IMPACT OF JOINT CAPSULE REPAIR AND EXTERNAL ROTATORS SUTURE ON PROGNOSIS IN PRIMARY TOTAL HIP ARTHROPLASTY BY POSTEROLATERAL APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Pengcheng , XU Neng , JIANG Fugui , ZHU Lifan , WENG Fengbiao , WANG Youhua.

Department of Orthopedics, the First People’s Hospital of Wujiang City &;
Wujiang Hospital, Affiliated to Nantong University, Wujiang Jiangsu, 215200, P.R.China. Corresponding author: WANG Youhua, E-mail: wangyouhuantu@126.com;

Corresponding author：

Keywords：

Total hip arthroplasty; External rotators suture; Joint capsule repair; Hip dislocation

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Objective To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty (THA) by posterolateral approach. Methods Between January 2006 and June 2009, 159 patients with femoral neck fracture underwent primary THA by posterolateral approach, and were divided into 4 groups according to different treatments: joint capsule repair and external rotators suture were given in group A (n=38), only joint capsule repair in group B (n=39), only external rotators suture in group C (n=41), and no joint capsule repair or external rotators suture in group D (n=41). There was no significant difference in gender, age, cause of injure, disease duration, type of fracture, combined medical disease, or prosthesis selection among 4 groups (P gt; 0.05). The bleeding volume, drainage, postoperative hip dislocation rate, hip Harris score, and the hip range of motion (ROM) in internal rotation and external rotation were compared. Results There was no significant difference in operative time, bleeding volume, or drainage among 4 groups (P gt; 0.05). Postoperative hip dislocation occurred in 0, 0, 4 (9.8%), and 4 (9.8%) cases of groups A, B, C, and D, respectively, showing significant difference in incidence of postoperative hip dislocation among 4 groups (χ2=7.910, P=0.048). The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups (P lt; 0.05). Significant differences were found in hip Harris score at 6 weeks and 6 months after operation among 4 groups (P lt; 0.05); group D was significantly lower than groups A, B, and C, and groups B and C were significantly lower than group A (P lt; 0.05). There was no significant difference in the hip ROM in internal rotation among 4 groups at 6 weeks and 6, 12 months after operation (P gt; 0.05); but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation (P lt; 0.05). Conclusion Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage, but can reduce the early postoperative hip dislocation risk, increase the Harris score, and recover the external rotation function of involved hip. So joint capsule and external rotators should be repaired in THA by posterolateral approach.

Citation： SHEN Pengcheng,XU Neng,JIANG Fugui,ZHU Lifan,WENG Fengbiao,WANG Youhua.. IMPACT OF JOINT CAPSULE REPAIR AND EXTERNAL ROTATORS SUTURE ON PROGNOSIS IN PRIMARY TOTAL HIP ARTHROPLASTY BY POSTEROLATERAL APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(11): 1300-1305. doi: Copy

1.	Mihalko WM, Whiteside LA. Hip mechanics after posterior structure repair in total hip arthroplasty. Clin Orthop Relat Res, 2004, (420): 194-198.
2.	Sculeo TP,Moran MC. Posterior tenocapsulorthappy in primary total hip arthroplasty.American Academy of Orthop Surgeons. Anaheim: 1991.
3.	Kao JT, Woolson ST. Piriformia tendon repair failure after total hip replacement. Orthop Rev, 1992, 21(2): 171-174.
4.	Stähelin T, Vienne P, Hersche O. Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplasty, 2002, 17(5): 604-607.
5.	Robbins GM, Masri BA, Garbuz DS, et al. Treatment of hip instability. Orthop Clin North Am, 2001, 32(4): 593-610, viii.
6.	Yamaguchi T, Nation M, Asayama I, et al. The effect of posterolateral reconstruction on range of motion and strength in total hip arthroplasty. J Arthroplasty, 2003, 18(3): 347-351.
7.	Ko CK, Law SW, Chiu KH. Enhanced soft tissue repair using locking loop stitch after posterior approach for hiphemiarthroplasty. J Arthroplasty, 2001, 16(2): 207-211.
8.	Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res, 2004, (418): 162-167.
9.	Ji HM, Kim KC, Lee YK, et al. Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplasty, 2012, 27(3): 378-385.
10.	Chiu FY, Chen CM, Chung TY, et al. The effect of posterior capsulorrhaphy in primary total hip arthroplasty. J ArthropIasty, 2000, 15(2): 194-199.
11.	Khan JT, Yao F, Li M, et al. Capsular-enhanced repair of the short external rotators after total hip arthroplasty. J ArthropIasty, 2007, 22(6): 840-843.
12.	Chivas DJ, Smith K, Tanzer M. Role of capsular repair on dislocation in revision total hip arthroplasty. Clin Orthop Relat Res, 2006, (453): 147-152.
13.	Stahelin T, Drittenbass L, Hersece O, et al. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res, 2004, (420): 199-204.
14.	Osmani O, Malkani A. Posterior capsular repair following total hip arthroplasty: a modified technique. Orthopedics, 2004, 27(6): 553-555.
15.	White RE Jr, Forness TJ, Allman JK, et al. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res, 2001, (393): 163-167.
16.	李永奖, 张力成, 杨国敬, 等. 后方关节囊修补预防全髋关节置换术后早期脱位. 中国矫形外科杂志, 2006, 14(12): 891-894.
17.	李永奖, 张力成, 杨国敬, 等. 人工全髋关节置换术后早期假体脱位的原因及防治措施. 中国中医骨伤科杂志, 2007, 15(2): 1-3．.
18.	Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
19.	Tarasevicius S, Kesteris U, Kalesinskas RJ, et al. Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty. Int Orthop, 2006, 30(4): 233-236.
20.	张磊, 李熙雷, 董健, 等. 修复关节囊及外旋肌群对预防全髋关节置换术后关节脱位的作用. 中华创伤骨科杂志, 2008, 10(12): 1138-1140.

