KSSTA - 2026-08-18 - Journal Article
Minimum 10-year patient-reported outcomes and survivorship after primary hip arthroscopy with interportal capsulotomy without capsular repair for stable femoroacetabular impingement syndrome: Female sex, elevated BMI and Tönnis grade predict inferior outcomes.
Gosnell GG, Berzolla E, Lezak BA, Mercer NP, Ruff G, Morgan AM, Lott A, Youm T
Topics
Key Takeaway
Primary hip arthroscopy with interportal capsulotomy without capsular repair achieved 90.7% survivorship and 76.0% PASS achievement for mHHS at mean 11.7-year follow-up in structurally stable FAIS.
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Summary
This single-surgeon retrospective series evaluated minimum 10-year PROs and survivorship in 150 patients undergoing primary hip arthroscopy with interportal capsulotomy without capsular repair for structurally stable FAIS (Tönnis ≤1, no dysplasia). mHHS improved from 52.0 to 87.9 and NAHS from 49.5 to 86.2 (both p<0.001), with 7 patients (4.7%) converting to THA and 7 (4.7%) undergoing revision arthroscopy. Female sex and elevated BMI predicted worse PROs; Tönnis Grade 1 and lower preoperative NAHS predicted failure.
Key Limitation
Absence of a capsular repair comparison group makes it impossible to determine whether the 9.3% failure rate is attributable to omitting capsular repair or reflects the natural history of the disease in this population.
Original Abstract
PURPOSE
The purpose of this study was to report minimum 10-year survivorship, patient-reported outcomes (PROs), clinically significant outcome achievement and predictors of outcomes and failure in patients with structurally stable femoroacetabular impingement syndrome (FAIS) who underwent primary hip arthroscopy with interportal capsulotomy without capsular repair.
METHODS
A retrospective review was conducted of patients undergoing primary hip arthroscopy for FAIS from 2010 to 2013 with a minimum 10-year follow-up. Exclusion criteria included hip dysplasia, Tönnis Grade >1, prior ipsilateral hip surgery and unavailable preoperative radiographs. All patients underwent interportal capsulotomy without capsular repair. Outcomes included modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), minimal clinically important difference (MCID) achievement, survivorship and predictors of PROs and failure.
RESULTS
A total of 150 patients were included (62.7% female), with mean follow-up of 11.7 ± 1.1 years and mean age of 38.3 ± 12.1 years. Ten-year survivorship was 90.7%; 7 patients (4.7%) underwent total hip arthroplasty and 7 (4.7%) underwent revision arthroscopy. mHHS improved from 52.0 ± 11.7 to 87.9 ± 16.7 (p < 0.001), and NAHS improved from 49.5 ± 11.4 to 86.2 ± 18.0 (p < 0.001). Patient Acceptable Symptom State (PASS) was achieved by 76.0% of patients for mHHS and 65.3% for NAHS. Female sex and higher body mass index (BMI) were associated with worse 10-year PROs, whereas Tönnis Grade 1 (p = 0.003) and lower preoperative NAHS (p = 0.034) were associated with failure.
CONCLUSION
Primary hip arthroscopy for structurally stable FAIS performed with interportal capsulotomy and without capsular repair demonstrated favourable 10-year outcomes, high PASS achievement and 90.7% survivorship. Clinically, these findings provide long-term benchmarking data for counselling appropriately selected patients with structurally stable hips. Higher BMI and female sex were associated with worse 10-year PROs, while Tönnis Grade 1 and lower preoperative NAHS were associated with increased failure risk, supporting their use in preoperative risk stratification and shared decision-making.
LEVEL OF EVIDENCE
Level IV, retrospective case series (single-surgeon, without comparison group).