Capsular Closure in Patients with Femoroacetabular Impingement Syndrome (FAIS): Results of a Matched-cohort Study from the Danish Hip Arthroscopy Registry

Overview

Journal J Hip Preserv Surg

Publisher Oxford University Press

Date 2024 Oct 21

PMID 39429717

Authors

Bjarne Mygind-Klavsen

Bent Lund

Torsten Gronbech Nielsen

Otto Kraemer

Per Holmich

Niels Maagaard

Soren Winge

Martin Lind

Affiliations

Soon will be listed here.

Abstract

Capsular closure in femoroacetabular impingement syndrome (FAIS) patients during hip arthroscopy procedures is debated. The Danish Hip Arthroscopy Registry (DHAR) contains data to perform matched-cohort analyses. The purpose of this study is to evaluate 1-year subjective outcome data from DHAR after hip arthroscopy for FAIS with capsular closure and compare these outcome data with a matched-cohort study group. The primary hypothesis was that there would be no difference in Copenhagen Hip and Groin Outcome Score (HAGOS) subjective outcome between patients with and without capsular closure. This is a retrospective cohort study (level of evidence, 3). FAIS patients eligible for hip arthroscopy between January 2012 and December 2017, and where the interportal capsulotomy was closed, were identified and matched with patients without capsular closure. Matching criteria were gender (1:1), age (±5 years), degree of cartilage injury: ICRS and modified Becks grade (±1 grade) and radiological parameters: lateral center edge angle and alpha angle (±10°). A comparison between cohorts regarding differences in patient outcome scores, HAGOS, Hip Sports Activity Scale (HSAS), EuroQol-5 Domain (EQ-5D) and numeric rating scale (NRS) pain at 1-year follow-up were performed. Wilcoxon rank-sum test was used to compare differences between preoperative and postoperative subjective outcome scores, level of statistical significance was 0.05. A total of 189 patients were included in the capsular closure group and matched with 189 control patients. The mean age in years (±standard deviation) was 39.4 (±11.8) and 39.3 (±11.2), respectively, 55% females. Both groups improved significantly at 1-year follow-up. Significant improvements in the capsular closure group were found in HSAS, EQ-5D, NRS pain (rest and walk) and most HAGOS subscales compared with the non-closure group. All patients underwent labral repair in combination with both femoral osteochondroplasty and acetabuloplasty. The revision rate reported after 2 years was 6.8% in the non-closure group and 3.5% in the closure group. One patient in each cohort received a total hip replacement after 2 years. Capsular closure during arthroscopic FAIS treatment resulted in better subjective outcomes and less pain during rest and walking compared with matched controls. Both groups demonstrated improved outcome at 1-year follow-up. Furthermore, capsular closure might result in a lower risk of a revision hip arthroscopy.

References

Griffin D, Dickenson E, ODonnell J, Agricola R, Awan T, Beck M . The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016; 50(19):1169-76. DOI: 10.1136/bjsports-2016-096743. View

Tannast M, Siebenrock K, Anderson S . Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR Am J Roentgenol. 2007; 188(6):1540-52. DOI: 10.2214/AJR.06.0921. View

Gupta A, Suarez-Ahedo C, Redmond J, Gerhardt M, Hanypsiak B, Stake C . Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons. Arthroscopy. 2015; 31(9):1722-7. DOI: 10.1016/j.arthro.2015.03.023. View

Domb B, Stake C, Lindner D, El-Bitar Y, Jackson T . Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med. 2013; 41(11):2591-8. DOI: 10.1177/0363546513499154. View

Thorborg K, Tijssen M, Habets B, Bartels E, Roos E, Kemp J . Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence. Br J Sports Med. 2015; 49(12):812. DOI: 10.1136/bjsports-2014-094224. View

Thorborg K, Holmich P, Christensen R, Petersen J, Roos E . The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011; 45(6):478-91. DOI: 10.1136/bjsm.2010.080937. View

Nepple J, Philippon M, Campbell K, Dornan G, Jansson K, LaPrade R . The hip fluid seal--Part II: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014; 22(4):730-6. DOI: 10.1007/s00167-014-2875-y. View

Beck M, Kalhor M, Leunig M, Ganz R . Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87(7):1012-8. DOI: 10.1302/0301-620X.87B7.15203. View

Mygind-Klavsen B, Nielsen T, Maagaard N, Kraemer O, Holmich P, Winge S . Danish Hip Arthroscopy Registry: an epidemiologic and perioperative description of the first 2000 procedures. J Hip Preserv Surg. 2016; 3(2):138-45. PMC: 5005047. DOI: 10.1093/jhps/hnw004. View

10.

Kuhns B, Weber A, Levy D, Bedi A, Mather 3rd R, Salata M . Capsular Management in Hip Arthroscopy: An Anatomic, Biomechanical, and Technical Review. Front Surg. 2016; 3:13. PMC: 4778552. DOI: 10.3389/fsurg.2016.00013. View

11.

Ortiz-Declet V, Mu B, Chen A, Litrenta J, Perets I, Yuen L . Should the Capsule Be Repaired or Plicated After Hip Arthroscopy for Labral Tears Associated With Femoroacetabular Impingement or Instability? A Systematic Review. Arthroscopy. 2017; 34(1):303-318. DOI: 10.1016/j.arthro.2017.06.030. View

12.

McCormick F, Slikker 3rd W, Harris J, Gupta A, Abrams G, Frank J . Evidence of capsular defect following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2013; 22(4):902-5. DOI: 10.1007/s00167-013-2591-z. View

13.

Myers C, Register B, Lertwanich P, Ejnisman L, Pennington W, Giphart J . Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med. 2011; 39 Suppl:85S-91S. DOI: 10.1177/0363546511412161. View

14.

Larson C, Ross J, Stone R, Samuelson K, Schelling E, Giveans M . Arthroscopic Management of Dysplastic Hip Deformities: Predictors of Success and Failures With Comparison to an Arthroscopic FAI Cohort. Am J Sports Med. 2015; 44(2):447-53. DOI: 10.1177/0363546515613068. View

15.

Riff A, Kunze K, Movassaghi K, Hijji F, Beck E, Harris J . Systematic Review of Hip Arthroscopy for Femoroacetabular Impingement: The Importance of Labral Repair and Capsular Closure. Arthroscopy. 2019; 35(2):646-656.e3. DOI: 10.1016/j.arthro.2018.09.005. View

16.

Duplantier N, McCulloch P, Nho S, Mather 3rd R, Lewis B, Harris J . Hip Dislocation or Subluxation After Hip Arthroscopy: A Systematic Review. Arthroscopy. 2016; 32(7):1428-34. DOI: 10.1016/j.arthro.2016.01.056. View

17.

Naal F, Miozzari H, Kelly B, Magennis E, Leunig M, Noetzli H . The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement. Hip Int. 2013; 23(2):204-11. DOI: 10.5301/hipint.5000006. View

18.

Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R . Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004; (418):67-73. View

19.

Wuerz T, Song S, Grzybowski J, Martin H, Mather 3rd R, Salata M . Capsulotomy Size Affects Hip Joint Kinematic Stability. Arthroscopy. 2016; 32(8):1571-80. DOI: 10.1016/j.arthro.2016.01.049. View

20.

Lund B, Mygind-Klavsen B, Nielsen T, Maagaard N, Kraemer O, Holmich P . Danish Hip Arthroscopy Registry (DHAR): the outcome of patients with femoroacetabular impingement (FAI). J Hip Preserv Surg. 2017; 4(2):170-177. PMC: 5467416. DOI: 10.1093/jhps/hnx009. View