• Luca Miranda, Marco Quaranta, Francesco Oliva, Attilio Giuliano, and Nicola Maffulli.
• Faculty of Medicine and Surgery, Department of Musculoskeletal Disorders, University of Salerno, 84084 Baronissi, Italy.
• Br. Med. Bull. 2021 Sep 10; 139 (1): 36-47.

BackgroundA major complication of total hip arthroplasty is dislocation. The hip joint capsule can be incised and repaired, or can be excised.Sources Of DataWe performed a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines focusing on capsular repair and capsulectomy.Areas Of AgreementWe identified 31 articles (17 272 patients). Capsular repair produced a lower blood loss (465.2 vs 709.2 ml), and the procedure lasted 102.5 vs 96.08 min in patients who underwent capsulectomy. The patients undergoing capsulectomy experienced a dislocation rate of 3.06%, whereas in the patients undergoing capsular repair, the dislocation rate was 0.65%.Areas Of ControversyMost studies are retrospective observational studies, with no prospective randomized trials.Growing PointsCapsular preservation is association with a lower dislocation rate and a lower blood loss. Capsular excision does take statistically less time, but it is uncertain how a 6 min difference is clinically relevant.Areas Timely For Developing ResearchAppropriately powered randomized clinical trials should be conducted to better define the association between the chosen implants, approach and outcome.© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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