Editorial Commentary: Thermal Pie-Crusting the Hip Capsule Improves Exposure: But Is it Safe?

Thermal pie-crusting of the capsule can increase hip arthroscopy surgical exposure in the peripheral compartment. Recent time-zero biomechanical research suggests that repairing the capsule after pie-crusting yields similar strength and increased stiffness when compared to a T-capsulotomy. However, the risks of thermal damage to the capsule should be weighed against the biomechanical advantages of repairing a pie-crusted capsule versus a T-capsulotomized capsule. In addition, if a surgeon wants to inject an intra-articular orthobiologic such as platelet-rich plasma (PRP), I would not recommend pie-crusting because the full-thickness slits in the capsule could allow the PRP to escape, even after capsular repair. I will still use traction sutures for 100% of my hip arthroscopy procedures. However, in the very rare setting when traction sutures alone yield inadequate exposure, I will perform pie-crusting instead of a T-capsulotomy.