Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy
Background: The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of ad...
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| Veröffentlicht in: | The American journal of sports medicine 2023-02, Vol.51 (2), p.487-493 |
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| creator | Ruzbarsky, Joseph J. Comfort, Spencer M. Martin, Maitland D. Briggs, Karen K. Philippon, Marc J. |
| description | Background:
The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of adhesions.
Purpose:
To evaluate patient-reported outcomes (PROs) and survivorship at a minimum of 2 years after revision hip arthroscopic surgery with capsular spacer placement for capsular adhesions.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between January 2013 and June 2018, a total of 95 patients (99 hips) aged ≥18 years underwent revision hip arthroscopic surgery for the treatment of capsular adhesions with the placement of a capsular spacer. Overall, 53 patients (56 hips) met the inclusion criteria and had a minimum 2-year follow-up, forming the cohort of this study. Exclusion criteria included confounding metabolic bone diseases (eg, Legg-Calve-Perthes disease, Marfan syndrome), labral deficiency, or advanced osteoarthritis (Tönnis grade 2 or 3). Preoperative and postoperative outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sport-Specific Subscale [HOS-SSS], 12-Item Short Form Health Survey [SF-12], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected and compared in addition to the revision rate, conversion to total hip arthroplasty, and patient satisfaction.
Results:
The mean age of the cohort was 32 ± 11 years, with 32 female hips (57%) and a median number of previous hip arthroscopic procedures of 1 (range, 1-5). The arthroplasty- and revision-free survivorship rate at 2 years was 91%. Overall, 5 patients (6 hips; 11%) underwent revision surgery at a mean of 2.4 ± 1.4 years after capsular spacer placement, with symptomatic capsular defects being the most common finding. There were 4 patients (7%) who converted to total hip arthroplasty. For hips not requiring subsequent surgery (n = 46), there was a significant improvement in outcome scores except for the SF-12 Mental Component Summary, with rates of achieving the minimal clinically important difference of 70%, 70%, and 65% for the mHHS, HOS-ADL, and HOS-SSS, respectively.
Conclusion:
Capsular spacers, as part of a systematic approach including lysis of adhesions with early and consistent postoperative physical therapy including circumduction exercises, resulted in improved P |
| doi_str_mv | 10.1177/03635465221145704 |
| format | Article |
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The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of adhesions.
Purpose:
To evaluate patient-reported outcomes (PROs) and survivorship at a minimum of 2 years after revision hip arthroscopic surgery with capsular spacer placement for capsular adhesions.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between January 2013 and June 2018, a total of 95 patients (99 hips) aged ≥18 years underwent revision hip arthroscopic surgery for the treatment of capsular adhesions with the placement of a capsular spacer. Overall, 53 patients (56 hips) met the inclusion criteria and had a minimum 2-year follow-up, forming the cohort of this study. Exclusion criteria included confounding metabolic bone diseases (eg, Legg-Calve-Perthes disease, Marfan syndrome), labral deficiency, or advanced osteoarthritis (Tönnis grade 2 or 3). Preoperative and postoperative outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sport-Specific Subscale [HOS-SSS], 12-Item Short Form Health Survey [SF-12], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected and compared in addition to the revision rate, conversion to total hip arthroplasty, and patient satisfaction.
Results:
The mean age of the cohort was 32 ± 11 years, with 32 female hips (57%) and a median number of previous hip arthroscopic procedures of 1 (range, 1-5). The arthroplasty- and revision-free survivorship rate at 2 years was 91%. Overall, 5 patients (6 hips; 11%) underwent revision surgery at a mean of 2.4 ± 1.4 years after capsular spacer placement, with symptomatic capsular defects being the most common finding. There were 4 patients (7%) who converted to total hip arthroplasty. For hips not requiring subsequent surgery (n = 46), there was a significant improvement in outcome scores except for the SF-12 Mental Component Summary, with rates of achieving the minimal clinically important difference of 70%, 70%, and 65% for the mHHS, HOS-ADL, and HOS-SSS, respectively.
