EP3.44 Long-Term Outcomes of Patients Undergoing Primary Hip Arthroscopy Without Capsular Repair: A 15-Year Follow-Up Study

Abstract

Abstract Purpose Hip arthroscopy is an established treatment for femoroacetabular impingement syndrome (FAIS). Although capsular repair is now commonly performed to restore hip stability and optimize biomechanics, its importance was less recognized 10–15 years ago. As a result, long-term outcomes after arthroscopy without capsular repair remain incompletely defined. This study evaluated 15-year survivorship, patient-reported outcomes (PROs), and clinically meaningful improvement following hip arthroscopy with interportal capsulotomy without repair, and identified predictors of outcomes and failure. Methods Patients who underwent primary hip arthroscopy for FAIS between 2007 and 2011 with minimum 15-year follow-up were retrospectively reviewed. Exclusion criteria included hip dysplasia (lateral center-edge angle <25°), Tönnis grade >1, osteoarthritis, and prior ipsilateral hip surgery. Outcomes included modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and achievement of minimal clinically important difference (MCID). Failure was defined as revision arthroscopy or conversion to total hip arthroplasty (THA). Multivariate regression analyses were used to identify predictors of long-term outcomes and failure. Results A total of 141 patients were included with a mean follow-up of 15.0 ± 0.6 years, mean age of 38.8 ± 11.8 years, and 60.3% female. Fifteen-year survivorship was 80.8%, with 16 patients (11.4%) converting to THA and 12 patients (8.5%) undergoing revision arthroscopy. Significant improvements were observed for mHHS (50.7 ± 13.6 preoperatively to 87.8 ± 16.7 at 15 years) and NAHS from (46.8 ± 12.3 preoperatively to 86.1 ± 17.5 at 15 years). MCID achievement rates at final follow up were 96.5% for mHHS and 95.7% for NAHS. Multivariate regression demonstrated that male sex and lower BMI were independently associated with superior 15-year PROs (p < 0.010). Older age at surgery was associated with failure on univariate analysis (p = 0.021); however, multivariate logistic regression identified lower preoperative mHHS as the only independent predictor of failure (p = 0.037). Conclusion Hip arthroscopy without capsular repair demonstrated durable improvement and acceptable survivorship at 15 years. Male sex and lower BMI predicted superior outcomes, while worse preoperative function increased failure risk. These findings suggest sustained benefit without routine capsular repair in appropriately selected patients.