Summary

Hip arthroscopy patients treated via puncture capsulotomy report excellent outcomes at five-year follow-up.

Abstract

Introduction

Puncture capsulotomy is a surgical technique for hip arthroscopy that preserves the stability of the capsule by avoiding iatrogenic transection of the iliofemoral ligament, while maintaining osseous visualization. Other common arthroscopic approaches transect the iliofemoral ligament, thus introducing instability to the capsule. As this is a novel approach, there has yet to be long-term follow up on patients undergoing arthroscopic treatment for labral tears and concomitant femoroacetabular impingement via puncture capsulotomy. Therefore, the purpose of this study was to present minimum five-year functional outcomes for this approach. As preliminary findings at two years report improved functional outcomes compared to baseline values, we hypothesize that patients will maintain this improvement at five years as well.

Methods

IRB approval was obtained for this study. This is a case series of prospectively collected data that included patients ≤18 who underwent hip arthroscopy via puncture capsulotomy for labral tears and concomitant femoroacetabular impingement. All surgeries were conducted by the senior surgeon between May 2014 to May 2019. Exclusion criteria included patients under 18 years old or patients who failed to complete a minimum of five years of postoperative PROM surveys.

Results

A total of 109 hips were included in this study (49.5% female; mean age±SD: 37.7±14.1), with a patient follow up time of minimum five years and a mean body mass index of 25.5±3.93 kg/m2.When compared to mean enrollment values, the mean modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific Subscale, International Hip Outcome Tool were all significantly improved (p<0.001) at five-year follow-up: (63.1±14.6 vs 88.9±14.6), (71.1±19.5 vs. 92.7±11.1), (41.8±25.3 vs. 81.7±23.8) and (41.9±19.1 vs. 84.4±19.6), respectively. Furthermore, 86.27%, 72.54%, and 63.72% of patients achieved minimally clinically important difference (MCID), Patient Acceptable Symptomatic Scores (PASS) and Substantial Clinical Benefit (SCB), respectively. The rate of revision hip arthroscopy was 2.83% and the conversion rate to total hip arthroplasty was 12.84%.

Discussion

At minimum five year follow up, puncture capsulotomy results in significantly improved functional and clinically meaningful outcomes. A majority of patients achieved favorable MCID, PASS, and SCB thresholds, with no incidences of instability or dislocation. This study agrees with previous positive 24-month findings and illustrates how this relationship persists over time. Puncture capsulotomy is an arthroscopic surgical technique that avoids introducing iatrogenic microinstability by preserving capsuloligamentous integrity. Patients treated via puncture capsulotomy report excellent long-term functional outcomes.

REFERENCES: Conaway WK, Martin SD. Puncture Capsulotomy During Hip Arthroscopy for Femoroacetabular Impingement: Preserving Anatomy and Biomechanics. Arthroscopy Techniques. 2017;6(6):e2265-e2269. doi:10.1016/j.eats.2017.08.036
Eberlin CT, Kucharik MP, Abraham PF, Nazal MR, Conaway WK, Varady NH, Martin SD. Puncture Capsulotomy Technique for Hip Arthroscopy: Midterm Functional Outcomes. Orthop J Sports Med. 2023 Jan 26;11(1):23259671221144056. doi: 10.1177/23259671221144056. PMID: 36743736; PMCID: PMC9893367.