AIMS It is not known whether preservation of the capsule of the hip positively affects patient-reported outcome measures (PROMs) in total hip arthroplasty using the direct anterior approach (DAA-THA). A recent randomized controlled trial found no clinically significant difference at one year postoperatively. This study aimed to determine whether preservation of the anterolateral capsule and anatomical closure improve the outcome and revision rate, when compared with resection of the anterolateral capsule, at two years postoperatively. METHODS Two consecutive groups of patients whose operations were performed by the senior author were compared. The anterolateral capsule was resected in the first group of 430 patients between January 2012 and December 2014, and preserved and anatomically closed in the second group of 450 patients between July 2015 and December 2017. There were no other technical changes between the two groups. Patient characteristics, the Charlson Comorbidity Index (CCI), and surgical data were collected from our database. PROM questionnaires, consisting of the Oxford Hip Score (OHS) and Core Outcome Measures Index (COMI-Hip), were collected two years postoperatively. Data were analyzed with generalized multiple regression analysis. RESULTS The characteristics, CCI, operating time, and length of stay were similar in both groups. There was significantly less blood loss in the capsular preservation group (p = 0.037). The revision rate (n = 3, (0.6%) in the resected group, and 1 (0.2%) in the preserved group) did not differ significantly (p = 0.295). Once adjusted for demographic and surgical factors, the preserved group had significantly worse PROMs: + 0.24 COMI-Hip (p < 0.001) and -1.6 OHS points (p = 0.017). However, the effect sizes were much smaller than the minimal clinically important differences (MCIDs) of 0.95 and 5, respectively). The date of surgery (influencing, for instance, the surgeon's age) was not a significant factor. CONCLUSION Based on the MCID, the lower PROMs in the capsular preservation group do not seem to have clinical relevance. They do not, however, confirm the expected benefit of capsular preservation reported for the posterolateral approach. Cite this article: Bone Joint J 2022;104-B(7):826-832.

中文翻译：

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使用直接前路入路的全髋关节置换术中保留关节囊对患者报告的结果和并发症发生率的影响。

目的 目前尚不清楚在使用直接前路入路 (DAA-THA) 的全髋关节置换术中保留髋关节囊是否会对患者报告的结果测量 (PROM) 产生积极影响。最近的一项随机对照试验发现术后一年没有临床显着差异。本研究旨在确定与切除前外侧囊相比，保留前外侧囊和解剖闭合是否可以改善术后两年的结果和翻修率。方法对连续两组由资深作者实施手术的患者进行比较。第一组430例患者于2012年1月至2014年12月期间切除前外侧囊，第二组450例患者于2015年7月至2017年12月期间保留并解剖闭合。两组之间没有其他技术变化。从我们的数据库中收集患者特征、查尔森合并症指数 (CCI) 和手术数据。术后两年收集 PROM 问卷，包括牛津髋关节评分 (OHS) 和核心结果测量指数 (COMI-Hip)。采用广义多元回归分析对数据进行分析。结果 两组的特征、CCI、手术时间和住院时间相似。保留囊膜组的失血量显着减少 (p = 0.037)。翻修率（切除组中 n = 3（0.6%），保留组中 n = 1（0.2%））没有显着差异（p = 0.295）。根据人口和手术因素进行调整后，保留组的 PROM 明显较差：+ 0.24 COMI-Hip (p < 0.001) 和 -1.6 OHS 分 (p = 0.017)。然而，效应大小远小于最小临床重要差异 (MCID) 分别为 0.95 和 5。手术日期（例如影响外科医生的年龄）并不是一个重要因素。结论 根据 MCID，保留囊膜组中较低的 PROM 似乎不具有临床相关性。然而，他们并没有证实后外侧入路所报告的包膜保留的预期益处。引用本文：Bone Joint J 2022；104-B(7):826-832。