Comparable patient-reported outcomes in females with or without joint hypermobility after hip arthroscopy and capsular plication for femoroacetabular impingement syndrome

Stone, Austin V.; Mehta, Nabil; Beck, Edward C.; Waterman, Brian R.; Chahla, Jorge; Ukwuani, Gift; Nho, Shane J.

doi:10.1093/jhps/hnz004

Cited by 27 publications

(39 citation statements)

References 46 publications

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“…Regarding latest follow-up specific to hip preservation–designed PRO results, no differences were found. The authors of the previous study 75 stated that appropriate capsular management is essential to achieve good results in GLL populations, and we agree with this concept in addition to the combination of labral function/seal restoration. 2,24,59 In almost 94% of the patients, the capsule was plicated.…”

Section: Discussionsupporting

confidence: 83%

“…With longer follow-up, Stone et al 75 recently published their results regarding patients with GLL (Beighton score ≥4) who underwent hip arthroscopy. The authors reported similar improvement in outcomes at average 2-year follow-up to a matched control group based on Δ value for mHHS ( P = .913), HOS-SSS ( P = .944), HOS–Activities of Daily Living ( P = .618), and VAS ( P = .512).…”

Section: Discussionmentioning

confidence: 99%

“…13,23,80 Regarding GLL and outcomes after hip arthroscopy, there is a paucity in the current literature, with only a few studies reporting favorable results, most of which are limited by small series and relative short-term follow-up. 43,67,75…”

mentioning

confidence: 99%

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Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

et al. 2020

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Background: Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established. Purposes: (1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL. Study Design: Cohort study; Level of evidence, 3. Methods: Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score–Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12) were calculated. Results: A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups ( P > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications ( P = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS ( P < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS ( P > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12. Conclusion: Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

et al. 2020

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“…Capsular management after hip arthroscopy varies among surgeons, ranging from T-capsulotomy without closure (TC) to partial closure of the T-capsulotomy and interportal capsulotomy with or without closure. 2,10,12,13,15,16,20,28,29. No consensus has been defined regarding the best approach to capsular management.…”

mentioning

confidence: 99%

Prospective Randomized Comparison of Capsular Management Techniques During Hip Arthroscopy

2019

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Background: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. Purpose/Hypothesis: The purpose was to perform a prospective randomized trial to comparatively assess 3 commonly performed capsular management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes when compared with unclosed capsulotomy management techniques. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients (N = 150) who had hip arthroscopy with labral repairs and femoral osteoplasties performed by the senior author were randomly assigned into 3 groups at the time of their surgery: T-capsulotomy without closure (TC), interportal capsulotomy without closure (IC), and interportal capsulotomy with closure (CC). All patients underwent labral repair and femoral osteoplasty. Patient-reported outcomes were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Other outcomes obtained included the need for future hip surgery. Results: Patient demographics, preoperative patient-reported outcomes, and radiographic measurements were similar among all 3 groups. Revision hip arthroscopy was performed in 5 TC cases, 2 IC cases, and 1 CC case ( P = .17). Conversion to hip arthroplasty occurred in 4 patients in the TC group and none in the IC and CC groups ( P = .02). The CC group showed higher modified Harris Hip Score (mHHS) and Hip Outcome Score–Activities of Daily Living (HOS-ADL) at the 2-year follow-up when compared with the IC group ( P = .003 and P < .001, respectively). When compared with the TC group, the CC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (Hip Outcome Score–Sports-Specific Subscale; 74.4 vs 65.3) at the final 2-year follow-up ( P < .001). At the 2-year follow-up, the IC group had a higher mHHS (81.7 vs 76), HOS-ADL (82 vs 76.8), and HOS-SSS (71.4 vs 65.3; P > .001) as compared with the TC group. Conclusion: Patients undergoing complete capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes when compared with those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsular management technique.

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“…Previous authors have reported good outcomes in female patients with hypermobility by use of an arthroscopic approach with capsular plication. 10 However, this finding cannot be generalized to the dancer's hip. In addition, it would have been interesting to report the reason that 16% of dancers did not return to the previous level of activity.…”

mentioning

confidence: 95%

Editorial Commentary: The Competitive Dancer’s Hip—An Acquired Flexible Attitude to a High-Performance Hip

Pascual‐Garrido¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Competitive dancers have a high prevalence of hip injuries. The dancer's hip is a unique scenario in which hip impingement is associated with compensatory soft-tissue laxity. Particularly in these athletes, normal osseous hip morphology with symptomatic femoroacetabular impingement may be observed. The repetitive training, including extreme daily hip range of motion, results in compensatory soft-tissue laxity and secondary impingement-induced subluxation. Peculiarly, hip impingement in dancers occurs in the posterosuperior aspect of the hip and extra-articularly between the anterior inferior iliac spine and the distal femoral neck (subspinous impingement). Normal or even dysplastic hips might impinge during extreme range of motion. An atypical osteochondroplasty, including a subtle distalbased femoral resection, anterior inferior iliac spine decompression, and excellent management of the capsule, should be considered in this population for a successful outcome. Hip dysplasia should always be ruled out in these athletes, and if present, a periacetabular osteotomy should be indicated.

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Comparable patient-reported outcomes in females with or without joint hypermobility after hip arthroscopy and capsular plication for femoroacetabular impingement syndrome

Cited by 27 publications

References 46 publications

Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

Prospective Randomized Comparison of Capsular Management Techniques During Hip Arthroscopy

Editorial Commentary: The Competitive Dancer’s Hip—An Acquired Flexible Attitude to a High-Performance Hip

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