensation claim, and acetabular coverage. Inclusion criteria were unrepaired capsulotomy or closure and lateral-center edge angle (LCEA) ≥18°. Exclusion criteria were previous hip surgery or conditions and preoperative Tönnis grade >1. Patient-reported outcome scores (PROs) including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-sport specific subscale (HOS-SSS) and Visual Analogue Score for pain (VAS) were collected preoperatively, at 3 months, and annually thereafter. Patient satisfaction was recorded from 0-10 (10=most satisfied). Minimum five-year follow-up was available for 287 (82.5%) of 348 hips that met inclusion criteria. Of these 287 hips, 172 underwent unrepaired capsulotomy and 115 underwent capsular repair. Sixty-five capsular closure patients were matched in a 1:1 ratio to 65 capsular release patients. Both groups saw significant improvements in all mean PROs at latest follow-up. In the repair group, mean PROs, VAS, and patient satisfaction were significantly improved at two and minimum five-year follow-up. In the unrepaired group, there was significant decrease in mHHS (p=0.001) and patient satisfaction (p=0.01) between two and five-year follow-up. More patients in the release group required conversion to hip arthroplasty (18.5% vs. 10.8%). The rate of revision arthroscopy was the same in both groups (15.4%). This study demonstrates that patients undergoing hip arthroscopy can expect to have significant improvement at minimum five-year follow-up, whether or not the capsule is closed. However, patients who underwent capsular release had a significant deterioration in mHHS between two and five years postoperatively and a higher rate of conversion to arthroplasty.