Conclusion:
Capsular spacers, as part of a systematic approach including lysis of adhesions with early and consistent postoperative physical therapy including circumduction exercises, resulted in improved PROs as well as high arthroplasty– and revision-free survivorship (91%) at a minimum 2-year follow-up. Capsular spacers should be considered in revision hip arthroscopic procedures when an adequate labral volume remains but adhesions continue to be a concern.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/03635465221145704</identifier><identifier>PMID: 36661250</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Activities of Daily Living ; Adolescent ; Adult ; Arthritis ; Arthroplasty, Replacement, Hip - methods ; Arthroscopy - methods ; Female ; Femoracetabular Impingement - surgery ; Follow-Up Studies ; Hip Joint - surgery ; Humans ; Joint replacement surgery ; Osteoarthritis ; Osteoarthritis - surgery ; Patient Reported Outcome Measures ; Patient satisfaction ; Retrospective Studies ; Sports medicine ; Treatment Outcome ; Young Adult</subject><ispartof>The American journal of sports medicine, 2023-02, Vol.51 (2), p.487-493</ispartof><rights>2023 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-ae3a4b0d71362a558b243cf0a7c7bbd6f3ea39058a96024ca7430fd42157dc103</citedby><cites>FETCH-LOGICAL-c368t-ae3a4b0d71362a558b243cf0a7c7bbd6f3ea39058a96024ca7430fd42157dc103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/03635465221145704$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/03635465221145704$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36661250$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruzbarsky, Joseph J.</creatorcontrib><creatorcontrib>Comfort, Spencer M.</creatorcontrib><creatorcontrib>Martin, Maitland D.</creatorcontrib><creatorcontrib>Briggs, Karen K.</creatorcontrib><creatorcontrib>Philippon, Marc J.</creatorcontrib><title>Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of adhesions.
Purpose:
To evaluate patient-reported outcomes (PROs) and survivorship at a minimum of 2 years after revision hip arthroscopic surgery with capsular spacer placement for capsular adhesions.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between January 2013 and June 2018, a total of 95 patients (99 hips) aged ≥18 years underwent revision hip arthroscopic surgery for the treatment of capsular adhesions with the placement of a capsular spacer. Overall, 53 patients (56 hips) met the inclusion criteria and had a minimum 2-year follow-up, forming the cohort of this study. Exclusion criteria included confounding metabolic bone diseases (eg, Legg-Calve-Perthes disease, Marfan syndrome), labral deficiency, or advanced osteoarthritis (Tönnis grade 2 or 3). Preoperative and postoperative outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sport-Specific Subscale [HOS-SSS], 12-Item Short Form Health Survey [SF-12], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected and compared in addition to the revision rate, conversion to total hip arthroplasty, and patient satisfaction.
Results:
The mean age of the cohort was 32 ± 11 years, with 32 female hips (57%) and a median number of previous hip arthroscopic procedures of 1 (range, 1-5). The arthroplasty- and revision-free survivorship rate at 2 years was 91%. Overall, 5 patients (6 hips; 11%) underwent revision surgery at a mean of 2.4 ± 1.4 years after capsular spacer placement, with symptomatic capsular defects being the most common finding. There were 4 patients (7%) who converted to total hip arthroplasty. For hips not requiring subsequent surgery (n = 46), there was a significant improvement in outcome scores except for the SF-12 Mental Component Summary, with rates of achieving the minimal clinically important difference of 70%, 70%, and 65% for the mHHS, HOS-ADL, and HOS-SSS, respectively.
Conclusion:
Capsular spacers, as part of a systematic approach including lysis of adhesions with early and consistent postoperative physical therapy including circumduction exercises, resulted in improved PROs as well as high arthroplasty– and revision-free survivorship (91%) at a minimum 2-year follow-up. Capsular spacers should be considered in revision hip arthroscopic procedures when an adequate labral volume remains but adhesions continue to be a concern.</description><subject>Activities of Daily Living</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Arthritis</subject><subject>Arthroplasty, Replacement, Hip - methods</subject><subject>Arthroscopy - methods</subject><subject>Female</subject><subject>Femoracetabular Impingement - surgery</subject><subject>Follow-Up Studies</subject><subject>Hip Joint - surgery</subject><subject>Humans</subject><subject>Joint replacement surgery</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis - surgery</subject><subject>Patient Reported Outcome Measures</subject><subject>Patient satisfaction</subject><subject>Retrospective Studies</subject><subject>Sports medicine</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1Lw0AQhhdRbK3-AC-y4MVL6n5vPZb6UaEgaMVjmGw2bUqSjbuJ0H9vQquC4mkO87zvzLyD0DklY0q1viZccSmUZIxSITURB2hIpWQR50oeomHfj3pggE5C2BBCqFaTYzTgSinKJBmi9VPbGFfagDPn8dJbaEpbNdhleAZ1aAtXQOKhwNN0bUPuqoDf8maNYd8Gj19qMNbj29bn1Qo_24-85_A8r_HUN2vvgnH19hQdZVAEe7avI_R6f7eczaPF08PjbLqIDFeTJgLLQSQk1ZQrBlJOEia4yQhoo5MkVRm3wG-InMCNIkwY0IKTLBWMSp0aSvgIXe18a-_eWxuauMyDsUUBlXVtiFmXABOsC6VDL3-hG9f6qtuuo7SgjBPaU3RHme6S4G0W1z4vwW9jSuL-DfGfN3Sai71zm5Q2_VZ85d4B4x0QYGV_xv7v-Akrm47P</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Ruzbarsky, Joseph J.