Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Periportal Capsulotomy Yields Shorter Procedure Times and Shorter Recovery Room Length of Stay Compared With Interportal Capsulotomy.

Abstract

To compare perioperative outcomes between periportal and interportal capsulotomy techniques during hip arthroscopy for femoroacetabular impingement syndrome including operative time, recovery room length of stay, pain levels, narcotic and non-narcotic analgesic use. Retrospective analysis of a matched cohort derived from a single-institutional database of femoroacetabular impingement syndrome primary hip arthroscopy cases between 2020 and 2023 was performed. Patients were separated into 3 groups based on capsular management technique: interportal capsulotomy with capsule closure, periportal capsulotomy with capsule closure, and periportal capsulotomy with no capsule closure. The groups were matched based on age, sex, body mass index, and traction time. Short-term perioperative data including operative times, post-anesthesia care unit (PACU) medication use, PACU length of stay, and pain scores up to 1 week postop were collected and compared using analysis of variance testing and pairwise comparisons using Tukey's test. The matched cohort included 201 patients, 98 female and 103 male (mean age 32.8 ± 10.3), with no significant demographic differences between the 67 patients in each group. The interportal capsulotomy with capsule closure group showed longer procedure times (109 ± 26.6 min) compared with periportal capsulotomy with capsule closure (86.1 ± 20.6) (mean difference: 23.4 min, P < .001) and periportal capsulotomy with no capsule closure (86.2 ± 19.2) (mean difference: 23.3, P < .001) groups, longer PACU length of stay relative to the periportal capsulotomy with no capsule closure group (mean difference: 23.9 min, P = .014), and greater Acetaminophen use relative to the periportal capsulotomy with capsule closure group (mean difference: 211.9 mg, P = .008). There were no differences in rescue nerve block frequency, PACU oral morphine equivalent use, postoperative complications or PACU, and 1-week postop pain scores across groups. Patients who underwent periportal capsulotomy during hip arthroscopy for femoroacetabular impingement syndrome had significantly shorter operative time and reduced PACU length of stay compared with patients who underwent interportal capsulotomy. Periportal capsulotomy patients also required less acetaminophen in the PACU, but the difference may not be clinically meaningful. Level III, retrospective therapeutic comparative case series.