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A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach

ABSTRACT: Background Dislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach. Methods From September of 2008 to August of 2019, we evaluated 841 THAs performed by a single surgeon using a posterior approach. Before November of 2015, the capsule was repaired to the greater trochanter (group 1, 605 patients). Starting November 2015, the posterior capsule was repaired in a side-to-side fashion (direct soft-tissue repair) (group 2, 236 patients). There was a mean follow-up of 31.1 months (range, 2.5-122.5 months). A multivariable logistic regression model was constructed to assess the impact of baseline patient and operative factors on the dislocation rate. Results There were 22 dislocations, all of which occurred in group 1. There were no dislocations in group 2. After adjusting for patient and operative factors, the direct soft-tissue repair had a large impact on the overall multivariable model as indicated by its effect likelihood ratio of 10.33 (P = .001); however, the odds ratio was not calculable for this factor, given that there were no dislocations in hips with direct soft-tissue repair. Increasing age was associated with an increased odds of dislocation (odds ratio, 1.04, P = .017), with an effect likelihood ratio of 6.25 (P = .012). Conclusions Switching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.

SUBMITTER: Hernandez N

PROVIDER: S-EPMC7509067 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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MAASH Technique for Total Hip Arthroplasty: A Capsular Work.

Project description:BackgroundDislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure.PurposesModified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the "weak area" of the capsule, in the so called "internervous safe zone" and introducing the "box concept" for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier.MethodsFrom November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique.ResultsMAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development.ConclusionMAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.

| S-EPMC3757492 | biostudies-literature

Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty.

Project description:Dislocation after total hip replacement is more common in the early, postoperative period. Postoperative intraarticular haematoma and remaining seroma fluid and/or weakened posterior soft tissue wall may be contributing factors. Our purpose was to compare and follow with sonography the resorption of the postoperative volume of intraarticular fluid/synovial oedema after total hip arthroplasty (THA) with or without posterior soft tissue repair. Thirty-three consecutive patients with hip osteoarthritis were admitted for THA. All of them received the same type of cemented implant. Patients were randomised for posterior soft tissue repair or not. Sonography, measuring the anterior capsular distension, indicating the volume of intraarticular fluid/synovial oedema in the prosthetic hip joints, was performed after six and 12 months in all patients. At six months postoperatively greater capsular distension, i.e., remaining volume of intraarticular fluid/synovial oedema, was observed in the group with posterior soft tissue repair than in the group without. After one year the capsular distension had decreased in both groups and there was no significant difference between the groups. Our results show that posterior soft tissue repair after THA is associated with increased capsular distension during the first six months. After 12 months the volume of intraarticular fluid/synovial oedema is the same with or without posterior soft tissue repair.

| S-EPMC2532125 | biostudies-other

A Simple Technique for Capsular Repair After Hip Arthroscopy.

Project description:Capsulotomy is typically performed during arthroscopic treatment for femoroacetabular impingement. As the frequency of hip arthroscopy continues to expand rapidly, increased attention is being paid to the implications of interportal capsulotomy and the need for repair. To minimize the risk of postoperative instability, capsular closure has been recommended to restore the anatomy and biomechanical function of the capsule. We present a reliable, efficient, and effective method for arthroscopic closure of the interportal capsulotomy after hip arthroscopy.

| S-EPMC4739034 | biostudies-literature

Combined anteversion technique for total hip arthroplasty.

Project description:Combined cup and stem anteversion in THA based on femoral anteversion has been suggested as a method to compensate for abnormal femoral anteversion. We investigated the combined anteversion technique using computer navigation. In 47 THAs, the surgeon first estimated the femoral broach anteversion and validated the position by computer navigation. The broach was then measured with navigation. The navigation screen was blocked while the surgeon estimated the anteversion of the broach. This provided two estimates of stem anteversion. The navigated stem anteversion was validated by postoperative CT scans. All cups were implanted using navigation alone. We determined precision (the reproducibility) and bias (how close the average test number is to the true value) of the stem position. Comparing the surgeon estimate to navigation anteversion, the precision of the surgeon was 16.8 degrees and bias was 0.2 degrees ; comparing the navigation of the stem to postoperative CT anteversion, the precision was 4.8 degrees and bias was 0.2 degrees , meaning navigation is accurate. Combined anteversion by postoperative CT scan was 37.6 degrees +/- 7 degrees (standard deviation) (range, 19 degrees -50 degrees ). The combined anteversion with computer navigation was within the safe zone of 25 degrees to 50 degrees for 45 of 47 (96%) hips. Femoral stem anteversion had a wide variability.Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

| S-EPMC2600986 | biostudies-other

The effect of posterior capsule repair in total hip arthroplasty: a systematic review and meta-analysis.

