No Significant Differences in Clinical Outcomes Were Observed between the Healed and Unhealed Hip Joint Capsules in Femoroacetabular Impingement Syndrome After Arthroscopy.

Abstract

Purpose: To explore the healing status of interportal capsulotomies without repair after arthroscopy in patients with femoroacetabular impingement syndrome (FAIS), and to examine its correlation with clinical outcomes, including the relationship with age and gender subgroups.

Methods: Data collected between August 2015 and January 2022 were reviewed. Patients with FAIS aged 18-65 years who underwent hip arthroscopy with interportal capsulotomies without repair with a minimum 2-year follow-up were included. Patients with a lateral center-edge angle (LCEA) of less than 25°, a Tönnis grade of greater than 1, Perthes' disease, slipped upper femoral epiphysis, avascular necrosis, prior ipsilateral hip injury or surgery, and absence of magnetic resonance imaging (MRI) at final follow-up were excluded. Patients were divided into healed and unhealed capsular groups according to MRI evaluation. The primary patient-reported outcomes (PROs) were the modified Harris Hip Score (mHHS). The secondary PROs were the Hip Outcome Score-Activity of Daily Living Scale (HOS-ADL), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), University of California at Los Angeles (UCLA) score, and visual analog scale (VAS) for pain at final follow-up. The percentages of patients achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) for the PROs were also calculated.

Results: The cohort comprised 69 patients (72 hips), with 28 hips (38.89%) in the unhealed capsular group and 44 (61.11%) in the healed capsular group. The cohort comprised 32 male and 37 female patients and the mean age of these patients was 44.15 years. Within each group, there were significant pre- to postoperative increase in the mHHS, HOS-ADL, HOS-SSS, UCLA score, and decrease in VAS for pain (all P < .001). There were no significant differences between the healed and unhealed groups in the PROs and the achievement rates of the MCID and PASS (all P > 0.05). In addition, compared with healed group, the age over 40 years (P = 0.003) or female groups (P = 0.036) showed worse mHHS in unhealed group, respectively.

Conclusion: At a minimum 2-year follow-up, 38.89% of patients with FAIS who underwent arthroscopic surgery with inter-portal capsulotomy without repair had unhealed hip capsules. There were no significant differences in PROs, achieving rates of MCID and PASS between the healed and unhealed groups. Subgroup analysis showed age over 40 years old, female may be associated with worse efficacy in unhealed patients.

Study design: Level III, retrospective case-control study.