Capsular Arthroplasty (Modified Codivilla-Colonna)

Capsular arthroplasty of the hip was abandoned for decades until better understanding of the vascular supply to the hip region and consequent intracapsular procedures allowed reconsideration. Safe surgical hip dislocation (SHD), observance of the capsular blood supply, and dissection of the retinacular flap guaranteed optimal quality of the capsular coverage. Shelf acetabular augmentation, relative lengthening of the neck, reduction of femoral head size, as well as femoral shortening and derotation increased the spectrum of indications and helped increase the pelvi-femoral clearance and avoid femoral head necrosis and stiffness. The capsular arthroplasty is a procedure used to treat congenital hip dislocation by wrapping the capsule around the femoral head and relocating it into a newly reamed anatomically located acetabulum. By interposing capsule, like in the Chiari and shelf procedures, load transmission induces metaplasia of the interposed capsular tissue to fibrous cartilage. When properly selected and executed, such hips can last for decades, function well, and facilitate a routine total hip replacement at an appropriate age. Subsequent to the original technique description, the decreasing prevalence of severe developmental dysplasia of the hip (DDH), in addition to historically high rate of complications like stiffness, necrosis, and the need for early revision, led to the near abandonment of the Colonna following the introduction of total hip arthroplasty (THA). This chapter describes indications, surgical technique, and complications and concludes with a summary of results.