Disclosures: McLawhorn reports he is a paid consultant for Intellijoint Surgical Inc. and is on the editorial or governing board for the HSS Journal. Please see the study for all other authors relevant financial disclosures.
June 05, 2020
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Capsulotomy with repair during THA yielded no anterior capsular defects

Disclosures: McLawhorn reports he is a paid consultant for Intellijoint Surgical Inc. and is on the editorial or governing board for the HSS Journal. Please see the study for all other authors relevant financial disclosures.
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Published results showed patients who underwent total hip arthroplasty through the direct anterior approach with capsulotomy and repair had no anterior capsular defects compared with patients who underwent capsulectomy only.

Alexander S. McLawhorn
Alexander S. McLawhorn

Alexander S. McLawhorn, MD, MBA, of Hospital for Special Surgery, and colleagues collected metal artifact reduction sequence (MARS) MRI at discharge and 1-year follow-up for 32 patients who underwent THA through the direct anterior approach. Of these patients, 17 underwent capsulotomy and repair and 15 underwent capsulectomy only. Each MARS MRI was scored by a radiologist blinded to intraoperative data, and researchers graded anterior capsular integrity, status of the piriformis and conjoint tendons, and muscle atrophy.

Results showed 75% of piriformis tendons and 38% of conjoined tendons were intact immediately postoperatively. Researchers found intact piriformis and conjoined tendon in 97% of patients at 1 year. However, researchers noted many of the intact piriformis and conjoined tendons were in continuity through scar with the capsule. All patients had direct contact between posterior capsule and bone, according to results.

McLawhorn noted formation of an anterior pseudocapsule occurred in 100% of patients who underwent anterior capsule repair, while 27% of patients who underwent capsulectomy had persistent anterior defects.

“Thus, we can speculate that anterior capsular repair may improve anterior stability for [direct-anterior approach] DAA THA, as we have observed for posterior capsular repair and posterior stability for posterior approach THA,” McLawhorn told Healio Orthopedics.