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Capsular closure in hip arthroscopy may lead to improved activities in patients vs unclosed capsule
Regardless of capsule management technique, researchers found no difference in the rates of revision hip arthroscopy.
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During hip arthroscopy, patients showed more improvement in patient-reported and clinical outcomes after interportal capsulotomy with closure than with unrepaired T-capsulotomy or interportal capsulotomy without closure.
“[We] found no difference with rate of revision hip arthroscopy regardless of the capsular technique used,” Kostas John Economopoulos, MD, said at the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day. “But, we did find significant increase in conversion to hip arthroplasty in patients with T-capsulotomy without closure. We also found that activities of daily living scores improved with complete capsular closure as compared to interportal capsulotomy without closure but not for sport specific activities.”
In a prospective study of patients undergoing hip arthroscopy, which included labral repair and femoral osteoplasty, Economopoulos and colleagues randomly assigned 50 patients to T-capsulotomy without closure, 50 patients to interportal capsulotomy without closure and 50 patients to interportal capsulotomy with closure. Preoperatively and at intervals through 2 years, they obtained the modified Harris Hip Score (mHHS), and both the Hip Outcome Score (HOS) for activities of daily living and the HOS sports specific subscale. Investigators also evaluated rates of revision hip arthroscopy and of conversion to total hip arthroplasty.
All three treatment groups achieved improved patient-reported outcomes.
“Regardless of the capsular management techniques used, all patients showed significant improvements of their preoperative values at the 2-year time period,” Economopoulos said.
However, patients who underwent interportal capsulotomy with closure had superior mHHS, HOS-activities of daily living and HOS-sports specific subscale values at the final 2-year follow-up compared with patients who underwent T-capsulotomy.
“The complete capsular closure group did show a significant increase of their scores compared with the interportal capsulotomy without closures from the mHHS and the HOS-activities of daily living,” Economopoulos said. “However, this significance did not continue on to sport-specific subgroups.”
At the 2-year follow-up, patients with T-capsulotomy without closure had higher rates of both revision arthroscopy and conversion to THA, according to the results.
Economopoulos told Orthopedics Today, “To truly know that capsular closure leads to better results than leaving the capsule open, we must look at more long-term outcomes at the 5- and 10-year time points. – by Monica Jaramillo
Reference:
Economopoulos KJ, et al. Paper 10. Presented at: Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day; March 16, 2019; Las Vegas.
For more information:
Kostas John Economopoulos, MD, can be reached at The Orthopedic Clinic Association, 2222 E. Highland Ave., #300, Phoenix, AZ 85016; email: kecono13@gmail.com.
Disclosure: Economopoulos reports no relevant financial disclosures.