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Dartus J, Putman S, Champagne G, Matache BA, Pelet S, Belzile EL. Validation of the French version of the Non-Arthritic Hip Score (NAHS) in 113 hip arthroscopy procedures. Orthop Traumatol Surg Res 2023; 109:103683. [PMID: 37696391 DOI: 10.1016/j.otsr.2023.103683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The Non-Arthritic Hip Score (NAHS) used to evaluate the hip in younger patients is a self-administered questionnaire with 20 items in four sections: pain, symptoms, function, and activities. Although used in France, no transcultural version had been validated. The objective of this study was to translate the NAHS into French then assess the validity, reliability, and sensitivity to change of the French-language version (NAHS-Fr) in younger patients with hip conditions other than osteoarthritis. HYPOTHESIS The NAHS-Fr demonstrates good validity and reliability when used in younger French-speaking patients with hip pain. MATERIAL AND METHODS We conducted a prospective observational study in 105 patients (62 males and 43 females) scheduled for surgery on one or both hips (113 hips in total) to treat cam-type femoro-acetabular impingement or labral lesions. Before and 6 months after surgery, each patient completed the NAHS-Fr and Western Ontario and McMaster Osteoarthritis Index (WOMAC). Statistical tests were done to evaluate validity, reliability, and sensitivity to change, as recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS The response rate was 100%, confirming that the NAHS-Fr was easy to use. The NAHS-Fr was both valid and reliable. No ceiling or floor effect was detected for the total NAHS-Fr score. All items had Cronbach alpha coefficients greater than 0.8, indicating good internal consistency. External consistency between the NAHS-Fr and WOMAC was negative (-0.676) due to inversely proportional score indexing. Before surgery, the NAHS-Fr and WOMAC scores were strongly and significantly correlated (p<0.0001). The effect size was greater than 0.8, indicating good sensitivity to the change induced by surgery. DISCUSSION These results confirm the study hypothesis: the NAHS-Fr has the same good psychometric characteristics as does the original version and versions in other languages. The NAHS-Fr is useful for evaluating younger patients with non-osteoarthritic hip pain and can be used by French-speaking surgeons in everyday clinical practice. LEVEL OF EVIDENCE IV, prospective observational non-comparative cohort study.
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Affiliation(s)
- Julien Dartus
- Université de Lille, CHU de Lille, ULR 4490, hôpital Salengro, 59000 Lille, France; Département universitaire de chirurgie orthopédique et traumatologique, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59037 Lille, France; Department of Surgery, Division of Orthopaedic Surgery, CHU de Québec-université Laval, Quebec City, QC, Canada; Department of Surgery, School of Medicine, Laval University Quebec City, Quebec City, QC, Canada.
| | - Sophie Putman
- Université de Lille, CHU de Lille, ULR 4490, hôpital Salengro, 59000 Lille, France; Département universitaire de chirurgie orthopédique et traumatologique, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59037 Lille, France; Université de Lille, CHU de Lille, EA 2694 - Metrics: évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - Gabriel Champagne
- Department of Surgery, School of Medicine, Laval University Quebec City, Quebec City, QC, Canada
| | - Bogdan Alexandru Matache
- Department of Surgery, Division of Orthopaedic Surgery, CHU de Québec-université Laval, Quebec City, QC, Canada; Department of Surgery, School of Medicine, Laval University Quebec City, Quebec City, QC, Canada
| | - Stéphane Pelet
- Department of Surgery, Division of Orthopaedic Surgery, CHU de Québec-université Laval, Quebec City, QC, Canada; Department of Surgery, School of Medicine, Laval University Quebec City, Quebec City, QC, Canada
| | - Etienne L Belzile
- Department of Surgery, Division of Orthopaedic Surgery, CHU de Québec-université Laval, Quebec City, QC, Canada; Department of Surgery, School of Medicine, Laval University Quebec City, Quebec City, QC, Canada
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Dasari SP, Kasson LB, Condon JJ, Mameri ES, Kerzner B, Khan ZA, Jackson GR, Gursoy S, Sivasundaram L, Hevesi M, Chahla J. Systematic Review and Meta-analysis of Studies Comparing Complete Capsular Closure Against Unrepaired Hip Capsules During Hip Arthroscopy. Orthop J Sports Med 2023; 11:23259671231197435. [PMID: 37868216 PMCID: PMC10585995 DOI: 10.1177/23259671231197435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background While the biomechanical importance of the hip capsule is well described, there remains controversy over the necessity of routine capsular closure after hip arthroscopy. Purpose To perform a meta-analysis of clinical studies to compare pooled outcomes of complete hip capsular closure cohorts against unrepaired hip capsule cohorts. Study Design Systematic review; Level of evidence, 3. Methods The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, CINAHL/EBSCO, and Scopus were queried in February 2022 for studies that directly compared clinical outcomes for hip arthroscopy