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Capsular repair vs capsulectomy in total hip arthroplasty
Luca Miranda1,2, Marco Quaranta1,2, Francesco Oliva1,2
1Faculty of Medicine and Surgery, Department of Musculoskeletal Disorders, University of Salerno, 84084 Baronissi, Italy.
Background:
A major complication of total hip arthroplasty is dislocation. The hip joint capsule can be incised and repaired, or can be excised.
Sources Of Data:
We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines focusing on capsular repair and capsulectomy.
Areas Of Agreement:
We identified 31 articles (17 272 patients). Capsular repair produced a lower blood loss (465.2 vs 709.2 ml), and the procedure lasted 102.5 vs 96.08 min in patients who underwent capsulectomy. The patients undergoing capsulectomy experienced a dislocation rate of 3.06%, whereas in the patients undergoing capsular repair, the dislocation rate was 0.65%.
Areas Of Controversy:
Most studies are retrospective observational studies, with no prospective randomized trials.
Growing Points:
Capsular preservation is association with a lower dislocation rate and a lower blood loss. Capsular excision does take statistically less time, but it is uncertain how a 6 min difference is clinically relevant.
Areas Timely For Developing Research:
Appropriately powered randomized clinical trials should be conducted to better define the association between the chosen implants, approach and outcome.
