The complete hip capsular ligament system comprises the iliofemoral Y-ligament (strongest), pubofemoral ligament (anteromedial), ischiofemoral ligament (posterior), and the zona orbicularis (circular fibres), collectively forming the strongest joint capsule in the body.
Together, these four ligamentous components provide complete hip joint containment, resisting hyperextension (iliofemoral), abduction and external rotation (pubofemoral), internal rotation and extension from flexion (ischiofemoral), and circumferential radial containment (zona orbicularis).
Total hip arthroplasty approaches are defined by which capsular component is sacrificed — posterior approach sacrifices ischiofemoral; anterior approach risks iliofemoral; anterolateral approach divides parts of both. Comprehensive capsular repair reduces dislocation risk in all approaches.
Posterior approach THA requires ischiofemoral and posterior capsule repair; anterior approach THA preserves the posterior capsule — the approach determines the dislocation risk pattern and the repair strategy required.
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