patients treated with either complete capsular closure or an unrepaired capsule. Outcomes assessed were incidence of revision hip arthroscopy, incidence of subsequent conversion to total hip arthroplasty (THA), and improvement from baseline in modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) activities of daily living (ADL), HOS sports specific (SS) subscale, Copenhagen Hip and Groin Outcome Score (HAGOS) ADL, and HAGOS SS subscale. A pooled weighted mean difference (WMD) was used to compare changes in mHHS. A pooled standardized mean difference (SMD) was used to compare changes in the ADL and SS outcomes. A pooled risk ratio (RR) was used to compare the probability of revision hip arthroscopy and conversion to THA based on capsular management. For pooled outcomes where heterogeneity was regarded as potentially unimportant, a fixed-effects model was implemented. For pooled outcomes with considerable heterogeneity, a random-effects model was implemented. Results Of the 1896 records identified in our search, 11 studies (1897 patients) were included. A significantly higher improvement in mHHS (WMD, -3.72; 95% CI, -4.95 to -2.50; P < .00001) and ADL outcomes (SMD, -0.30; 95% CI, -0.54 to -0.07; P = .01) were seen after complete capsular closure. There was a significantly lower probability of subsequent revision hip arthroscopy (RR, 1.67; 95% CI, 1.14 to 2.45; P = .008) and conversion to THA (RR, 2.01; 95% CI, 1.06 to 3.79; P = .03) after complete capsular repair. There was no difference in SS outcomes (SMD, -0.02; 95% CI, -0.16 to 0.13; P = .81) between the 2 groups. Conclusion This meta-analysis demonstrated that routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules.
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Affiliation(s)
- Suhas P. Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Luke B. Kasson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua J. Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S. Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A. Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Garrett R. Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Mario Hevesi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Carbone AD, Prabhavalkar O, Chishti Z, Curley AJ, Parsa A, Domb BG. Hip Capsular Repair Results in Improved Patient-Reported Outcomes and Survivorship: A Systematic Review of the Literature. Arthroscopy 2023; 39:488-497. [PMID: 36395962 DOI: 10.1016/j.arthro.2022.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether routine capsular closure following hip arthroscopy for femoroacetabular impingement (FAI) in patients without dysplasia results in improved patient-reported outcomes (PROs) and increased survivorship rates. METHODS A literature search of the PubMed, Embase, and Cochrane Library databases was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting PROs following arthroscopic hip labral repair for FAI. A quality assessment was performed using the Methodological Index for Non-randomized Studies grading system. Inclusion criteria consisted of comparative clinical studies investigating routine capsular closure with nonclosure in patients undergoing hip arthroscopy for the treatment of FAI and labral tears. Exclusion criteria included non-English language, minimum follow-up of less than 2 years after surgery, technique articles, case reports, noncomparative case series of fewer than 10 patients, failure to report surgical technique, absence of postoperative PROs, or partial repair. Data collection included study characteristics, demographics, indications, radiographic metrics, perioperative findings, surgical technique, baseline and most recent PROs, and subsequent surgeries. RESULTS A total of 531 articles were reviewed, of which 3 were included with 249 hips that underwent capsular repair and 157 hips that underwent capsulotomy with no repair. There were 2 Level III studies and 1 Level II study, with an average The Methodological Index for Non-randomized Studies score of 16.7. All studies cited FAI and labral tear as an indication for surgery. All studies demonstrated improved PROs from baseline to most recent follow-up. Postoperatively, the repair group reported modified Harris Hip Score values ranging from 80.8 to 87, whereas the nonrepair group reported scores ranging from 76 to 81.7. In addition, the repair group reported postoperative Hip Outcome Score - Sports-Specific Subscale values ranging from 68.1 to 9, whereas the nonrepair group reported scores ranging from 65.3 to 76.1. The studies also reported minimal clinically important difference for modified Harris Hip Score, with the repair group reporting percentages ranging from 71 to 100 and the nonrepair group reporting percentages ranging from 52 to 95.6. All 3 studies also observed a lower rate of hip survivorship in the nonrepair group, ranging from 94.6 to 100 in the repair group and 90.8 to 100 in the nonrepair group. There were no significant differences in the rate of revision arthroscopy between groups. CONCLUSIONS Patients without dysplasia who undergo capsular repair have greater improvements in PROs and greater survivorship rates at early- and mid-term follow-up than patients who do not undergo capsular repair. LEVEL OF EVIDENCE III, systematic review of level II and III studies.
