Capsular management in posterolateral total hip arthroplasty: impact on proprioception, balance, functional outcomes, and complications

Background: The role of capsular management in total hip arthroplasty (THA) performed via the posterolateral approach remains debated, particularly regarding its effects on proprioception, balance, and postoperative stability. While capsular repair may reduce dislocation risk, partial capsular excision may facilitate surgical exposure. This study compared T-capsulotomy with capsular repair and partial capsular excision in terms of proprioception, balance, functional and radiological outcomes, operative time, and complications. Methods: A retrospective cohort of 177 patients who underwent primary THA between February 2019 and April 2024 was analyzed. Patients were assigned to either T-capsulotomy with capsular repair (n = 91) or partial capsular excision (n = 86). Proprioception was assessed using the Hip Joint Position Sense test; balance with the Berg Balance Scale; function with the Forgotten Joint Score (FJS-12) and Harris Hip Score (HHS); and pain with the Visual Analog Scale (VAS). Radiographic evaluation included acetabular anteversion, inclination, offsets, and leg-length discrepancy. Operative time and postoperative complications were recorded. Results: No significant differences were found between groups in proprioception, balance, FJS-12, HHS, or VAS scores (p > 0.05). Radiological parameters were similar. Operative time was significantly shorter in the partial excision group (70.5 vs. 80.1 min, p < 0.001). Complications were infrequent, and no dislocations occurred. Conclusions: At one-year follow-up, no statistically significant differences were identified between the two capsular management techniques in terms of proprioceptive, functional, and radiological outcomes. Although partial capsular excision shortened operative time, it did not yield superior clinical results. Capsular management may be guided by surgeon preference and intraoperative considerations when accurate component positioning is achieved. Further prospective studies are needed to clarify early postoperative proprioceptive differences and long-term outcomes. Level of Evidence: Level III (retrospective cohort study).