Project description:BackgroundPrior studies have compared the posterior capsule repair group in primary total hip arthroplasty by posterior approach with the control group without posterior capsule repair suggesting that the posterior capsule repair group had better clinical outcomes. However, it is still a controversy which treatment is more helpful for hip diseases. The purpose of our article is to obtain the postoperative outcomes between the 2 procedures.MethodsWe performed a systematic search by browsing the MEDLINE, EMBASE, Cochrane Library. There is no restriction on the date of publication. Before we submit our manuscript, we have re-searched the literatures again, including the articles which directly compared the postoperative outcomes of the 2 procedures.ResultsA total of 8 comparative studies were included in our meta-analysis. The posterior capsule repair group showed less dislocation rate, higher HHS, and even less postoperative bleeding volume. Meanwhile, there is no significant difference in ROM between 2 groups.ConclusionIn conclusion, according to current evidences, repairing posterior capsule during primary THA may have better functional outcomes, less dislocation incidence, and less loss of blood.

| S-EPMC7175585 | biostudies-literature

The Patient With Chronic Total Hip Arthroplasty Dislocations: A Case Series of Five Patients Who Underwent Revision THA Using Polypropylene Mesh for Capsular Reconstruction.

Project description:We report a case series of 5 patients who underwent revision total hip arthroplasty (THA) using a polypropylene mesh for capsular reconstruction for chronic THA instability. The average follow-up is 16.6 months (range, 9-20 months). There were no postoperative dislocations in our series. Three patients had previous infections with two-stage revisions before final revision surgery and were infection free at their most recent follow-up. One patient developed a prosthetic joint infection 2 months postoperatively. The use of a polypropylene mesh appears to be another tool that surgeons can use when dealing with the difficult dilemma on how to treat the patient with chronic THA instability and severe abductor and capsular tissue loss.

| S-EPMC7451887 | biostudies-literature

The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty.

Project description:IntroductionRecurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene.Materials and methodsThe regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included.ResultsThe rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2-2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models.ConclusionBearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

| S-EPMC8443492 | biostudies-literature

Direct Anterior Cup-Half Cage for Revision and Complex Primary Total Hip Arthroplasty: Surgical Technique.

Project description:As surgeons' comfort with the direct anterior approach (DAA) for total hip arthroplasty continues to increase, there is a growing interest in performing complex surgeries through this approach. Acetabular bone loss and/or pelvic discontinuity in the primary or revision setting often requires specialized implants such as a cup-cage construct. We describe our surgical technique for implanting modified cup-half cages through the DAA and show 2 case examples of how this technique was utilized in the setting of complex acetabular bone loss. In our experience, this is an effective method for complex total hip arthroplasty, with the potential added benefits of the DAA of reduced soft-tissue dissection, direct measurement of leg length, and ease of fluoroscopic navigation for implant positioning.

| S-EPMC9184889 | biostudies-literature

Intraoperative bladder perforation during primary total hip arthroplasty.

Project description:We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality. Management of bladder injury, should it occur, includes bladder decompression with a Foley catheter, antibiotic administration, hemodynamic monitoring, and urology consult with close follow-up. This case reinforces the importance of urologic preoperative evaluation for anatomic variations of the bladder. In such cases, intraoperative Foley catheters to prevent distension may reduce the risk of perforation.

| S-EPMC5859462 | biostudies-literature

Key performance and training parameters in primary total hip arthroplasty - an expert consensus using the Delphi technique.

Project description:AimsPrimary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome.Materials and methodsThe Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3.Results50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching.ConclusionsThe results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.

| S-EPMC10170576 | biostudies-literature

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