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Affiliation(s)
- Andrew D Carbone
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - Zayd Chishti
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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Cong S, Pan J, Huang G, Xie D, Zeng C. The Modified Longitudinal Capsulotomy by Outside-In Approach in Hip Arthroscopy for Femoroplasty and Acetabular Labrum Repair-A Cohort Study. J Clin Med 2022; 11:jcm11154548. [PMID: 35956163 PMCID: PMC9369754 DOI: 10.3390/jcm11154548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Hip arthroscopy is difficult to perform due to the limited arthroscopic view. To solve this problem, the capsulotomy is an important technique. However, the existing capsulotomy approaches were not perfect in the surgical practice. Thus, this study aimed to propose a modified longitudinal capsulotomy by outside-in approach and demonstrate its feasibility and efficacy in arthroscopic femoroplasty and acetabular labrum repair. A retrospective cohort study was performed and twenty-two postoperative patients who underwent hip arthroscopy in our hospital from January 2019 to December 2021 were involved in this study. The patients (14 females and 8 males) had a mean age of 38.26 ± 12.82 years old. All patients were diagnosed cam deformity and labrum tear in the operation and underwent arthroscopic femoroplasty and labrum repair by the modified longitudinal capsulotomy. The mean follow-up time was 10.4 months with a range of 6−12 months. There were no major complications, including infection, neurapraxias, hip instability or revision in any patients. The average mHHS were 74.4 ± 15.2, 78.2 ± 13.7 and 85.7 ± 14.5 in 3 months, 6 months and 12 months after surgery, respectively, which were all better than that before surgery (44.9 ± 8.6) (p < 0.05). The average VAS were 2.8 ± 1.2, 1.5 ± 0.6 and 1.2 ± 0.7 in 3 months, 6 months and 12 months after surgery, respectively, which were all lower than that before surgery (5.5 ± 2.0) (p < 0.05). The modified longitudinal capsulotomy by outside-in approach is proved to be a safe and feasible method for hip arthroscopy considering to the feasibility, efficacy and security. The arthroscopic femoroplasty and labrum repair can be performed conveniently by this approach and the patient reported outcomes after surgery were better that before surgery in short-term follow-up. This new method is promising and suggested to be widely used clinically.
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Owens JS, Jimenez AE, Shapira J, Saks BR, Glein RM, Maldonado DR, Ankem HK, Sabetian PW, Lall AC, Domb BG. Capsular Repair May Improve Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review of Comparative Outcome Studies. Arthroscopy 2021; 37:2975-2990. [PMID: 33887416 DOI: 10.1016/j.arthro.2021.03.063] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To review the existing literature in order to determine the effect of hip capsule repair on outcomes after hip arthroscopy for femoroacetabular impingement syndrome. METHODS This study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find articles by using PubMed and Embase. Included studies were Level I through III studies that focused on patient outcomes as a function of hip capsular treatments: capsulotomy repair, partial repair, plication, and unrepaired capsulotomies. The Methodological Index for Non-randomized Studies was used for quality assessment of clinical outcome studies. After applying inclusion and exclusion criteria, a total of 16 comparative outcome studies evaluating 2,996 hips were included; they evaluated the following capsular management techniques: complete repair (n = 1,112, 37.1%), partial repair (n = 32, 1.1%), plication (n = 223, 7.4%), and unrepaired capsulotomy (n = 1629, 54.4%). RESULTS Of the 16 studies, 13 included patient-reported outcome scores (PROs), 3 included imaging outcomes data, and 2 reported on reoperation. Of the studies, 10 directly compared patient-reported outcomes between a capsular repair group and an unrepaired group. Of the 10 studies that directly compared PROs between a group with unrepaired capsulotomy and a group with capsular repair, 8 studies demonstrated statistically significantly better PROs in the repaired group compared to the unrepaired group, and 2 studies found no difference between the groups. Reoperation rates demonstrated mixed results between groups, and no difference was found in regard to imaging outcomes. CONCLUSIONS Midterm outcome studies suggest that capsular repair is safe and effective in patients without arthritis who are undergoing hip arthroscopy, and it may result in superior PROs compared with those found after unrepaired capsulotomy. Studies consistently demonstrate similar or superior outcomes in cohorts after capsular repair compared to unrepaired capsulotomy, and no studies reported superior results in unrepaired capsulotomy patients. LEVEL OF EVIDENCE Level IV, systematic review of Level I through Level III studies.
