Complete Capsular Repair Using a Knotless Barbed Suture With a Mini-direct Lateral Approach for Total Hip Arthroplasty: A Technique Note and Feasibility Study

Introduction: How the hip joint capsule is processed during total hip arthroplasty (THA) and whether a capsular repair is needed, are important factors determining the success of the procedure. In this surgical technique report, we present a detailed technical discussion of the pearls and pitfalls of complete capsular repair using knotless barbed sutures for a mini-direct lateral approach THA. Materials and Methods: A total of 45 consecutive cases that underwent a mini-direct lateral approach for THA with a complete capsular repair were included. A historical control group of 169 cases with partial capsulectomy without repair were also reviewed. This technique is based on a modified mini-incision direct lateral approach. A T-shaped capsulotomy was performed. The margin to be seamed at the femoral side of the capsular ligament must be preserved. A knotless barbed suture was applied for repairing the capsular ligament and gluteus minimus. Results: In 42 cases (93.3%), a complete capsular repair was achieved successfully. The average operative time was 106±20 minutes. The average intraoperative bleeding was 369±241 mL. There was no major complication both intra and postoperatively. Conclusion: Complete capsular repair through a mini-direct lateral approach was feasible by using a knotless barbed suture. Preserving the margin used to seam the femoral side of the capsular ligament is a key requirement for reattachment of the capsule. In addition, a continuous knotless barbed suture facilitates gradual plication of the capsule without a cheese cut.