Failure of Capsular Enhanced Short External Rotator Repair After Total Hip Replacement

The failure rate of repaired short external rotator muscles was determined in 20 total hip replacements done in 19 patients. The piriformis, both obturator and gemellus muscles, and the capsule were released close to the femur in a single flap leaving the tendon-capsule junction intact. After implantation of the prosthetic components, the flap was transosseously reattached with three grasping stitches, each encompassing the entire tendon-capsule junction. Radiopaque markers were attached to each side of the suture. The distance between markers was measured intraoperatively and then determined on radiographs 1 day and 3 months postoperatively; 25 mm or more and at least double the distance measured intraoperatively indicated failure. In 15 of the 20 hips the repair failed; in three hips the repaired flap was pulled out within the first day, and in 12, within 3 months. Capsular enhanced repairs of the short extensor rotator muscles, using the technique described, largely are unable to withstand forces that occur at the site of repair during the healing process. The quality of other repair techniques should be determined to identify superior techniques.

[1]  A. Vicar,et al.  A Comparison of the Anterolateral, Transtrochanteric, and Posterior Surgical Approaches in Primary Total Hip Arthroplasty , 1984, Clinical orthopaedics and related research.

[2]  W M Goldstein,et al.  Prevalence of Dislocation After Total Hip Arthroplasty Through a Posterolateral Approach with Partial Capsulotomy and Capsulorrhaphy , 2001, The Journal of bone and joint surgery. American volume.

[3]  D. McCollum,et al.  Dislocation after total hip arthroplasty. Causes and prevention. , 1990, Clinical orthopaedics and related research.

[4]  J. Kao,et al.  Piriformis tendon repair failure after total hip replacement. , 1992, Orthopaedic review.

[5]  A. Hedley,et al.  A posterior approach to the hip joint with complete posterior capsular and muscular repair. , 1990, The Journal of arthroplasty.

[6]  R. Robinson,et al.  Comparison of the transtrochanteric and posterior approaches for total hip replacement. , 1980, Clinical orthopaedics and related research.

[7]  I. Kessler.  The “Grasping” Technique for Tendon Repair , 1973, The Hand.

[8]  L. Labey,et al.  Posterior Transosseous Capsulotendinous Repair in Total Hip Arthroplasty: A Cadaver Study , 2002, The Journal of bone and joint surgery. American volume.

[9]  K. Chiu,et al.  Enhanced soft tissue repair using locking loop stitch after posterior approach for hip hemiarthroplasty. , 2001, The Journal of arthroplasty.

[10]  P. Vienne,et al.  Failure of reinserted short external rotator muscles after total hip arthroplasty. , 2002, The Journal of arthroplasty.

[11]  Robert Poss,et al.  Posterior Approach to Total Hip Replacement Using Enhanced Posterior Soft Tissue Repair , 1998, Clinical orthopaedics and related research.

[12]  L.-j. Yuan,et al.  Dislocation after total hip arthroplasty , 1999, Archives of Orthopaedic and Trauma Surgery.

[13]  Richard E. White,et al.  Effect of Posterior Capsular Repair on Early Dislocation in Primary Total Hip Replacement , 2001, Clinical orthopaedics and related research.

[14]  D. Lester,et al.  Mini-Incision Posterior Approach for Hip Arthroplasty , 2001 .

[15]  W. Lo,et al.  The effect of posterior capsulorrhaphy in primary total hip arthroplasty: a prospective randomized study. , 2000, The Journal of arthroplasty.

[16]  M. Jacobs,et al.  Posterior augmentation during closure following total hip arthroplasty. , 1990, Orthopedics.