Summary

Gross hip instability following hip arthroscopy is a rare but catastrophic complication. Capsular management (e.g. closure vs. non-closure) has been raised as a potential etiological factor. This review reports the most commonly used capsulotomy and capsular management strategies reported in the hip arthroscopy literature.

Abstract

Background

Hip arthroscopy is increasingly used to address hip joint pathology. Reports of iatrogenic instability following hip arthroscopy have surfaced, leading to the evaluation of various hip capsulotomy management strategies. The ideal strategy for capsular management (i.e. no repair, partial repair, or complete repair) at the end of arthroscopic procedures remains unclear.

Methods

The databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, indications, surgical technique, rehabilitation strategies, and complication rates were obtained. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies (MINORS) Criteria.

Results

Eighty-two studies of primarily level IV evidence (80%) and of fair quality involving 4504 patients with a mean age of 35 years old (range 1.2-82 years) were included. Fifty percent of patients were male. Mean follow-up was 24.9 months (range 5 days-13 years). Of 68 studies reporting capsulotomy technique (only 7% of all eligible studies), 55% performed an interportal capsulotomy while 24% performed a T-Capsulotomy. Of 36 studies reporting capsular management strategy post-arthroscopy, 22% did not repair the capsulotomy, 6% routinely performed a partial repair, and 50% performed routine complete repair. Of three studies (206 patients) directly comparing capsular management strategies, only one study found a statically significant difference between complete and partial repair on the Hip Outcome Score – Sport Specific Subscale, though this difference was less than the minimal clinically important difference (83.6 vs. 87.3). The total rate of reported post-operative dislocation, instability, or instability was 0.3% (5 patients).

Conclusions

Technical details regarding capsulotomy and capsular management post-hip arthroscopy are not consistently reported in the literature. Capsulotomies are most often performed using an interportal technique, and more recent studies report routine closure. Overall, post-operative instability is rare and there is no consistent trend for capsular management strategy. Given current evidence, there is little basis on which to establish the relationship between surgical technique and post-operative instability or long-term consequences (e.g. kinematic changes). Thus, while capsular closure/plication may be suitable for specific populations (i.e., dysplasia or laxity), evidence-based indications for capsular repair remain unclear at this time.