Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

Dual Cannula Combined With Modified Shoelace Continuous Capsular Closure Technique in Hip Arthroscopic Surgery

The Technical Note aims to present an arthroscopic capsular closure technique at the end of the hip arthroscopy. The technology employs a dual-channel approach and modified shoelace suture technique to continuously suture the hip capsule. Recent studies have indicated that routine intraoperative repair of the articular capsule at the end of the hip arthroscopy is advocated. However, the majority of the hip capsular closure techniques are relatively complex, time-consuming, and bring many complications, which has hindered their widespread use in clinical practice. Herein, we provide an arthroscopic capsular closure technique using the modified shoelace continuous suture in combination with a dual cannula for correcting hip instability during hip arthroscopic surgery of femoroacetabular impingement.

Minimum 10-year Survivorship and Clinical Outcomes Following Primary Hip Arthroscopy with Acetabular Microfracture

PURPOSE

To report minimum 10-year follow-up survivorship, defined as non-conversion to total hip arthroplasty (THA), and patient-reported outcome scores (PROS) after primary hip arthroscopy with acetabular microfracture in the setting of femoroacetabular impingement syndrome (FAIS) and acetabular chondral lesions, respectively.

METHODS

Data were prospectively collected and retrospectively analyzed on all patients who underwent a primary hip arthroscopy and received an acetabular microfracture between June 2009 and January 2011. Patients with a minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain were included. If available, the minimum 10-year follow-up for the Hip Outcome Score-Sport-Specific Subscale was reported. The demographics, intraoperative findings, surgical procedures, PROS, rate of achieving the minimal clinical important difference (MCID), and secondary surgeries were analyzed and reported.

RESULTS

Twenty-two hips (20 patients) were included in the study, and the mean follow-up time was 124.5 ± 2.2 months. There were 17 hips (77.3%) from males and 5 hips (22.7%) from females. The average patient age at the time of surgery was 42.3 years ± 9.6. All patients on average experienced statistically significant improvement (P < .05) between preoperative and minimum 10-year follow-up scores for all PROs. In total, 77.3% of the patients did not require conversion to THA. Additionally, 83.3% of the patients achieved the MCID for the mHHS, NAHS, and VAS for pain.

CONCLUSION

At a minimum 10-year follow-up, survivorship of 77.3% was reported for patients who underwent primary hip arthroscopy with acetabular microfracture for the treatment of FAIS and focal/full-thickness acetabular cartilage lesions. Further, in the patients that did not require THA conversion, significant improvement in all PROS was demonstrated.

LEVEL OF EVIDENCE

IV, case-series study.