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Puncture Capsulotomy for Hip Arthroscopy: A Report of Two-Year Functional Outcomes

Puncture Capsulotomy for Hip Arthroscopy: A Report of Two-Year Functional Outcomes

Christopher T Eberlin, BS, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Paul F Abraham, BS, UNITED STATES Mark R. Nazal, MPH, UNITED STATES Nathan Varady, MD, MBA, UNITED STATES Wendy Madeline Meek, BBA, UNITED STATES Kaveh A. Torabian, MS, UNITED STATES Nathan J Cherian, MD, UNITED STATES Scott D Martin, MD, UNITED STATES

Department of Orthopaedic Surgery, Massachusetts General Hospital / Harvard Medical School, Boston, MA, UNITED STATES


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Summary: Puncture capsulotomy demonstrated significantly improved functional and clinically meaningful outcomes at a minimum of two-years follow-up, along with a minimal complication rate.


Introduction

The most common surgical approaches in hip arthroscopy are interportal and T-capsulotomy. However, these methods may introduce capsuloligamentous instability due to transection of the iliofemoral capsule ligament. Thus, there is a clinical demand for an alternative arthroscopic approach that preserves capsuloligamentous integrity, maintains adequate osseous visualization, and demonstrates excellent functional outcomes.

Methods

This is a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral tear treatment between December 2013 and May 2019. Inclusion criteria included adult patients (age =18) who consented to hip arthroscopy performed by the senior author and completed a minimum of two years
of PROM surveys. Intraoperatively, patients underwent hip arthroscopy via puncture capsulotomy to treat labral tears and any concomitant femoroacetabular impingement. Clinical outcome data consisted of PROMs.

Results

A total of 163 hips were included in this study with a mean patient follow-up of 30.4 (95% CI: 28.5-32.3) months. Patients had a mean age of 37.9 (36.1-39.6) years with a mean body mass index of 25.9 (25.2-26.5) kg/m 2. There were significant improvements in mean enrollment compared to final follow-up scores for the iHOT-33 [39.6 (36.8-42.4) vs. 76.1 (72.7-79.6)], HOS-ADL [70.0 (67.0-73.0) vs 89.3 (87.3-91.3)], mHHS [60.1 (57.9-62.4) vs. 84.9 (82.5-87.2)] and HOS-Sport [41.8 (37.9-45.6) vs. 75.7 (71.7-79.7)]. Additionally, VAS pain scores were noted to significantly improve throughout the duration of the postoperative period [6.3 (5.9-6.7) to 2.2 (1.8-2.6)]. At 2-year follow-up, 81.0%, 62.0%, and 58.9% of hips achieved clinically meaningful iHOT-33 thresholds for Minimally Clinically Important Difference, Patient-Acceptable Symptomatic Scores, and Substantial Clinical Benefit, respectively.

Discussion And Conclusion

Puncture capsulotomy demonstrated significantly improved functional and clinically meaningful outcomes at a minimum of two-years follow-up, along with a minimal complication rate. Long-term evaluation of outcomes is warranted to completely encompass the benefits of puncture capsulotomy.

ACKNOWLEDGEMENTS: Conine Family Foundation for Joint Preservation


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