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

Nicholas M Hernandez; John R Steele; Christine J Wu; Daniel J Cunningham; Gerald K Aggrey; Michael P Bolognesi; Samuel S Wellman

doi:10.1016/j.artd.2020.07.044

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

Arthroplast Today. 2020 Sep 18;6(4):813-818. doi: 10.1016/j.artd.2020.07.044. eCollection 2020 Dec.

Authors

Nicholas M Hernandez¹, John R Steele², Christine J Wu³, Daniel J Cunningham², Gerald K Aggrey², Michael P Bolognesi², Samuel S Wellman²

Affiliations

¹ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
³ Duke University School of Medicine, Durham, NC, USA.

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.

Keywords: Capsular repair; Dislocation; Posterior approach; Total hip arthroplasty.