Does Capsular Repair in Anterior Total Hip Arthroplasty Reduce the Incidence of Iliopsoas Tendonitis?

Total hip arthroplasty (THA) is one of the most popular and successful operations in the United States. One of the known complications of THA is iliopsoas tendonitis (ITS), which is seen in 4.5% of all THAs. ITS can lead to extreme discomfort for the patient, requiring multiple interventions, with the most severe being revision of arthroplasty components. Thus, ITS is an important complication to prevent. This study looked to see if repairing the hip capsule after direct anterior approach (DAA) to the hip played a role in ITS development.

This was a retrospective study comparing the incidence of ITS symptoms for 5 different surgeons with the goal to further explore whether complete capsulectomy during DAA increases the incidence of ITS when compared to capsular repair. Telephone interviews and retrospective chart review were used to identify symptoms consistent with a diagnosis of ITS.

Two hundred thirty-seven patients were studied: 187 in the DAA group, with 101 receiving capsular repair and 86 with capsulectomy; and then 50 patients received a posterior hip approach, and this was used as a control group. Overall, there was no significant difference in symptom incidence (9.9% vs 10.5%) between the capsular repair and capsulectomy groups. When analyzed for each surgeon individually, there were also no statistically significant differences.

There is no statistically significant difference in ITS incidence between patients receiving a direct anterior THA with capsulectomy vs those receiving a direct anterior THA with a capsular repair.