The “capsular noose”: A new capsular repair technique to diminish dislocation risk after the posterior approach total hip arthroplasty

Post-operative hip dislocation has been commonly associated with primary THA as a troublesome complication after posterior approach. Although several other risk factors have been implicated, techniques of capsular repair and closure have also been described. A new technique for repair of the capsule...

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Bibliographic Details
Published in:	International journal of surgery open Vol. 17; pp. 8 - 14
Main Authors:	Swanson, Todd V., Kukreja, Mohit M., Ballard, James C., Calleja, Henry G.M., Brown, Jonathon M.
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 2019
Subjects:	Capsular noose Capsular repair Capsule Dislocation Posterior approach Total hip arthroplasty Capsular noose Capsule Capsular repair Posterior approach Total hip arthroplasty Dislocation
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Summary:	Post-operative hip dislocation has been commonly associated with primary THA as a troublesome complication after posterior approach. Although several other risk factors have been implicated, techniques of capsular repair and closure have also been described. A new technique for repair of the capsule after posterior, minimally invasive, total hip arthroplasty is described. In Part A of this two-part study, 133 classic repairs of the capsule and external rotators to the greater trochanter (Group 1) were retrospectively compared to 144 capsular noose repairs (Group 2). After minimum 24-month follow up, dislocation was more common in Group 1 than in Group 2 (5.3% vs. 0.69%, p = 0.02). In Part B, 20 consecutive patients were tested intra-operatively for torque and internal rotation to dislocation using three capsular repair techniques. The capsular noose repair provided greater resistance to dislocation than no repair (p < 0.01) and to simulated classic repair (p < 0.05). The capsular noose repair may reduce dislocation risk after posterior approach total hip arthroplasty. •This repair tightens the capsule around the neck of the prosthetic femoral component similar to a noose.•It acts by obliterating dead space and reconstructing the posterior tension band effect of the capsule.•Advancing the posterior capsule and external rotators as a flap to the superior capsule provides for a solid repair.•Maintenance of the piriformis insertion may add additional posterior stability and external rotation strength.•It provides a physiologic and mechanical restraint superior to the traditional posterior soft-tissue repair techniques.
ISSN:	2405-8572 2405-8572
DOI:	10.1016/j.ijso.2018.12.005