Is capsular repair necessary in direct anterior total hip arthroplasty? Clinical outcomes from an Indian retrospective series.

BACKGROUND

Capsular management during total hip arthroplasty (THA), in the context of the direct anterior approach (DAA), remains an underexplored aspect. This study aimed to evaluate whether anterior capsular excision or repair during DAA-THA influences early clinical outcomes and joint function in a real-world setting.

METHODS

A retrospective cohort analysis was conducted on 168 patients undergoing primary DAA-THA between January and December 2023. Based on intraoperative capsular integrity and surgeon discretion, patients were categorized into excision (n = 92) or repair (n = 76) groups. Functional outcomes were assessed using Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip Disability and Osteoarthritis Outcome Score (HOOS), and Forgotten Joint Score (FJS) at baseline, 6 weeks, and 1 year postoperatively. Comparative analysis was performed using paired and independent t-tests (p < 0.05).

RESULTS

Osteonecrosis of the femoral head was the predominant surgical indication in both groups (76.1% and 76.3%, respectively). Both groups showed significant improvements in all outcomes (p < 0.001). At 1 year, HHS (excision: 94.4 vs. repair: 94.9) and WOMAC (4.8 vs. 4.6) improvement were similar. The repair group had marginally better HOOS (90.1 vs. 88.8) and FJS (89.8 vs. 88.3) scores, though statistically nonsignificant. One dislocation occurred in the excision group (slipped on a wet surface; managed with closed reduction), with none in the repair group.

CONCLUSIONS

Both capsular excision and repair provided excellent early outcomes, with no significant differences in functional scores or complication rates between groups. These findings suggest that either strategy may be safely employed during DAA-THA, with the choice guided by intraoperative considerations rather than expectations of superior clinical outcomes.

LEVEL OF EVIDENCE: Level III, Retrospective cohort Study.