Comparison of Capsular Closure and Capsulectomy in Primary Total Hip Arthroplasty Using the Direct Anterior Approach

Objective: To compare the clinical, radiographic, and complication outcomes of patients undergoing capsular repair or resection during total hip arthroplasty (THA) using the anterior approach. Methods: The present prospective cohort study included 232 patients submitted to THA at a tertiary hospital, who were divided according to exposure. One group of subjects underwent THA with capsular preservation and closure, and the other underwent THA with capsular resection (capsulectomy). Clinical assessment included the Harris Hip Score (HHS), evaluation of hip range of motion, and identification of symptoms indicative of iliopsoas tendinitis. Additionally, a radiological assessment determined the presence of heterotopic ossification, and we evaluated any postoperative complications. Results: There was no statistically significant difference in HHS and hip range of motion. No patient from the capsular closure group presented complications. In the capsulectomy group, 7 (5.20%) subjects presented with heterotopic ossification, including 1 case classified as Brooker grade 3, besides 3 (2.25%) cases of iliopsoas tendinitis and 1 (0.75%) case of prosthesis dislocation. Conclusion: Capsular closure in THA using the direct anterior approach resulted in a lower incidence of iliopsoas tendinitis, heterotopic ossification, and complications, such as prosthesis dislocation, compared with the capsulectomy group.