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Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Chicago, Illinois, U.S.A.; Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Chicago, Illinois, U.S.A.; Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A..
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6
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Yin QF, Wang L, Liang T, Zhao H, Wang XS. Longitudinal Capsulotomy in Hip Arthroscopy: A Safe and Feasible Procedure for Cam-Type Femoracetabular Impingement. Orthop Surg 2021; 13:1793-1801. [PMID: 34351688 PMCID: PMC8523749 DOI: 10.1111/os.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the surgical security, feasibility, and clinical efficacy of the longitudinal outside‐in capsulotomy in hip arthroscopic treatment for cam‐type femoracetabular impingement (FAI). Methods We retrospectively reviewed patients with cam‐type FAI who underwent hip arthroscopy in our institute from January 2018 to June 2019. All hip arthroscopic procedures were performed by one experienced surgeon in the same manner, except the fashions of capsulotomy. Fifty six patients with mean age of 39.1 and mean body mass index (BMI) of 24.5 were categorized into two groups according to the fashions of capsulotomy. Twenty six cases with longitudinal outside‐in capsulotomy were categorized into Group L, and 30 cases with transversal interportal capsulotomy were categorized into Group T as the control group. The demographic parameters were retrieved from medical documents and compared between the two groups. Surgical outcome including overall surgical time, traction time, complications, visual analogue score (VAS), and intraoperative radiation exposure were compared to investigate the security and feasibility. Radiographic assessment, and functional outcome were compared between the two groups to determine the clinical efficacy of the longitudinal capsulotomy. Results There was no significant difference in the demography and duration of follow‐up between the two groups. The overall surgical time demonstrated no significant difference between Group L and Group T (130.8 ± 16.6 min and 134.0 ± 14.7 min, P = 0.490). Significantly decreased traction time was found in Group L (43.2 ± 8.4 min and 62.2 ± 8.6 min, P < 0.001) compared to Group T. The Median of the fluoroscopic shot was 1 and 3 (P < 0.001). No major complications and reoperation were reported in both groups. The case of intraoperative iatrogenic injure was 0 (0%) and 6 (20%) in Group L and Group T respectively (P = 0.035), and the case of postoperative neurapraxia was 0 (0%) and 8 (26.6%) in Group L and Group T respectively (P = 0.017). The Median of postoperative VAS was 2 and 3 in Group L Group T (P = 0.002). The postoperative α angle was 42.3° ± 3.4° and 44.4° ± 3.5° in group L and group T respectively (P = 0.001). The postoperative iHOT‐12 score at final follow‐up was 79.3 ± 6.7 and 77.0 ± 7.9 respectively (P = 0.141). Conclusion Longitudinal outside‐in capsulotomy with less radiation exposure, reduced traction time, and reduced complications could be a safe and feasible procedure in arthroscopic treatment for cam FAI. Its clinical efficacy was not worse compared with traditional interportal capsulotomy in short‐term follow‐up.
