Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand.
Institute of Legal Medicine, Faculty of Medicine, University of Leipzig, Leipzig, Saxony, Germany.
PLoS One. 2020 Feb 26;15(2):e0229128. doi: 10.1371/journal.pone.0229128. eCollection 2020.
The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.
髋关节囊有助于髋关节和下肢的稳定性，但在全髋关节置换术 (THA) 中，该结构通常会被切开和切除。在过去几十年中，骨关节炎的发病率不断上升，导致 THA 手术数量急剧增加。因此，为了改进这种治疗方法，出现了带囊修复的 THA。与未进行囊修复的传统 THA 相比，这种对髋关节生理稳定性的部分恢复，显著降低了术后脱位率。该手术成功的另一个原因被认为是保留了囊的神经支配。通过 OVID 上的 Amed、Embase 和 Medline 数据库、PubMed、ScienceDirect、Scopus 和 Web of Science 等数据库，对使用组织学技术研究髋关节囊复合体和假性囊神经支配的研究进行了系统回顾，因为这方面的研究尚未得到充分证实。排除了没有组织学成分和涉及动物的文章，共确定了 21 篇关于该主题的文章。文献表明，囊神经支配有两个主要结果和潜在的临床意义。首先，在髋关节力学中起作用，因为机械感受器可能存在于囊内。然而，用于描述神经支配分布的命名法并不一致。此外，目前的文献无法可靠地证实囊的本体感受作用，因为迄今为止没有免疫组织化学研究报告囊内存在 I 型-III 型机械感受器。其次，囊可能在疼痛感知中起作用，因为在疼痛患者中，神经支配的密度似乎发生了改变。此外，随着年龄的增长，可能需要不同的策略来对髋关节囊进行手术管理。然而，这需要进一步研究，以及神经支配根据性别、特定病理和其他形态变量的作用。增加对这些问题的理解可能会强调 THA 后需要进行囊修复、如何进一步发展这种技术以及囊对关节功能和稳定性的贡献。
