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Surgical Technique of THR: Posterior Capsule

- Discussion:
    - insert blunt Homan retractors superiorly & inferiorly to obtain exposure of entire superior, posterior, & inferior portions of capsule;
    - divide exposed portion of capsule along its attachment to femur;
    - make a longitudinal or T shaped extension of capsular incision along axis of femoral neck, directing incision away from sciatic nerve;
    - retract the capsule, preserving for later repair;
    - excise the acetabular labrum;
    - isolate anterior capsule by passing a curved clamp w/in sheath of psoas tendon;
           - retract femur ant. w/ bone hook to place capsule under tension;
    - carefully divide anterior capsule between the jaws of the clamp;
    - place curved cobra or Hohmann retractor in interval between the anterior lip of acetabulum & psoas tendon;
           - errant placement of this retractor over the psoas tendon may cause injury to femoral nerve or adjacent vessels;
    - if after complete capsulotomy, femur cannot be fully retracted anteriorly, then divide tendinous insertion of maximus leaving a 1 cm cuff of tendon on femur
           for subsequent reattachment

A simple capsulorrhaphy in a posterior approach for total hip arthroplasty.

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