1. Mihalko WM, Whiteside LA. Hip mechanics after posterior structure repair in total hip arthroplasty. Clin Orthop Relat Res, 2004, (420): 194-198.
2. Sculeo TP,Moran MC. Posterior tenocapsulorthappy in primary total hip arthroplasty.American Academy of Orthop Surgeons. Anaheim: 1991.
3. Kao JT, Woolson ST. Piriformia tendon repair failure after total hip replacement. Orthop Rev, 1992, 21(2): 171-174.
4. Stähelin T, Vienne P, Hersche O. Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplasty, 2002, 17(5): 604-607.
5. Robbins GM, Masri BA, Garbuz DS, et al. Treatment of hip instability. Orthop Clin North Am, 2001, 32(4): 593-610, viii.
6. Yamaguchi T, Nation M, Asayama I, et al. The effect of posterolateral reconstruction on range of motion and strength in total hip arthroplasty. J Arthroplasty, 2003, 18(3): 347-351.
7. Ko CK, Law SW, Chiu KH. Enhanced soft tissue repair using locking loop stitch after posterior approach for hiphemiarthroplasty. J Arthroplasty, 2001, 16(2): 207-211.
8. Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res, 2004, (418): 162-167.
9. Ji HM, Kim KC, Lee YK, et al. Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplasty, 2012, 27(3): 378-385.
10. Chiu FY, Chen CM, Chung TY, et al. The effect of posterior capsulorrhaphy in primary total hip arthroplasty. J ArthropIasty, 2000, 15(2): 194-199.
11. Khan JT, Yao F, Li M, et al. Capsular-enhanced repair of the short external rotators after total hip arthroplasty. J ArthropIasty, 2007, 22(6): 840-843.
12. Chivas DJ, Smith K, Tanzer M. Role of capsular repair on dislocation in revision total hip arthroplasty. Clin Orthop Relat Res, 2006, (453): 147-152.
13. Stahelin T, Drittenbass L, Hersece O, et al. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res, 2004, (420): 199-204.
14. Osmani O, Malkani A. Posterior capsular repair following total hip arthroplasty: a modified technique. Orthopedics, 2004, 27(6): 553-555.
15. White RE Jr, Forness TJ, Allman JK, et al. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res, 2001, (393): 163-167.
16. 李永奖, 张力成, 杨国敬, 等. 后方关节囊修补预防全髋关节置换术后早期脱位. 中国矫形外科杂志, 2006, 14(12): 891-894.
17. 李永奖, 张力成, 杨国敬, 等. 人工全髋关节置换术后早期假体脱位的原因及防治措施. 中国中医骨伤科杂志, 2007, 15(2): 1-3．.
18. Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
19. Tarasevicius S, Kesteris U, Kalesinskas RJ, et al. Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty. Int Orthop, 2006, 30(4): 233-236.
20. 张磊, 李熙雷, 董健, 等. 修复关节囊及外旋肌群对预防全髋关节置换术后关节脱位的作用. 中华创伤骨科杂志, 2008, 10(12): 1138-1140.

Chinese Journal of Reparative and Reconstructive Surgery

IMPACT OF JOINT CAPSULE REPAIR AND EXTERNAL ROTATORS SUTURE ON PROGNOSIS IN PRIMARY TOTAL HIP ARTHROPLASTY BY POSTEROLATERAL APPROACH

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