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Affiliation(s)
- Qing-Feng Yin
- Department of Orthopedics, The Second Hospital of Shandong University, Jinan, China
| | - Long Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Tao Liang
- Department of Orthopedics, The First People's Hospital of Ningyang county, Taian, China
| | - Heng Zhao
- Department of Orthopedics, The Second Hospital of Shandong University, Jinan, China
| | - Xue-Song Wang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
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Kunze KN, Vadhera A, Devinney A, Nwachukwu BU, Kelly BT, Nho SJ, Chahla J. Effect of Capsular Closure After Hip Arthroscopy for Femoroacetabular Impingement Syndrome on Achieving Clinically Meaningful Outcomes: A Meta-analysis of Prospective and Comparative Studies. Orthop J Sports Med 2021; 9:23259671211017467. [PMID: 34262982 PMCID: PMC8243105 DOI: 10.1177/23259671211017467] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Recent literature has demonstrated conflicting evidence as to whether
capsular closure after hip arthroscopy for femoroacetabular impingement
syndrome (FAIS) results in superior outcomes compared with capsulotomy
without repair. Additionally, these studies have not explored the effect of
capsular management on clinically significant outcome improvement. Purpose: To perform a meta-analysis of prospective and comparative studies to
determine whether capsular management influences the rate of clinically
significant outcome improvement after hip arthroscopy for FAIS. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, OVID/Medline, EMBASE, and Cochrane databases were queried in
September 2020 for studies with evidence levels 1 to 3 that directly
compared capsular management cohorts and reported rates of achieving the
minimal clinically important difference (MCID) at a minimum follow-up of 2
years. Studies of level 4 evidence, those not describing or directly
comparing capsular management techniques as well as those not reporting the
MCID were excluded. Methodological quality was assessed using the
methodological index for nonrandomized studies tool. Mantel-Haenszel
fixed-effects models were constructed to quantitatively evaluate the
association between capsular management and achievement of the MCID by
generating effect estimates in the form of relative risk (RR) with 95%
CIs. Results: A total of 6 studies with 1611 patients were included. The overall pooled
rate of MCID achievement for the modified Harris Hip Score (mHHS), Hip
Outcome Score Activities of Daily Living (HOS-ADL), and HOS Sports Subscale
(HOS-SS) were 84.4%, 80.3%, and 82.5%, respectively, at a mean follow-up of
40.8 months (range, 24-87.6 months). Capsular closure was associated with a
significantly higher rate of MCID achievement for the mHHS (RR, 1.06; 95%
CI, 1.01-1.10; P = .001) and trended toward statistical
significance for the HOS-ADL (RR, 1.11; 95% CI, 1.0-1.24; P
= .055) and the HOS-SS (RR, 1.09; 95% CI, 0.99-1.21; P =
.094). Conclusion: Although capsular closure appeared to result in higher rates of clinically
significant outcome improvement in hip function, there was no definitively
increased likelihood of achieving clinically significant improvement in
relevant hip outcome scores with capsular closure.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Amar Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Annie Devinney
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Di Benedetto P, Zangari A, Giardini P, Mancuso F, Castriotta L, Causero A. Capsular closure after hip arthroscopy: our experience. Acta Biomed 2020; 91:92-97. [PMID: 32555082 PMCID: PMC7944825 DOI: 10.23750/abm.v91i4-s.9664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK In the last decade, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral- acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been hugely developed, opening a heated debate. The Literature is still torn about the need for a capsular suture, but more recent studies are more oriented in its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function of primary stability, and its closure is therefore necessary to restore the native anatomy and physiology. Nevertheless, capsular management remains a controversial topic. This is a retrospective study with the aim of assessing the influence of capsular suture on the patient's functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated. HYPOTHESIS Our hypothesis is that an adequate capsular suture positively influences the patient's functional outcome. METHODS AND RESULTS 50 patients treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two-years (2017-2018); collected data have been analysed and compared with a retrospective model. Patients have been divided into two equivalent groups, 25 treated with capsular suture, 25 without performing the suture. Patient's post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS) and the Hip Outcome Score-Sport Scale (HOS-SS). The functional outcome in patients where capsular sutures were performed was better than in non-sutured patients, in all three analysed scales. CONCLUSIONS Capsular suture with a single side-to-side stitch at the end of the procedure can positively influence the patient's functional outcome.
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Affiliation(s)
| | - Andrea Zangari
- Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy.
| | - Piero Giardini
- Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy.
| | - Francesco Mancuso
- Orthopaedics and Traumatology Unit, ASUFC - Tolmezzo General Hospital, Tolmezzo (UD), Italy.
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, Academic Hospital of Udine, Udine, Italy.
| | - Araldo Causero
- Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy; 2DAME - University of Udine.
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