Superior Clinical Outcomes with Capsular Closure versus Non-Closure in Patients Undergoing Arthroscopic Hip Labral Repair

Abstract

Objectives:Controversy still exists on closing the capsule following hip arthroscopy. It is unclear if capsular closure at the end of hip arthroscopy results in better clinical outcomes compared to non-closure. The purpose of this study was to compare the clinical outcomes in patients who had a closed capsule to those without a closed capsule following hip arthroscopic labral repair by a single surgeon.Methods:Patients who did not have capsular closure were identified by reviewing arthroscopy video (non-closure group). Fifty consecutive patients without capsular closure were matched with fifty patients who had capsular closure. All patients underwent primary hip arthroscopy and labral repair. The primary patient-reported outcome measure was Hip Outcome Score(HOS)-ADL. Secondary outcome measures included the modified Harris hip score(MHHS), HOS-Sport, WOMAC, general health, and patient satisfaction with outcome. Patients with lateral center edge angle less than 25º were excluded.Results:There were 23 females and 27 males with an average age of 36 years (range:14 to 77) in each group. The average lateral center edge angle was 34º (range, 27 to 48) in both groups. The alpha angle was 68º (range, 40 to 134) in the non-closure group and 70º (range, 41 to 98) in the closure group. No patient had microfractures at the time of surgery. The average follow-up time was 5 years (non-closure group range: 3-10; closure group range 3-9). Eight patients (16%) in the non-closure group required total hip arthroplasty(THA), while 4 patients (8%) in the closure group required THA. Six patients in the non-closure group and 3 patients in the closure group required revision hip arthroscopy. Of those patients who did not require revision or THA, there was a significant difference in the HOS ADL score and the secondary outcome measures (see table). Capsular closure resulted in superior clinical outcomes compared to non-closure.Conclusion:There were twice as many conversion to THA and twice as many hip arthroscopy revisions in patients undergoing hip arthroscopic labral repair without capsular closure compared to those with closure. In addition, the closure group showed significantly higher outcomes scores compared to the non-closure at 5-year follow-up time.Mid-term follow-up outcome scores in closure and non-closure groupOutcome scoreWithout closureWith closurep valueSF12 PCS50.0 SD 1054.2 SD 5.90.04SF12MCS50.9 SD 9.754.3 SD 7.30.11HOS ADL83.9 SD 1490.4 SD 8.80.02HOS SPORT72.4 SD 2686 SD 180.006WOMAC11.6 SD 16.27.1 SD 8.40.067Modified Harris Hip Score81.5 SD 16.690.1 SD 110.016Patient Satisfaction with Outcome (median, range)9.5 (1 to 10)10 (3 to 10)ns