Summary

This study evaluates the impact of capsular repair in patients who were at highest risk for conversion to arthroplasty while examining outcomes following primary hip arthroscopy with capsular repair for FAIS.

Abstract

Background

There is a paucity of literature evaluating long term outcomes and survivorship of patients undergoing primary hip arthroscopy with capsular repair for femoroacetabular impingement syndrome (FAIS).

Purpose

The primary purpose of this study is to report 10-year survivorship and patient-reported outcomes (PROs) following primary hip arthroscopy with capsular repair for FAIS. The secondary purpose was to evaluate the impact of capsular repair in those patients who were at highest risk for conversion to arthroplasty.

Methods

Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Patients with minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Visual Analog Scale for pain (VAS). If available, preoperative and minimum 10-year follow-up for the Hip Outcome Score—Sports Specific Subscale (HOS-SSS) were reported. Patients with ipsilateral hip surgery, worker’s compensation, Tönnis osteoarthritis grade > 1, and hip dysplasia (lateral center-edge angle < 25°) were excluded. Survivorship, PROS, and clinical benefit (minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS)) were reported. An additional propensity-matched sub-analysis was performed on patients at highest risk for conversion to arthroplasty, comparing patients undergoing capsular repair with patients undergoing capsular release.

Results

145 (130 patients) out of 180 eligible hips (165 patients) had minimum 10-year follow-up (80.6%). 126 hips (86.9%) were female, and 19 hips (13.1%) were male. The average patient age was 30.3 ± 12.9 years. The survivorship rate was 91.0% at 10-year follow-up. The cohort experienced significant improvement (P < 0.001) in the mHHS, NAHS, HOS-SSS, and VAS for pain. Additionally, the cohort achieved high rates of PASS for the mHHS (89.8%), and high rates of the MCID for the mHHS (82.4%) and VAS for pain (80.6%).

Conclusion

Patients undergoing primary hip arthroscopy with capsular repair experienced a high rate of survivorship of 91% at minimum 10-year follow-up. Patients that did not convert to THA saw favorable improvements in PROs and achieved high rates of clinical benefit. Additionally, amongst those patients at highest risk for conversion to arthroplasty, greater survivorship was seen with capsular repair.