title: Arthroscopic Capsular Repair for Symptomatic Hip Instability After Previous Hip Arthroscopic Surgery.
abstract: BACKGROUND
  Management of the hip capsule has been a topic of recent debate in hip arthroscopic surgery. Postoperative instability after hip arthroscopic surgery has been reported and can lead to poor outcomes.
  
  
  OBJECTIVE
  To determine the outcome of patients diagnosed with symptomatic instability after hip arthroscopic surgery at a minimum of 12 months and 24 months after revision surgery for capsular repair.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  In a cohort of approximately 1100 patients who underwent hip arthroscopic surgery, 33 patients (33 hips) developed symptomatic instability requiring a revision surgery. Two patients suffered anterior dislocations following their initial surgery. Radiographs were reviewed to evaluate for acetabular dysplasia. Three patients were lost to follow-up and 10 patients were excluded as they were <1 year out from the revision surgery. A total of 20 patients (18 female, 2 male) completed a preoperative and postoperative modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) at a minimum of 12 months. Eleven of these patients had a minimum follow-up of 24 months. All patients filled out a Likert scale of perceived improvement in physical ability at final follow-up.
  
  
  RESULTS
  The mean age of the patients was 29.7 years (range, 15.2-55.5 years). The mean lateral center-edge angle was 25°, and the mean acetabular index was 7° before revision. All patients underwent interportal capsulotomy during the index arthroscopic procedure. After their index arthroscopic procedures, patients had minimal improvement at a mean of 19.1 months postoperatively on the mHHS (from 57.1 to 57.6; P = .423), HOS-Activities of Daily Living (ADL) (from 62.7 to 66.4; P = .260), and HOS-Sports (from 42.0 to 39.1; P = .800). For the patients with a minimum 1-year follow-up after revision surgery (n = 20; mean follow-up, 21.3 months), the mean mHHS (from 57.6 preoperatively to 85.8 at final follow-up; P < .001), HOS-ADL (from 66.4 to 85.7; P < .001), and HOS-Sports (from 39.1 to 79.8; P < .001) all improved significantly. The results were similar when looking at only the patients with a minimum 2-year follow-up after revision surgery (n = 11; mean follow-up, 26.1 months); the mean mHHS (from 56.0 preoperatively to 91.5 at final follow-up; P = .001), HOS-ADL (from 68.3 to 89.9; P = .009), and HOS-Sports (from 35.7 to 87.9; P = .001) all improved significantly. When comparing patients with isolated capsular repair to those with additional procedures performed, there were no differences between the groups (all P > .05). At final follow-up, all but 1 patient had improved overall physical ability levels.
  
  
  CONCLUSIONS
  Revision hip arthroscopic surgery for capsular repair in patients with symptomatic instability after hip arthroscopic surgery provides good functional outcomes at a minimum of 1 and 2 years postoperatively.
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Wylie
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Beckmann
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Travis G
authors.initials: TG
authors.lastname: Maak
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA stephen.aoki@hsc.utah.edu.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Aoki
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D005260:Female; D057925:Femoracetabular Impingement / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013177:Sports / Q000502:physiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: capsular repair; functional outcome; hip arthroscopic surgery; hip instability