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Hip Capsular Repair Results in Improved Patient-Reported Outcomes and Survivorship: A Systematic Review of the Literature

Published:November 14, 2022DOI:https://doi.org/10.1016/j.arthro.2022.11.013

      Abstract

      Purpose

      To determine if routine capsular closure following hip arthroscopy for FAI in non-dysplastic patients results in improved patient-reported outcomes (PROs) and increased survivorship rates.

      Methods

      A literature search of the Pubmed, Embase, and Cochrane Library databases was performed using the PRISMA guidelines for clinical studies reporting PROs following arthroscopic hip labral repair for FAI. A quality assessment was performed using the MINORS grading system. Inclusion criteria consisted of comparative clinical studies investigating routine capsular closure to non-closure in patients undergoing hip arthroscopy for the treatment of FAI and labral tears. Exclusion criteria included non-English language, minimum follow-up of less than 2 years after surgery, technique articles, case reports, non-comparative case series of fewer than 10 patients, failure to report surgical technique, absence of postoperative PROs, or partial repair. Data collection included study characteristics, demographics, indications, radiographic metrics, perioperative findings, surgical technique, baseline and most recent PROs, and subsequent surgeries.

      Results

      A total of 531 articles were reviewed, of which 3 were included with 249 hips which underwent capsular repair and 157 hips which underwent capsulotomy with no repair. There were two level III studies and one level II study, with an average MINORS score of 16.7. All studies cited femoroacetabular impingement and labral tear as an indication for surgery. All studies demonstrated improved PROs from baseline to most recent follow-up. Postoperatively, the repair group reported mHHS values ranging from 80.8 to 87, while the non-repair group reported scores ranging from 76 to 81.7. Additionally, the repair group reported postoperative HOS-SSS values ranging from 68.1 to 9, while the non-repair group reported scores ranging from 65.3 to 76.1. The studies also reported MCID for mHHS, with the repair group reporting percentages ranging from 71 to 100 and the no repair group reporting percentages ranging from 52 to 95.6. All three studies also observed a lower rate of hip survivorship in the non-repair group, rangingfrom 94.6 to 100 the repair group and 90.8 to 100 in the non-repair group. There were no significant differences in the rate of revision arthroscopy between groups.

      Conclusion

      Non-dysplastic patients who undergo capsular repair have greater improvements in PROs and higher survivorship rates at early- and mid-term follow-up than patients who do not undergo capsular repair.

      Level of Evidence

      Level III, systematic review of level II and III studies

      Keywords

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