Influence of non-sutured hip joint capsule on medium and long-term clinical efficacy of arthroscopic treatment of patients with femoral acetabular impingement syndrome

Linyi SHEN; Qianru LI; Hongyun LI; Jiwu CHEN

ABSTRACT

Objective:

To investigate the medium to long-term clinical outcomes of arthroscopic treatment for femoral acetabular impingement (FAI) without capsular closure.

Methods:

A retrospective analysis was performed on 62 patients (63 hips) with FAI who underwent hip arthroscopy in Huashan Hospital Affiliated to Fudan University from February 2015 to June 2018. There were 29 male patients (30 hips) and 33 female patients (33 hips) with an average age of 43.08±8.88 years. Thirty-two surgeries were performed on the left hip, thirty-one on the right, and one patient underwent bilateral surgery. All 62 patients underwent arthroscopic surgery without capsular closure. The preoperative and postoperative final follow-up assessments included the hip outcome score-activity of daily living scale (HOS-ADL), hip outcome score-sport specific subscale (HOS-SSS), Harris hip score (HHS), University of California at Los Angeles (UCLA) score, Non arthritic hip score (NAHS), visual analogue scale (VAS) for pain, and observation of complications.

Results:

All the patients completed the operation successfully, and the surgical incisions healed well. No complications such as wound infection, local incisional hematoma, local skin redness, lateral femoral cutaneous nerve injury, or perineal crush injury occurred in any one case. All 62 patients were followed up for 71 (60, 100) months. The VAS before surgery was 6 (0, 10) points and 1 (0, 6) point at the last follow-up, with statistical significance ( Z=-6.81, P<0.001). Preoperative scores were as follows HOS-ADL 78.03±5.30; HOS-SSS 59.88±12.51; HHS 78.98±7.50; UCLA 2.00 (2.00, 5.00); NAHS 83.75 (81.25, 97.50). Postoperative final follow-up scores were as follows HOS-ADL 94.77±4.79; HOS-SSS 79.89±9.07; HHS 90.75±5.59; UCLA 4.00 (3.00, 6.00); NAHS 92.50 (88.75, 98.75). At the final follow-up, HOS-ADL ( t=19.10, P<0.001), HOS-SSS ( t=12.29, P<0.001), HHS ( t=11.21, P<0.001), UCLA ( Z=-6.92, P<0.001), and NAHS ( Z=-6.52, P<0.001) showed significant improvement. Until the end of the follow-up period, no patients underwent revision surgery or hip arthroplasty on the treated hip.

Conclusion:

For patients with FAI without developmental dysplasia of the hip and generalized ligament laxity, arthroscopic treatment without capsular closure yields favorable medium to long-term clinical outcomes.