</creator><creator>Comfort, Spencer M.</creator><creator>Martin, Maitland D.</creator><creator>Briggs, Karen K.</creator><creator>Philippon, Marc J.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>202302</creationdate><title>Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy</title><author>Ruzbarsky, Joseph J. ; Comfort, Spencer M. ; Martin, Maitland D. ; Briggs, Karen K. ; Philippon, Marc J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-ae3a4b0d71362a558b243cf0a7c7bbd6f3ea39058a96024ca7430fd42157dc103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Activities of Daily Living</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Arthritis</topic><topic>Arthroplasty, Replacement, Hip - methods</topic><topic>Arthroscopy - methods</topic><topic>Female</topic><topic>Femoracetabular Impingement - surgery</topic><topic>Follow-Up Studies</topic><topic>Hip Joint - surgery</topic><topic>Humans</topic><topic>Joint replacement surgery</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis - surgery</topic><topic>Patient Reported Outcome Measures</topic><topic>Patient satisfaction</topic><topic>Retrospective Studies</topic><topic>Sports medicine</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruzbarsky, Joseph J.</creatorcontrib><creatorcontrib>Comfort, Spencer M.</creatorcontrib><creatorcontrib>Martin, Maitland D.</creatorcontrib><creatorcontrib>Briggs, Karen K.</creatorcontrib><creatorcontrib>Philippon, Marc J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruzbarsky, Joseph J.</au><au>Comfort, Spencer M.</au><au>Martin, Maitland D.</au><au>Briggs, Karen K.</au><au>Philippon, Marc J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2023-02</date><risdate>2023</risdate><volume>51</volume><issue>2</issue><spage>487</spage><epage>493</epage><pages>487-493</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of adhesions.
Purpose:
To evaluate patient-reported outcomes (PROs) and survivorship at a minimum of 2 years after revision hip arthroscopic surgery with capsular spacer placement for capsular adhesions.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between January 2013 and June 2018, a total of 95 patients (99 hips) aged ≥18 years underwent revision hip arthroscopic surgery for the treatment of capsular adhesions with the placement of a capsular spacer. Overall, 53 patients (56 hips) met the inclusion criteria and had a minimum 2-year follow-up, forming the cohort of this study. Exclusion criteria included confounding metabolic bone diseases (eg, Legg-Calve-Perthes disease, Marfan syndrome), labral deficiency, or advanced osteoarthritis (Tönnis grade 2 or 3). Preoperative and postoperative outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sport-Specific Subscale [HOS-SSS], 12-Item Short Form Health Survey [SF-12], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected and compared in addition to the revision rate, conversion to total hip arthroplasty, and patient satisfaction.
Results:
The mean age of the cohort was 32 ± 11 years, with 32 female hips (57%) and a median number of previous hip arthroscopic procedures of 1 (range, 1-5). The arthroplasty- and revision-free survivorship rate at 2 years was 91%. Overall, 5 patients (6 hips; 11%) underwent revision surgery at a mean of 2.4 ± 1.4 years after capsular spacer placement, with symptomatic capsular defects being the most common finding. There were 4 patients (7%) who converted to total hip arthroplasty. For hips not requiring subsequent surgery (n = 46), there was a significant improvement in outcome scores except for the SF-12 Mental Component Summary, with rates of achieving the minimal clinically important difference of 70%, 70%, and 65% for the mHHS, HOS-ADL, and HOS-SSS, respectively.
Conclusion:
Capsular spacers, as part of a systematic approach including lysis of adhesions with early and consistent postoperative physical therapy including circumduction exercises, resulted in improved PROs as well as high arthroplasty– and revision-free survivorship (91%) at a minimum 2-year follow-up. Capsular spacers should be considered in revision hip arthroscopic procedures when an adequate labral volume remains but adhesions continue to be a concern.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>36661250</pmid><doi>10.1177/03635465221145704</doi><tpages>7</tpages></addata></record> |
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| ispartof | The American journal of sports medicine, 2023-02, Vol.51 (2), p.487-493 |
| issn | 0363-5465 1552-3365 |
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| source | SAGE Complete A-Z List; MEDLINE; Alma/SFX Local Collection |
| subjects | Activities of Daily Living Adolescent Adult Arthritis Arthroplasty, Replacement, Hip - methods Arthroscopy - methods Female Femoracetabular Impingement - surgery Follow-Up Studies Hip Joint - surgery Humans Joint replacement surgery Osteoarthritis Osteoarthritis - surgery Patient Reported Outcome Measures Patient satisfaction Retrospective Studies Sports medicine Treatment Outcome Young Adult |
| title | Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy |
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