Complete Capsule Closure Provides Clinically Significant Outcome Improvement and Higher Survivorship After Hip Arthroscopy at Minimum 5-year Follow-up.

2021 
ABSTRACT Purpose To 1) compare the rates of reaching threshold hip-specific outcome scores for achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptomatic State (PASS) between patients who had partial vs complete T-capsulotomy repair, and 2) identify the failure rates in each group 5-years after undergoing hip arthroscopy for FAIS. Methods Data from consecutive patients undergoing hip arthroscopy for FAIS by a single fellowship trained surgeon from 01/2011 to 03/2013 were collected and analyzed. Baseline data, hip-specific outcomes, and clinical failure rates were recorded at 5-years minimum postoperatively. Patient receiving partial T-capsulotomy repair matched 1:3 by age, BMI, and sex to patients with complete T-capsulotomy repair. Threshold scores for achieving MCID and PASS were calculated and compared between the two groups. Additionally, revisions and conversion to total hip arthroplasty (THA) were compared between the groups. Results A total of 379 patients were available for analysis (39 partial and 340 complete repairs), with 100 patients included in the matching (25 partial and 75 complete repair group). Comparison of radiographic parameters, including Tonnis grade, alpha angle, and lateral center edge angle, between both groups showed no statistical difference (p>0.05 for all). Comparison of postoperative score averages between partial and complete closure groups demonstrated a significant difference in the HOS-ADL (85.4 + 17.7 vs 94.6 + 7.8; p + 26.2 vs 89.3 + 16.8;p=0.034), mHHS(83.2 + 19.7 vs 90.5 + 11.2; p=0.035), and VAS Pain (24.5 + 30.8 vs 13.4 + 15.8; p=0.035). A total of 65(95.6%) complete repair patients achieved MCID on at least one outcome measure vs. 18(78.3%) patients with partial repair (p=0.04). A total of 69(92%) complete repair patients achieved PASS on at least one outcome measure vs 18(72%) of patients with partial repair (p=0.017). Of the 39 partial repair patients, 35.9%(n=14) underwent revision or THA conversion; compared to 2.9%(n=10) in the overall cohort Conclusion At minimum five year follow-up, patients with complete capsular closure after hip arthroscopy for FAIS demonstrate superior long-term achieve higher rates of meaningful clinical success when compared to patients with partial capsular closure. Furthermore, patients with partial capsular repair undergo revision or conversion to THA at high rates.
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