No Significant Differences in Clinical Outcomes Were Observed Between 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 sex subgroups.

Methods

Data collected between August 2015 and January 2022 were reviewed. Patients with FAIS aged 18 to 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 of less than 25°, Tönnis grade greater than 1, Perthes disease, slipped upper femoral epiphysis, avascular necrosis, prior ipsilateral hip injury or surgery, and absence of magnetic resonance imaging at final follow-up were excluded. Patients were divided into healed and unhealed capsule groups according to magnetic resonance imaging evaluation. The primary patient-reported outcome (PRO) was the modified Harris Hip Score (mHHS). The secondary PROs were the Hip Outcome Score–Activities of Daily Living subscale, Hip Outcome Score–Sport Specific subscale, University of California at Los Angeles score, and visual analog scale pain score 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 capsule group and 44 hips (61.11%) in the healed capsule group. The cohort comprised 32 male and 37 female patients, and the mean age of the patients was 44.15 years. Within each group, there were significant preoperative-to-postoperative increases in the mHHS, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport Specific subscale, and University of California at Los Angeles score and decreases in the visual analog scale pain score (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 > .05). In addition, compared with the healed group, the unhealed group showed worse mHHS values in patients older than 40 years (P = .003) and female patients (P = .036) on subgroup analysis by age and sex, respectively.

Conclusions

At a minimum 2-year follow-up, 38.89% of patients with FAIS who underwent arthroscopic surgery with interportal capsulotomy without repair had unhealed hip capsules. There were no significant differences in PROs or achievement rates of the MCID and PASS between the healed and unhealed groups. Subgroup analysis showed that age older than 40 years and female sex may be associated with worse efficacy in patients with unhealed capsules.

Level of Evidence

Level III, retrospective case-control study.