THE ROLE OF CAPSULAR CHANGES IN OSTEOARTHRITIS OF THE HIP JOINT

¹ Institute of Orthopaedics, Royal National Orthopaedic Hospital

1. The synovial membrane and capsule in osteoarthritis of the hip have been studied in twenty-five cases. Dissections have been made on fresh cadavers to establish the normal structure and function of these tissues at different ages.

2. Fragments of bone and cartilage were found beneath the synovial surface in twenty-three cases of the twenty-five cases of osteoarthritis.

3. The source of these fragments is the degenerate articular surfaces.

4. The fibrosis of the synovial membrane and capsule follows the synovial hyperplasia which accompanies the phagocytosis of these fragments.

5. A similar histological picture has been produced by injecting fragmented cartilage into the knee joints of rabbits. The injected fragments are found beneath the surface, and synovial hyperplasia is followed by subsynovial fibrosis.

6. The greatest amount of this joint debris is found in the lowest part of the joint cavity.

7. The joint capsule is particularly sensitive to traction.

8. All parts of the capsule are tight in extension, which is the weight-bearing position.

9. Fibrotic shortening of the capsule in the lowest part of the joint cavity explains many of the symptoms and signs of the disease: pain is caused by an attempt to stretch the capsule; muscle spasm occurs in the muscles supplied by the sensory nerves of this part of the capsule; extension, medial rotation and abduction, which tighten this area, are lost first; progressive shortening causes deformity in the opposite direction, namely flexion, lateral rotation and adduction; the loss of extension causes a more rapid wearing of articular cartilage on weight bearing; subperiosteal new bone is formed on the under-surface of the neck of the femur.

10. The symptomatology is discussed.