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

• 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
• ISSN: 2405-8572; 2405-8572
• DOI: 10.1016/j.ijso.2018.12.005

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.