Mygind-Klavsen Bjarne, Lund Bent, Grønbech Nielsen Torsten, Kraemer Otto, Hölmich Per, Maagaard Niels, Winge Søren, Lind Martin
Department of Orthopedics, Section of Sports Traumatology, Aarhus University Hospital, Aarhus N 8200, Denmark.
Department of Orthopedics, Horsens Regional Hospital, Horsens 8700, Denmark.
J Hip Preserv Surg. 2020 Oct 7;7(3):474-482. doi: 10.1093/jhps/hnaa033. eCollection 2020 Aug.
Capsular closure in femoroacetabular impingement syndrome (FAIS) patients during hip arthroscopy procedures is debated. The Danish Hip Arthroscopy Registry (DHAR) contains data to perform matched-cohort analyses. The purpose of this study is to evaluate 1-year subjective outcome data from DHAR after hip arthroscopy for FAIS with capsular closure and compare these outcome data with a matched-cohort study group. The primary hypothesis was that there would be no difference in Copenhagen Hip and Groin Outcome Score (HAGOS) subjective outcome between patients with and without capsular closure. This is a retrospective cohort study (level of evidence, 3). FAIS patients eligible for hip arthroscopy between January 2012 and December 2017, and where the interportal capsulotomy was closed, were identified and matched with patients without capsular closure. Matching criteria were gender (1:1), age (±5 years), degree of cartilage injury: ICRS and modified Becks grade (±1 grade) and radiological parameters: lateral center edge angle and alpha angle (±10°). A comparison between cohorts regarding differences in patient outcome scores, HAGOS, Hip Sports Activity Scale (HSAS), EuroQol-5 Domain (EQ-5D) and numeric rating scale (NRS) pain at 1-year follow-up were performed. Wilcoxon rank-sum test was used to compare differences between preoperative and postoperative subjective outcome scores, level of statistical significance was 0.05. A total of 189 patients were included in the capsular closure group and matched with 189 control patients. The mean age in years (±standard deviation) was 39.4 (±11.8) and 39.3 (±11.2), respectively, 55% females. Both groups improved significantly at 1-year follow-up. Significant improvements in the capsular closure group were found in HSAS, EQ-5D, NRS pain (rest and walk) and most HAGOS subscales compared with the non-closure group. All patients underwent labral repair in combination with both femoral osteochondroplasty and acetabuloplasty. The revision rate reported after 2 years was 6.8% in the non-closure group and 3.5% in the closure group. One patient in each cohort received a total hip replacement after 2 years. Capsular closure during arthroscopic FAIS treatment resulted in better subjective outcomes and less pain during rest and walking compared with matched controls. Both groups demonstrated improved outcome at 1-year follow-up. Furthermore, capsular closure might result in a lower risk of a revision hip arthroscopy.
髋关节镜手术中股骨髋臼撞击综合征（FAIS）患者的关节囊闭合存在争议。丹麦髋关节镜注册中心（DHAR）的数据可用于进行匹配队列分析。本研究的目的是评估髋关节镜治疗FAIS并进行关节囊闭合后1年的主观结局数据，并将这些结局数据与匹配队列研究组进行比较。主要假设是，关节囊闭合组和未闭合组患者的哥本哈根髋关节与腹股沟结局评分（HAGOS）主观结局无差异。这是一项回顾性队列研究（证据级别为3）。确定了2012年1月至2017年12月期间符合髋关节镜手术条件且关节间囊切开术已闭合的FAIS患者，并与未进行关节囊闭合的患者进行匹配。匹配标准为性别（1:1）、年龄（±5岁）、软骨损伤程度：国际软骨修复协会（ICRS）和改良贝克分级（±1级）以及放射学参数：外侧中心边缘角和α角（±10°）。对队列之间在1年随访时患者结局评分、HAGOS、髋关节运动活动量表（HSAS）、欧洲五维健康量表（EQ-5D）和数字评分量表（NRS）疼痛方面的差异进行了比较。采用Wilcoxon秩和检验比较术前和术后主观结局评分的差异，统计学显著性水平为0.05。关节囊闭合组共纳入189例患者，并与189例对照患者进行匹配。平均年龄（±标准差）分别为39.4（±11.8）岁和39.3（±11.2）岁，女性占55%。两组在1年随访时均有显著改善。与未闭合组相比，关节囊闭合组在HSAS、EQ-5D、NRS疼痛（休息和行走时）以及大多数HAGOS子量表方面有显著改善。所有患者均接受了盂唇修复术，并同时进行了股骨骨软骨成形术和髋臼成形术。2年后报告的未闭合组翻修率为6.8%，闭合组为3.5%。每个队列中有1例患者在2年后接受了全髋关节置换术。与匹配的对照组相比，关节镜下FAIS治疗期间进行关节囊闭合可带来更好的主观结局，休息和行走时疼痛更少。两组在1年随访时结局均有改善。此外，关节囊闭合可能会降低髋关节镜翻修的风险。
