Patients Undergoing Hip Arthroscopy With Periportal and Puncture Capsulotomy Demonstrate Favorable Outcomes at Short-Term Follow-Up: A Systematic Review.

PURPOSE: To evaluate whether patients undergoing primary hip arthroscopy with periportal or puncture capsulotomy demonstrate improved patient-reported outcomes (PROs) at minimum 2-year follow-up when compared with preoperative PROs.

METHODS

A systematic review was performed and registered in PROSPERO under ID: CRD42023466053. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus were searched in October of 2024 using the following string: (capsul∗ OR puncture OR periportal) and (hip OR femoroacetabular impingement) AND (arthroscop∗). Articles were included if they reported preoperative and minimum 2-year follow-up PROs in patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears with periportal or puncture capsulotomy and were written in English.

RESULTS

Six studies were included, with 5 studies reporting outcomes on periportal capsulotomy (313 hips) and 1 study on puncture capsulotomy (163 hips). Three studies were Level IV evidence and 3 were Level III. Study periods ranged from 2013 to 2020. Average improvement in the modified Harris Hip Score ranged from 21.1 to 32.56 (I2 = 97%). Average improvement in the visual analog scale for pain ranged from -2.5 to -5.3 (I2 = 94%). Minimal clinically important difference was achieved by 65.0% to 100% of patients for Hip Outcome Score - Activities of Daily Living, 71.8% to 88% for Hip Outcome Score-Sport, and 62.5% to 78% for analog scale for pain. Three studies reported rates of secondary total hip arthroplasty, ranging from 0% to 1.7%.

CONCLUSIONS

Patients undergoing hip arthroscopy with periportal capsulotomy showed improvements in multiple PROs at a minimum of 2-year follow-up. Periportal capsulotomy appears to be an effective capsulotomy technique in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears. Preliminary evidence shows puncture capsulotomy may be an effective way to access the capsule during hip arthroscopy, but conclusions are limited, given the lack of studies available.

LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.