ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Superior Outcomes With Routine Capsular Repair In Hip Arthroscopy

Austin M Looney, MD, Arlington, Va UNITED STATES
Spencer M Comfort, BS, Washington, DC UNITED STATES
Patrick T Connolly, BS, Washington, DC UNITED STATES
Julia E McCann, MD, Washington, DC UNITED STATES
Andrew Curley, MD, Great Falls, Virginia UNITED STATES
William F. Postma, MD, Bethesda, MD UNITED STATES

Georgetown University Hospital, Washington, DC, UNITED STATES

FDA Status Not Applicable

Summary

Routine capsular repair with hip arthroscopy results in superior outcomes.

Abstract

Background

In hip arthroscopy, a capsulotomy is created to improve visualization and allow instrumentation of the joint. Traditionally the defect was left unrepaired; however, increasing evidence suggests that this may contribute to persistent pain and iatrogenic capsular instability. Nevertheless, the clinical benefit of performing routine capsular repair remains controversial.

Methods

A systematic review and meta-analysis was conducted according to PRISMA guidelines. The terms “hip,” “arthroscopy,” “capsule,” “capsular,” “repair,” and “closure” were used to query OvidMedline, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, and PubMed. Articles with PROs stratified by capsular management were included. Multivariate mixed effects metaregression models were implemented with study-level random effects and fixed effects moderators for capsular closure vs non-repair, and controlling for surgical indication and preoperative PROs. Effect of repair on both postoperative score and change were evaluated forvia Harris Hip Score (HHS)/modified HHS (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and HOS-Sport Specific Subscale (HOS-SSS), with a supplemental analysis of additional outcomes.

Results

Out of 432 initial articles, 36 were eligible for analysis, with results for 5132 hip arthroscopies. The capsule was repaired in 3427 arthroscopies and unrepaired in 1705. Capsular repair was associated with significantly higher postoperative HHS/mHHS (2.011; SE, 0.743; 95% CI, 0.554 to 3.467; P = .007), HOS-ADL (3.635; SE, 0.873; 95% CI, 1.923 to 5.346; P < .001), and HOS-SSS (4.137; SE, 1.205; 95% CI, 1.775 – 6.499; P < .001), as well as significantly superior improvement in HHS/mHHS (2.571; SE, 0.878; 95% CI, 0.849 – 4.292; P = .003), HOS-ADL (3.315; SE, 1.131; 95% CI, 1.099 – 5.531; P = .003), and HOS-SSS (3.605; SE, 1.689; 95% CI, 0.295 – 6.915; P = .033).

Conclusion

This meta-analysis is the largest to date evaluating the impact of capsular managementclosure on PROs and demonstrates significantly higher mean postoperative scores and significantly superior improvement with repair, controlling for effects of preoperative score and indication. The true magnitude of the benefit of capsular repair may be clarified by large, prospective, randomized studies using PROs specifically targeted and validated for hip arthroscopy/preservation.

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