Interportal Capsulotomy Closure Does Not Improve the Results After Hip Arthroscopy at 1-Year Follow-up: A Prospective Randomized Controlled Study.

Abstract

Background: Management of the capsulotomy at termination of hip arthroscopic procedures in the treatment of femoroacetabular impingement syndrome (FAIS) is debated. Clinical outcomes in favor of capsular closure were demonstrated in a retrospective study; nonetheless, this finding could not be confirmed in a recent randomized, controlled trial comparing capsular closure with unrepaired capsulotomy.

Purpose/hypothesis: This randomized, controlled multicenter trial aimed to evaluate the effect of capsular closure on subjective postoperative outcomes and revision rates in patients undergoing hip arthroscopy for FAIS. It was hypothesized was that capsular closure would result in better patient-reported outcome scores compared with no closure of the interportal capsulotomy.

Study design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: All eligible patients with FAIS from 4 surgical centers in Denmark, referred for hip arthroscopy (n = 200), were randomly assigned to either closure or no closure of the interportal capsulotomy at termination of the arthroscopic procedure. The capsular closure was performed with 2 to 3 absorbable sutures, using the "Quebec City Slider" knot technique. The primary outcome was the Copenhagen Hip and Groin Outcome Score (HAGOS) Sport/Recreation subscale. The secondary outcomes were the other HAGOS subscales, International Hip Outcome Tool (iHOT-12), Hip Sports Activity Scale (HSAS), pain during rest and activity measured on a numerical rating scale (NRS), and a measure of the overall well-being by the European Quality of Life-5 dimensions (EQ-5D). Furthermore, the rate of revision procedures and the rate of conversion to total hip replacement were recorded.

Results: Baseline epidemiological and morphological characteristics were comparable between the treatment groups, except for a higher percentage of women in the capsular closure group (65% vs 48%; P < .05). Both cohorts had significantly improved scores 1 year after surgery, with no difference between the 2 groups, except for the HSAS: HAGOS-Pain (P = .19), HAGOS-Symptoms (P = .33), HAGOS-Activities of Daily Living (P = .21), HAGOS-Sport/Recreation (P = .52), HAGOS-Physical Activity (P = .59), HAGOS-Quality of Life (P = .16), iHOT-12 (P = .15), HSAS (P = .03), EQ-5D (P = .12), NRS-rest (P = .20), and NRS-activity (P = 0.23). Five patients received revision hip arthroscopy after 1 year-1 in the unrepaired versus 4 in the repaired cohort. No patients had conversion to total hip replacement.

Conclusion: This randomized, controlled multicenter trial showed no effect on clinical outcomes (HAGOS, iHOT-12, EQ-5D, and NRS) 1 year after hip arthroscopy for FAIS of closure of the interportal capsulotomy at termination of surgery.

Registration: NCT03158454 (ClinicalTrials.gov identifier); 1-10-72-279-16.