Surgical Technique: a Simple Soft-tissue-only Repair of the Capsule and External Rotators in Posterior-approach THA

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2011 Oct 13

PMID 21989783

Citations 24

Authors

James A Browne

Mark W Pagnano

Affiliations

Soon will be listed here.

Abstract

Background: Posterior soft tissue repair after posterior THA reportedly decreases the risk of dislocation. Previously described techniques often require drill holes through the greater trochanter, do not include both the short external rotators and the capsule, or require a complex series of multiple sutures. We therefore describe a technique to address these issues.

Description Of Technique: The posterior soft tissues were repaired with a single nonabsorbable suture passed through the external rotators and posterior capsule and then through the capsule and posterior border of minimus in a figure-of-eight pattern. This repair remains pliable and obliterates the dead space.

Methods: We retrospectively reviewed 165 patients who underwent 178 primary THAs through a mini-posterior THA and also underwent soft tissue repair using our technique. We determined the rate of dislocation and complications associated with this technique. The minimum clinical followup was 1 year (mean, 23 months; range, 12-37 months).

Results: This repair was associated with a low risk of dislocation at 1 year (one of 178 hips, 0.56%) and no apparent complications related to the technique.

Conclusions: This soft tissue to soft tissue repair technique after posterior-approach THA is technically straightforward and reliable with a low associated dislocation rate.

Level Of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Citing Articles

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Approaching total hip arthroplasty after Legg-Calvé-Perthes disease: A case series and literature review.

Tong Y, Ihejirika-Lomedico R, Rathod P, Deshmukh A J Clin Orthop Trauma. 2024; 53:102478.

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Selective THA-approach use amongst junior surgeons improves safety of introducing the anterior approach: a prospective, multi-surgeon, comparative, study.

Verhaegen J, Ojaghi R, Kim P, Schwarz A, Bingham J, Grammatopoulos G Arch Orthop Trauma Surg. 2023; 143(11):6829-6836.

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Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice.

Gulbrandsen T, Muffly S, Shamrock A, OReilly O, Bedard N, Otero J Iowa Orthop J. 2022; 42(1):127-136.

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Randomized Clinical Study on the Efficacy of Direct Anterior Approach Combined With Tendon Release and Repair After Total Hip Arthroplasty.

Li G, Chen Q, Zhou W, Li P, Ma P, Liu T Front Surg. 2022; 9:845478.

PMID: 35388359 PMC: 8978716. DOI: 10.3389/fsurg.2022.845478.

References

Pagnano M, Trousdale R, Meneghini R, Hanssen A . Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique. J Bone Joint Surg Am. 2009; 91 Suppl 2 Pt 1:50-73. DOI: 10.2106/JBJS.H.01531. View

Malkani A, Ong K, Lau E, Kurtz S, Justice B, Manley M . Early- and late-term dislocation risk after primary hip arthroplasty in the Medicare population. J Arthroplasty. 2010; 25(6 Suppl):21-5. DOI: 10.1016/j.arth.2010.04.014. View

Dixon M, Scott R, Schai P, Stamos V . A simple capsulorrhaphy in a posterior approach for total hip arthroplasty. J Arthroplasty. 2004; 19(3):373-6. DOI: 10.1016/j.arth.2003.10.002. View

Chiu F, Chen C, Chung T, Lo W, Chen T . The effect of posterior capsulorrhaphy in primary total hip arthroplasty: a prospective randomized study. J Arthroplasty. 2000; 15(2):194-9. DOI: 10.1016/s0883-5403(00)90220-1. View

Goldstein W, Gleason T, Kopplin M, Branson J . Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy. J Bone Joint Surg Am. 2001; 83-A Suppl 2(Pt 1):2-7. DOI: 10.2106/00004623-200100021-00002. View

Berry D, von Knoch M, Schleck C, Harmsen W . Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am. 2005; 87(11):2456-63. DOI: 10.2106/JBJS.D.02860. View

Stahelin T, Drittenbass L, Hersche O, Miehlke W, Munzinger U . Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res. 2004; (420):199-204. DOI: 10.1097/00003086-200403000-00028. View

Tsai S, Wang C, Jiang C . The effect of posterior capsule repair upon post-operative hip dislocation following primary total hip arthroplasty. BMC Musculoskelet Disord. 2008; 9:29. PMC: 2292160. DOI: 10.1186/1471-2474-9-29. View

White Jr R, Forness T, Allman J, Junick D . Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res. 2002; (393):163-7. DOI: 10.1097/00003086-200112000-00019. View

10.

Pellicci P, Bostrom M, Poss R . Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res. 1999; (355):224-8. DOI: 10.1097/00003086-199810000-00023. View

11.

Hedley A, Hendren D, Mead L . A posterior approach to the hip joint with complete posterior capsular and muscular repair. J Arthroplasty. 1990; 5 Suppl:S57-66. DOI: 10.1016/s0883-5403(08)80027-7. View