This 2019 JBJS current concepts review synthesizes the functional anatomy, material properties, and biomechanical contributions of the hip joint capsule. It addresses how different capsulotomy types, repair strategies, and arthroplasty implant parameters affect hip stability and range of motion. The review draws on in vitro cadaveric studies to guide capsular management decisions in both hip preservation and arthroplasty surgery.
The decision about how to manage the hip capsule — whether to cut it, how big to make the incision, and whether to repair it. Has long been debated without a clear mechanistic framework. This review consolidates the biomechanical evidence into actionable principles for both arthroscopy and arthroplasty.
In hip arthroscopy, capsulotomy size matters: larger interportal incisions progressively reduce distraction stability, so the smallest capsulotomy that provides adequate access is preferable. Capsular repair is not required for every case, but becomes most important after large capsulotomies or overresected cam deformities, where the native head size can no longer compensate for lost capsular tension. Avoid extending the vertical limb of a T-capsulotomy past the intertrochanteric line. This disrupts the zona orbicularis and eliminates its distraction-resisting aperture function.
In THA, target a femoral head size close to native and an offset that re-tensions the capsule without overtightening it. The anterior approach preserves the posterior ischiofemoral ligament and zona orbicularis, which is why it carries lower dislocation risk in deep flexion compared with the posterior approach.
This 2019 JBJS current concepts review synthesizes the functional anatomy, material properties, and biomechanical contributions of the hip joint capsule. It addresses how different capsulotomy types, repair strategies, and arthroplasty implant parameters affect hip stability and range of motion. The review draws on in vitro cadaveric studies to guide capsular management decisions in both hip preservation and arthroplasty surgery.
The decision about how to manage the hip capsule — whether to cut it, how big to make the incision, and whether to repair it. Has long been debated without a clear mechanistic framework. This review consolidates the biomechanical evidence into actionable principles for both arthroscopy and arthroplasty.
In hip arthroscopy, capsulotomy size matters: larger interportal incisions progressively reduce distraction stability, so the smallest capsulotomy that provides adequate access is preferable. Capsular repair is not required for every case, but becomes most important after large capsulotomies or overresected cam deformities, where the native head size can no longer compensate for lost capsular tension. Avoid extending the vertical limb of a T-capsulotomy past the intertrochanteric line. This disrupts the zona orbicularis and eliminates its distraction-resisting aperture function.
In THA, target a femoral head size close to native and an offset that re-tensions the capsule without overtightening it. The anterior approach preserves the posterior ischiofemoral ligament and zona orbicularis, which is why it carries lower dislocation risk in deep flexion compared with the posterior approach.