Eleven and a half years ago I thought I had closure to my hip issues. That was until my pain returned in the summer of 2018. Pain there was. It was calling my name morning, noon and night. Slow down, stop moving, give us a break. I tried to ignore Pain’s insistence after all, I had closure. My hips had been fixed and I had moved on from hip pain for almost a decade.
So here’s a little play on words. I’m actually talking about two types of closure. According to Psychology Today, closure means “finality; a letting go of what once was. Finding closure implies a complete acceptance of what has happened and an honoring of the transition away from what's finished to something new. In other words, closure describes the ability to go beyond imposed limitations in order to find different possibilities.”
For me, closure with my hips means that my mind and thoughts are okay in spite of the fact that I still have quirky hips. My mind and thoughts can look at this through a set of lenses that still allows positivity and growth. It has been important for me to find closure so that I can find acceptance and continue to move on with the understanding that my trajectory of hip healing could include a detour here and there!
But the other type of closure that I’m speaking about is incredibly important for your physical hip health. The lack of this type of closure was what lead to my experience of renewed hip pain and instability 10 years later. There is also a lot of research and talk among hip preservationists about proper closure of the hip capsule.
Here’s a bit of background. So, it used to be when the hip capsule aka ligaments were cut through in those beginning years of hip arthroscopy, the ligaments were not sewn back up or closed. And there were complications – many. In fact, as I mentioned it is one of those hot topics in the field of hip arthroscopy and it should be something that you query your prospective surgeon about before agreeing to surgery.
According to the research and an article by Beck, Suppauksorn and Nho, “patients who undergo hip arthroscopy for femoroacetabular impingement syndrome and have an unrepaired capsule have lower functional outcome scores, achievement of meaningful outcomes, success rates, as well as greater failure rates and reported pain when compared with patients who have complete capsular closure” (2019). Other studies show that in patients with closure as compared to non-closure of the hip capsule they did better! They had better self-reported satisfaction as evidenced by scores measured by the HOS-ADL and mHHS. Another study by Bolia, Briggs, Fagotti and Philippon shows that “a lower rate of conversion to THA was seen in the repair group” (2019). This information thus makes the case for closure of the hip capsule. Bolia, Briggs, Fagotti and Philippon also go on to show that “there were twice as many conversions to THA and twice as many hip arthroscopy revisions in patients undergoing hip arthroscopic labral repair without capsular closure compared to those with closure. In addition, the closure group showed significantly higher outcomes scores compared to the non-closure at 5-year follow-up time” (2018).
What is the lesson here then? Two things. Make sure that your surgeon routinely uses capsular closure as part of his or her hip arthroscopic procedures. If your surgeon does not, ask why?
Second thing. Work on that other type of closure. Yes, you may have to accept that your hips are flawed. You may have to accept that you have some limitations. You may have to accept that there are other procedures on the horizon. And I know it is totally easier said than done. But if you can come to the realization that closure means that, in spite of your hip woes, you will remain optimistic and accepting, then you are on the road to healing!
Beck, E. C., Suppauksom, S., & Nho, S. (2020). The Role of Comprehensive Capsular
Management in Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome. Arthroscopy, 36(1), 9–11. doi: 10.1016/j.arthro.2019.01.033
Bolia, I., Briggs, K. K., & Philippon, M. J. (2018). Superior Clinical Outcomes with Capsular
Closure versus Non-Closure in Patients Undergoing Arthroscopic Hip Labral Repair. Orthopaedic Journal of Sports Medicine, 6(3 Suppl), 2325967118S00009. https://doi.org/10.1177/2325967118S00009
Bolia, I. K., Fagotti, L., Briggs, K. K., & Philippon, M. J. (2019). Midterm Outcomes Following
Repair of Capsulotomy Versus Nonrepair in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement With Labral Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 35(6), 1828–1834. doi: 10.1016/j.arthro.2019.01.033
Brenner, A. (2011, April 6). 5 Ways to Find Closure From the Past. Retrieved from
https://www.psychologytoday.com/us/blog/in-flux/201104/5-ways-find-closure-the-past