Purpose
To evaluate the changes in anterior hip capsular thickness on pre- and postoperative
magnetic resonance imaging (MRI) and their associated clinical outcomes in patients
with borderline developmental dysplasia of the hip (BDDH).
Methods
A minimum 2-year follow-up retrospective analysis was performed using data from symptomatic
patients with BDDH who underwent hip arthroscopy with routine capsular closure between
2018 and 2020. An available postoperative hip MRI was a prerequisite for study inclusion.
Capsular thickness at the capsulotomy zone was measured on MRI. An analysis of the
correlations between anterior capsular thickness differences and demographic factors
(including age, sex, body mass index, laterality, preoperative alpha angle and lateral
center-edge angle, cartilage lesion grade, follow-up time, and capsule management)
was performed. Patients with unhealed or partially healed capsules (study group) were
propensity-score matched 1:1 to patients with completely healed capsules based on
age, sex, body mass index, and follow-up time. Comparisons and analyses of the following
parameters were completed for both groups: patient-reported outcomes (Hip Outcome
Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sports-Specific Subscale
[HOS-SSS], International Hip Outcome Tool 12-component form [iHOT-12], and modified
Harris Hip Score), visual analog scale scores, radiographic measures, performed procedures,
and complications.
Results
Data were compiled for 59 patients’ hips after patient selection. The majority of
the repaired hip capsules remained closed (93.2%) at a minimum 2-year follow-up. Propensity-score
matching was applied to distribute 25 subjects in the study group and 25 in the control
group. The anterior capsule was significantly thinner postoperation in the study group
(3.0 ± 1.2 mm vs 4.1 ± 0.6 mm; P < .001). Compared with the control group, patients in the study group had significantly
inferior postoperative HOS-ADL (75.1 vs 83.5, P = .007), HOS-SSS (64.5 vs 77.1, P = .005), and iHOT-12 scores (56.1 vs 70.2, P = .006). In addition, patients in the study group were significantly less likely
to achieve the minimum clinically important difference for the HOS-ADL score (52%
vs 80%, P = .037) score and patient acceptable symptomatic state for the HOS-ADL score (32%
vs 60%, P = .047).
Conclusions
The majority of the repaired hip capsules in patients with BDDH remained closed but
not all capsules completely healed at a minimum 2-year follow-up. Patients with an
unhealed or partially healed capsule had inferior HOS-ADL, HOS-SSS, and iHOT-12 scores
and were less likely to achieve the minimum clinically important difference and patient
acceptable symptomatic state for the HOS-ADL score.
Level of Evidence
III, retrospective comparative prognostic study.
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References
- Hip arthroscopy and borderline developmental dysplasia of the hip: A systematic review.Arthroscopy. 2020; 36: 2550-2567
- Patients with borderline hip dysplasia achieve clinically significant improvement after arthroscopic femoroacetabular impingement surgery: A case-control study with a minimum 5-year follow-up.Am J Sports Med. 2020; 48: 1616-1624
- Patients With borderline hip dysplasia achieve clinically significant outcome after arthroscopic femoroacetabular impingement surgery: A case-control study with minimum 2-year follow-up.Am J Sports Med. 2019; 47: 2636-2645
- Hip joint capsular anatomy, mechanics, and surgical management.J Bone Joint Surg Am. 2019; 101: 2141-2151
- Hip capsule dimensions in patients with femoroacetabular impingement: A pilot study.Clin Orthop Relat Res. 2012; 470: 3306-3312
- Biomechanical evaluation of capsulotomy, capsulectomy, and capsular repair on hip rotation.Arthroscopy. 2015; 31: 1511-1517
- Biomechanical assessment of hip capsular repair and reconstruction procedures using a 6 degrees of freedom robotic system.Am J Sports Med. 2017; 45: 1745-1754
- MRI evaluation of repaired versus unrepaired interportal capsulotomy in simultaneous bilateral hip arthroscopy: A double-blind, randomized controlled trial.J Bone Joint Surg Am. 2018; 100: 91-98
- Achieving successful outcomes in high-level athletes with borderline hip dysplasia undergoing hip arthroscopy with capsular plication and labral preservation: A propensity-matched controlled study.Am J Sports Med. 2021; 49: 2447-2456
- Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 1370-1377
- Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure.Arthroscopy. 2019; 35: 646-656
- Clinical and radiographic presentation of capsular iatrogenic Hip instability after previous hip arthroscopy.Am J Sports Med. 2020; 48: 2927-2932
- Does the hip capsule remain closed after hip arthroscopy with routine capsular closure for femoroacetabular impingement? A magnetic resonance imaging analysis in symptomatic postoperative patients.Arthroscopy. 2017; 33: 108-115
- The anterior hip capsule is thinner in dysplastic hips: A study comparing different young adult hip patients.Knee Surg Sports Traumatol Arthrosc. 2023; 31: 70-78
- Improved functional outcome scores associated with greater reduction in cam height using the femoroacetabular impingement resection arc during hip arthroscopy.Arthroscopy. 2021; 37: 3455-3465
- An intact ligamentum teres predicts a superior prognosis in patients with borderline dysplasia: A matched-pair controlled study with minimum 5-year outcomes after hip arthroscopic surgery.Am J Sports Med. 2020; 48: 673-681
- Volume of gluteus maximus and minimus increases after hip arthroscopy for femoroacetabular impingement syndrome.Arthroscopy. 2021; 37: 862-870
- Evidence of validity for the hip outcome score in hip arthroscopy.Arthroscopy. 2007; 23: 822-826
- Evidence of reliability and responsiveness for the hip outcome score.Arthroscopy. 2008; 24: 676-682
- Defining variations in outcomes of hip arthroscopy for femoroacetabular impingement using the 12-Item International Hip Outcome Tool (iHOT-12).Am J Sports Med. 2020; 48: 1175-1180
- Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy?.Am J Sports Med. 2012; 40: 2557-2560
- Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation.Med Care. 2003; 41: 582-592
van Arkel RJ, Amis AA, Cobb JP, Jeffers JR. T. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: An experimental study. Bone Joint J 2015;97-B:484-491.
- Vertical extension of the T-capsulotomy incision in hip arthroscopic surgery does not affect the force required for hip distraction: effect of capsulotomy size, type, and subsequent repair.Am J Sports Med. 2018; 46: 3127-3133
- The role of anterior capsular laxity in hip microinstability: A novel biomechanical model.Am J Sports Med. 2019; 47: 1151-1158
- Capsular laxity of the hip: Findings at magnetic resonance arthrography.Arthroscopy. 2013; 29: 1615-1622
- Hip microinstability: Understanding a newly defined hip pathology in young athletes.Arthroscopy. 2022; 38: 211-213
- Is the hip capsule thicker in diseased hips?.Bone Joint Res. 2016; 5: 586-593
Article info
Publication history
Published online: January 31, 2023
Accepted:
January 10,
2023
Received:
July 15,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: This work was supported by grants from the National Natural Science Foundation of China (Grant No.82072403, 81902205). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Hongjie Huang and Jianquan Wang contributed equally to this work.
Identification
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© 2023 by the Arthroscopy Association of North America
