Capsular repair vs capsulectomy in total hip arthroplasty

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.