Short-Term Outcomes Following Periportal Versus Interportal Capsulotomy With Closure in Nondysplastic Women Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Abstract

Background:

The periportal capsulotomy for hip arthroscopy minimizes iliofemoral ligament violation compared to T- and interportal capsulotomies, theoretically reducing the risk of postoperative instability secondary to capsular insufficiency.

Purpose/Hypothesis:

The purpose of this study was to compare patient-reported outcomes (PROs) and revision rates between women without dysplasia who underwent an interportal versus a periportal capsulotomy approach for the treatment of femoroacetabular impingement syndrome (FAIS). It was hypothesized that women without dysplasia would achieve better outcomes and a lower revision rate through a periportal approach.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Consecutive female patients with normal acetabular coverage (lateral center-edge angle >25° and ≤40°) who underwent primary hip arthroscopy with complete capsular closure by a single surgeon for the treatment of FAIS between February 2020 and November 2022 were prospectively added to a database and their records retrospectively reviewed. An interportal capsulotomy was utilized in all patients before June 2021, and periportal capsulotomies were utilized thereafter. Femoral osteoplasty was performed in all patients, and a labral repair was performed when indicated. PROs were collected preoperatively and at a 2-year minimum follow-up, including pain scores at rest and activities of daily living (range, 0-10), single assessment numeric evaluation (SANE) scores, and Patient-Reported Outcomes Measurement Information System–Physical Function (PROMIS-PF) scores. Minimal clinically important differences (MCIDs) were calculated using the distribution method. PROs, MCID achievement rates, and revision rates were compared between capsulotomy types.

Results:

In total, 105 women without dysplasia (41 interportal, 64 periportal) were included. There were no differences in baseline demographic or radiographic characteristics between groups. Follow-up time was longer in the interportal group compared to the periportal group (3.52 ± 1.04 years vs 2.67 ± 0.62 years; P < .001). The periportal group had greater improvements in SANE (30.0 ± 20.2 vs 17.3 ± 21.3; P = .004) and PROMIS-PF (13.7 ± 9.61 vs 7.62 ± 9.04; P = .003) scores compared to the interportal group. The periportal group also had higher rates of MCID achievement with SANE (87% vs 69%; P = .037) and PROMIS-PF (90% vs 68%; P = .018) scores compared to the interportal group. Overall, the 2-year revision rate was 12% for the interportal group and 4.7% for the periportal group (P = .26). All patients who required additional surgery underwent revision hip arthroscopy for instability.

Conclusion:

In female patients without hip dysplasia who underwent primary hip arthroscopy for the treatment of FAIS, periportal capsulotomies with complete capsular closure provided higher rates of clinically meaningful improvements in subjective outcomes of SANE and PROMIS-PF scores compared to an interportal capsulotomy with complete closure at 2 years postoperatively.