[Efficacy of puncture-based limited incision capsulotomy under hip arthroscopy for femoroacetabular impingement]

Objective: To explore the clinical effect of puncture-based limited incision capsulotomy under hip arthroscopy in the treatment of femoroacetabular impingement (FAI). Methods: A retrospective analysis was conducted on the data of patients with FAI who underwent hip arthroscopy surgery at Cangzhou Central Hospital from January 2020 to January 2023. All patients were divided into two groups based on capsular management during hip arthroscopy: the T-shaped capsulotomy group (TS group) and the puncture limited capsulotomy group (PL group). The TS group underwent traditional T-shaped capsulotomy via an outside-in approach, while the PL group received cannula-guided puncture and limited longitudinal capsulotomy via an inside-out approach. By comparing the incidence of postoperative complications, total surgical time (TOT), capsule suturing time (CST), CST/TOT, visual analog scale (VAS) pain score, modified Harris hip joint score (mHHS), nonarthritic hip score (NAHS), and international hip outcome tool-12 (iHOT-12) during preoperative and postoperative period at 6 months and 1 year follow-up between TS and PL group, the clinical efficacy in the two groups was evaluated. Results: A total of 82 patients were enrolled in this study, 30 males and 52 females with a mean age of (46.0±11.9) years; there were 32 cases (32 hips) in TS group and 50 cases (50 hips) in PL group. The TOT[(62.2±7.9) vs (50.2±7.2)min], CST[17.0(15.0, 22.8) vs 9.0(7.8, 10.0) min], and CST/TOT ratios [29.0%(22.5%, 34.8%) vs 17.5%(14.8%, 21.0%)] in TS group were all significantly higher than those in PL group (all P<0.001). Complication incidence rate in the TS and PL group was comparable [15.6% (5 cases) vs 14.0% (7 cases), P=0.840]. There was no significant differences in preoperative VAS, mHHS, NAHS, and iHOT-12 scores between the TS and PL group (all P>0.05). Both groups demonstrated progressive pain VAS reduction at 6 months and 1 year after the operation (all P<0.05 within groups), with the PL group exhibiting lower 6-month VAS (P<0.05). Functional scores (mHHS, NAHS, iHOT-12) improved progressively at 6 months and 1 year after the operation in both groups (all P<0.05 within groups). At 6 months, the PL group showed superior functional scores (all P<0.05), but no inter-group differences remained at 1 year (all P>0.05). Conclusion: The hip arthroscopy technique of puncture-based limited incision capsulotomy for treating FAI demonstrates favorable clinical outcomes, significantly reduces operative time, enhances surgical efficiency, and does not increase the incidence rate of surgical complications.