Hip Capsular Reconstruction

What is Hip Capsular Reconstruction?

Hip capsular reconstruction is a procedure aimed at restoring or replacing the hip capsule, a membranous fold made up of ligaments that surround and stabilize the hip joint. The capsule plays a critical role in maintaining hip stability and protecting the joint. During hip arthroscopy, the capsule is often penetrated to access the joint, and in some cases, may need to be reconstructed to avoid instability.

Why is Hip Capsular Reconstruction Performed?

The main goal of hip capsular reconstruction is to prevent or address instability in the hip joint. Instability may result from capsular insufficiency, either due to prior surgery (iatrogenic instability) or from damage caused by trauma or other conditions. Reconstructing the capsule helps restore stability, which is critical for active individuals who want to maintain a high level of function.

Who is a Candidate for Hip Capsular Reconstruction?

This procedure is typically recommended for patients who have experienced hip instability after a previous arthroscopic surgery or who have damaged their hip capsule through injury. It is particularly beneficial for young, active individuals who require a stable hip for athletic or physically demanding activities. The procedure may also be used for patients who are at risk for developing iatrogenic instability following a hip scope.

What Happens if the Hip Capsule is Not Reconstructed?

Failure to reconstruct the hip capsule can lead to a variety of complications, including:

• Deterioration of hip joint function
• An increased risk of anterior hip dislocations
• Development of further hip conditions like acetabular or femoral head cartilage damage
• The potential need for additional surgeries, such as a hip arthroplasty

The Procedure

Hip capsular reconstruction is often performed during hip arthroscopy. During the procedure, Dr. Nho will create portals through the capsule to access the hip joint. For further visualization and access, the capsule is cut between these portals. Once the necessary repairs inside the joint are completed, the surgeon reconstructs the capsule.

Reconstruction involves using sutures to bring together and close the capsular incision. Special suturing instruments are inserted through the portals, and the surgeon carefully places the sutures to ensure that the capsule is securely tightened without damaging nearby structures like the labrum or cartilage. The number of sutures used depends on the extent of the capsular damage, with most procedures requiring between three and eight sutures to achieve proper closure. Sometimes, a graft may also be used in cases when there is a large defect that cannot be closed by the native capsule tissue alone.

Benefits of Hip Capsular Reconstruction

Reconstructing the hip capsule offers several advantages:

• Reduces the risk of hip instability following arthroscopy
• Restores proper biomechanics of the hip
• Prevents anterior hip dislocations
• Improves overall function and stability of the hip joint

Contraindications

Hip capsular reconstruction is not recommended for individuals with certain conditions, such as:

• Hip stiffness
• Borderline or advanced arthritis
• Inflammatory hip disorders

Recovery After Capsular Reconstruction

Following hip capsular reconstruction, patients will need to follow a structured rehabilitation plan. Physical therapy is essential to regain strength and restore full range of motion. Recovery time can vary, but most patients can expect several months of rehabilitation before returning to full activity. Please refer to the physical therapy protocols page for further information on rehab after surgery.

Dr. Shane J. Nho is a board-certified fellowship-trained sports medicine orthopedic surgeon who specializes in the treatment of hip labral tears. For more information on hip capsular reconstruction or to schedule a consultation, contact our orthopedic team today.