CAPSULAR DETENSIONING IN HIP OSTEOARTHRITÌS

The causes of pain in Hip Osteoarthritìs (OA) can be dìvided in Intra-articular causes (i. e. cartilage or labrum lesions, subcondral bone damages or lose bodies) and Extrarticular causes (i. e. capsule or muscles sufferance. For patients in good generai condition, under eighteens thè first choice of treatment is thè hip replacement that ensures excellent resuits. How orthopaedic surgeons can manage symptomatic hip OA in elderly or fragile patients? We have some possibilities like theraoeutic exercise orpharmacolojical therapies that provide few guarantees in term of clinical evidences. Our experience in recent years has led us to practice a new therapeutic option called Ca.S.L.I. that combines ali thè safer treatments to ensure an effective therapy for older patients. What is thè rationale: thè Ca. S. is for Capsular Streatching. in patient in whom movements are almost lost and deformities are big, thè capsular derived pain is predominant because thè capsule surrounding thè femoral neck, is like a thought collar. So thè first step is thè Capsular detensioning: patient is placed on bed tractions and is praticateti 10 times of tractioning and unloading under fluoroscopy check. The second step is thè articular Lavage: using an hip needle by Anterolateral portai is inflated from 500 cc to 2000 cc of saline solution until thè joint fluid does not become clear. The last step is thè Injection of Hyaluronic Acid and Long acting Corticosteroid to ensure thè pain and inflammation decrease. Since 2014 we treated 22 patients with Ca.S.L.I. procedure with thè mean age oT84 years (range of 78-89 years) with pfimary Hip OA òbtàmmg good results at 12 months follow-up in terms of HHS, VAS, use of NSADs and better function.