PMID- 29373289 OWN - NLM STAT- MEDLINE DCOM- 20190123 LR - 20190123 IS - 1526-3231 (Electronic) IS - 0749-8063 (Linking) VI - 34 IP - 3 DP - 2018 Mar TI - Patient-Reported Outcomes of Capsular Repair Versus Capsulotomy in Patients Undergoing Hip Arthroscopy: Minimum 5-Year Follow-up-A Matched Comparison Study. PG - 853-863.e1 LID - S0749-8063(17)31323-3 [pii] LID - 10.1016/j.arthro.2017.10.019 [doi] AB - PURPOSE: To elucidate whether capsular closure during hip arthroscopy affected patient outcomes over midterm follow-up. METHODS: Between 2008 and 2011, data were prospectively collected and retrospectively reviewed on patients who underwent hip arthroscopy. Patients were then matched for age, gender, worker's compensation, body mass index, and acetabular coverage. The inclusion criteria were capsular repair or unrepaired capsulotomy, lateral-center edge angle >/=18 degrees , and minimum 5-year follow-up. The exclusion criteria were previous hip surgery or conditions and Tonnis grade >1. Patient-reported outcome scores (PROs) included modified Harris hip score (mHHS), nonarthritic hip score, hip outcome score sport-specific subscale, and visual analog score for pain, which were collected preoperatively, at 3 months, and annually thereafter. Minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for both groups were analyzed. Patient satisfaction was noted as well as any complications, secondary surgery, and conversion to arthroplasty. RESULTS: Minimum 5-year follow-up was available for 82.5% (287 of 348) hips that met the inclusion criteria and were eligible for matching. Ultimately, 65 patients who underwent capsular repair could be matched in a 1:1 ratio to 65 patients with release. Both groups had significant improvements in all mean PROs. The repair group had significant improvement of mean PROs, visual analog score, and patient satisfaction at both 2-year and minimum 5-year follow-up. The unrepaired group had a significant decrease in mHHS (P = .001) and patient satisfaction (P = .01) between 2- and 5-year follow-up. Despite decreasing mHHS in the repair group between 2- and 5-year follow-up, both groups met the MCID and PASS criteria with no significant difference between them. More patients in the release group required conversion to hip arthroplasty (18.5% vs 10.8%). Subgroup analysis considering various perioperative factors confirmed this trend. Rate of revision arthroscopy was the same in both groups (15.4%). Complication rate was low (4.6% vs 6.4%) in both groups. CONCLUSIONS: Patients undergoing hip arthroscopy and who have minimal or no arthritis have significant short-term improvement, whether the capsule is closed or left unrepaired. However, at midterm follow-up, patients who had unrepaired capsules had deterioration in mHHS as well as a higher rate of conversion to arthroplasty, even when controlling for various perioperative variables. Despite this, patients in both groups met the MCID and PASS criteria. This study suggests that routine capsular closure may lead to more consistently durable outcome in patients undergoing hip arthroscopy, but also that individual patient pathology may dictate capsular management. LEVEL OF EVIDENCE: Level III, retrospective comparative study. CI - Copyright (c) 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. FAU - Domb, Benjamin G AU - Domb BG AD - Department of Orthopaedic Surgery, American Hip Institute, Westmont, Illinois, U.S.A.; Department of Orthopaedic Surgery, Hinsdale Orthopaedics, Westmont, Illinois, U.S.A.. Electronic address: DrDomb@americanhipinstitute.org. FAU - Chaharbakhshi, Edwin O AU - Chaharbakhshi EO AD - Department of Orthopaedic Surgery, American Hip Institute, Westmont, Illinois, U.S.A. FAU - Perets, Itay AU - Perets I AD - Department of Orthopaedic Surgery, American Hip Institute, Westmont, Illinois, U.S.A. FAU - Walsh, John P AU - Walsh JP AD - Department of Orthopaedic Surgery, American Hip Institute, Westmont, Illinois, U.S.A. FAU - Yuen, Leslie C AU - Yuen LC AD - Department of Orthopaedic Surgery, American Hip Institute, Westmont, Illinois, U.S.A. FAU - Ashberg, Lyall J AU - Ashberg LJ AD - Department of Orthopaedic Surgery, American Hip Institute, Westmont, Illinois, U.S.A. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180117 PL - United States TA - Arthroscopy JT - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JID - 8506498 SB - IM CIN - Arthroscopy. 2018 Mar;34(3):864-865. PMID: 29502703 MH - Acetabulum/surgery MH - Adult MH - Arthritis/surgery MH - Arthroplasty MH - Arthroscopy/*methods MH - Body Mass Index MH - Female MH - Follow-Up Studies MH - Hip/*surgery MH - Humans MH - Male MH - Middle Aged MH - *Patient Reported Outcome Measures MH - Patient Satisfaction MH - Retrospective Studies MH - Treatment Outcome EDAT- 2018/01/27 06:00 MHDA- 2019/01/24 06:00 CRDT- 2018/01/27 06:00 PHST- 2017/01/25 00:00 [received] PHST- 2017/09/29 00:00 [revised] PHST- 2017/10/06 00:00 [accepted] PHST- 2018/01/27 06:00 [pubmed] PHST- 2019/01/24 06:00 [medline] PHST- 2018/01/27 06:00 [entrez] AID - S0749-8063(17)31323-3 [pii] AID - 10.1016/j.arthro.2017.10.019 [doi] PST - ppublish SO - Arthroscopy. 2018 Mar;34(3):853-863.e1. doi: 10.1016/j.arthro.2017.10.019. Epub 2018 Jan 17.