Longitudinal Capsulotomy in Hip Arthroscopy: A Safe and Feasible Procedure for Cam‐Type Femoracetabular Impingement

Abstract

Objective To evaluate the surgical security, feasibility, and clinical efficacy of the longitudinal outside‐in capsulotomy in hip arthroscopic treatment for cam‐type femoracetabular impingement (FAI). Methods We retrospectively reviewed patients with cam‐type FAI who underwent hip arthroscopy in our institute from January 2018 to June 2019. All hip arthroscopic procedures were performed by one experienced surgeon in the same manner, except the fashions of capsulotomy. Fifty six patients with mean age of 39.1 and mean body mass index (BMI) of 24.5 were categorized into two groups according to the fashions of capsulotomy. Twenty six cases with longitudinal outside‐in capsulotomy were categorized into Group L, and 30 cases with transversal interportal capsulotomy were categorized into Group T as the control group. The demographic parameters were retrieved from medical documents and compared between the two groups. Surgical outcome including overall surgical time, traction time, complications, visual analogue score (VAS), and intraoperative radiation exposure were compared to investigate the security and feasibility. Radiographic assessment, and functional outcome were compared between the two groups to determine the clinical efficacy of the longitudinal capsulotomy. Results There was no significant difference in the demography and duration of follow‐up between the two groups. The overall surgical time demonstrated no significant difference between Group L and Group T (130.8 ± 16.6 min and 134.0 ± 14.7 min, P = 0.490). Significantly decreased traction time was found in Group L (43.2 ± 8.4 min and 62.2 ± 8.6 min, P < 0.001) compared to Group T. The Median of the fluoroscopic shot was 1 and 3 (P < 0.001). No major complications and reoperation were reported in both groups. The case of intraoperative iatrogenic injure was 0 (0%) and 6 (20%) in Group L and Group T respectively (P = 0.035), and the case of postoperative neurapraxia was 0 (0%) and 8 (26.6%) in Group L and Group T respectively (P = 0.017). The Median of postoperative VAS was 2 and 3 in Group L Group T (P = 0.002). The postoperative α angle was 42.3° ± 3.4° and 44.4° ± 3.5° in group L and group T respectively (P = 0.001). The postoperative iHOT‐12 score at final follow‐up was 79.3 ± 6.7 and 77.0 ± 7.9 respectively (P = 0.141). Conclusion Longitudinal outside‐in capsulotomy with less radiation exposure, reduced traction time, and reduced complications could be a safe and feasible procedure in arthroscopic treatment for cam FAI. Its clinical efficacy was not worse compared with traditional interportal capsulotomy in short‐term follow‐up.

The Modified Longitudinal Capsulotomy by Outside-In Approach in Hip Arthroscopy for Femoroplasty and Acetabular Labrum Repair—A Cohort Study

“…The postoperative mHHS and VAS were both better than before surgery, and patient reported outcomes became better gradually with the time after surgery with no infection, neurapraxias, hip instability or revision appeared in all patients. In spite of the short follow-up time and no control group in this study, the modified longitudinal capsulotomy by outside-in approach was indicated to be a promising method in hip arthroscopy referencing the similar studies previously [ 6 , 7 ]. Moreover, the radiation exposure of surgeons and patients can be avoided because this method did not need intraoperative fluoroscopy.…”

“…This approach took the place of puncture approach by seldinger technique in traditional hip arthroscopy. In recent years, studies of hip arthroscopy using the outside-in approach has increased gradually [ 4 , 7 , 8 , 9 , 10 , 11 ]. This approach can make the operation process quite easy for surgeons performing hip arthroscopy, and all surgical procedures can be achieved without special surgical instruments for hip arthroscopy, or the intraoperative fluoroscopy.…”

“…For the different kinds of capsulotomy in previous studies, a systematic review showed 55% performed an interportal capsulotomy while 24% performed a T-capsulotomy [ 6 ]. Recently, some surgeons performed the longitudinal capsulotomy and obtained a satisfactory arthroscopic view for the consequent surgical procedures [ 7 , 11 ]. Based on this capsulotomy, we modified the technique by adding a small incision vertical to the longitudinal capsulotomy proximally.…”

“…Recently, some surgeons proposed a new approach for hip arthroscopy, the so-called outside-in approach [ 4 , 7 , 8 , 9 , 10 , 11 ]. By this approach, an extracapsular space anterior to the hip joint is established first.…”

“…Then, surgeons perform the capsulotomy in this extracapsular space and enter the peripheral compartment of hip joint directly without hip traction and fluoroscopy. In the previous studies, many different kinds of capsulotomy were reported, including interportal capsulotomy and T-capsulotomy, as well as longitudinal capsulotomy [ 6 , 7 ].…”