What did the study look at?
Hip arthroscopy (keyhole hip surgery) is used for non-arthritic problems such as hip impingement (femoroacetabular impingement) and labral tears. To reach the inside of the joint, the hip capsule is cut (capsulotomy), which also divides the iliofemoral ligament, the strongest ligament of the capsule. The authors note that, although the biomechanical importance of the capsule is well described, whether it should routinely be closed at the end of surgery remains controversial.
The aim was to compare pooled outcomes of patient groups whose capsule was completely closed with groups whose capsule was left unrepaired.
How was it done?
This is a systematic review and meta-analysis: no new patients were treated; data from published studies were combined statistically. Seven databases were searched in February 2022 for studies directly comparing complete capsular closure with an unrepaired capsule after hip arthroscopy. The authors report level of evidence 3.
Outcomes compared were the rate of revision hip arthroscopy, the rate of later conversion to total hip replacement, and improvement from baseline in several hip scores (the modified Harris Hip Score, mHHS, and activities of daily living and sport-specific subscales).
What did it find?
- Of 1896 records found, 11 studies (1897 patients) were included, three of them randomised controlled trials. There were 975 patients in the unrepaired group and 922 in the complete closure group.
- Improvement in mHHS was significantly greater after complete closure (weighted mean difference −3.72; 95% CI −4.95 to −2.50; P < .00001).
- Activities of daily living scores also significantly favoured complete closure (standardised mean difference −0.30; 95% CI −0.54 to −0.07; P = .01).
- The probability of revision arthroscopy (risk ratio 1.67; 95% CI 1.14 to 2.45; P = .008) and conversion to total hip replacement (risk ratio 2.01; 95% CI 1.06 to 3.79; P = .03) was significantly lower after complete closure.
- There was no difference between groups in sport-specific scores (standardised mean difference −0.02; P = .81).
The authors' conclusion
The authors conclude that this meta-analysis showed routine complete capsular closure after hip arthroscopy to be associated with superior clinical outcomes compared with unrepaired capsules.
Limitations
- A meta-analysis is limited by the design of the studies it includes.
- Most studies did not report outcomes as change from baseline, so these values were imputed using methods from the Cochrane handbook, which gives an approximation of real values.
- Most individual studies did not show a significant difference, while the pooled result did; the authors say this suggests underpowered studies and that an adequately powered randomised trial is needed.
- Few studies examined T-shaped capsulotomies, rehabilitation protocols varied, and follow-up was relatively short.
Reference
Dasari SP, Kasson LB, Condon JJ, Mameri ES, Kerzner B, Khan ZA, Jackson GR, Gürsoy S, Sivasundaram L, Hevesi M, Chahla J. (2023). Systematic Review and Meta-analysis of Studies Comparing Complete Capsular Closure Against Unrepaired Hip Capsules During Hip Arthroscopy. Orthopaedic Journal of Sports Medicine, 11(10), 23259671231197435. Licence: CC BY-NC-ND 4.0.
DOI: 10.1177/23259671231197435
Free full text: PMC10585995
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
