Hip Capsule Closure Using Absorbable Sutures Demonstrates Similar Patient-Reported Outcomes and Rates of Revision with Potentially Lower Complication Rates Compared to Nonabsorbable Suture Following Hip Arthroscopy: A Systematic Review

Background Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain often presenting in younger active patients. Hip arthroscopy has emerged in recent years as a viable method treating this condition, however there is significant variability in the techniques utilized in this procedure. One such variation is the decision of whether to use absorbable or nonabsorbable sutures to close the hip capsule. The purpose of this systematic review was to investigate outcomes of absorbable versus non-absorbable sutures for capsulotomy closure during hip arthroscopy for the treatment of femoroacetabular impingement syndrome. Methods A systematic review of the PubMed, Embase, and Web of Science databases was conducted according to the 2020 PRISMA guidelines to identify human clinical studies of level I-IV evidence reporting outcomes following hip arthroscopy with hip capsule closure using absorbable or non-absorbable sutures for femoracetabular impingement syndrome with a minimum follow-up of two years. Exclusion criteria consisted of studies lacking reporting outcomes and studies that did not report the suture type for capsule closure. MINORS criteria and the Revised Cochrane Risk of Bias 2 tool were utilized to evaluate study quality. Results Overall, 19 studies published from 2014 to 2024 met the final inclusion criteria. Six studies reported on absorbable sutures while thirteen studies reported on nonabsorbable sutures. At final follow-up, the change from preoperative to postoperative values for patient-reported outcome scores was the following: modified Harris Hip Score (mHHS) ranged from 21.1-25.8 (absorbable) vs. 7.6-24.19 (nonabsorbable) and Hip Outcome Score Sport (HOS-Sport) 31-37.2 (absorbable) vs. 38.0-48.3 (nonabsorbable). Postoperative complication rates varied between 0-10.7% (absorbable) vs. 0-31.8% (nonabsorbable) and revision rates ranged from 0-15.9% (absorbable) vs. 0-14.9% (nonabsorbable). Conversion to total hip arthroplasty ranged from 0-23.7% (absorbable) vs. 0-17.4% (nonabsorbable). Discussion The use of absorbable suture material for capsular closure in hip arthroscopy for femoroacetabular impingement syndrome demonstrates comparable outcomes and revision rates, with potentially lower complication rates compared to nonabsorbable sutures. Future studies should prospectively examine the long-term outcomes of each suture type when controlling for concurrent procedures and other important variables.