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. 2009 Apr;467(4):940-5.
doi: 10.1007/s11999-008-0503-1. Epub 2008 Sep 24.

MRI shows biologic restoration of posterior soft tissue repairs after THA

Paul M Pellicci  1 , Hollis G Potter, Li F Foo, Friedrich Boettner
Affiliations

MRI shows biologic restoration of posterior soft tissue repairs after THA

Paul M Pellicci et al. Clin Orthop Relat Res. 2009 Apr.

Abstract

Although posterior capsule repair reduces the incidence of dislocation after THA, radiographic imaging studies suggest a high failure rate of the repair. Using MRI, we prospectively followed patients to evaluate the integrity of the posterior soft tissue repair after primary THA. Thirty-six patients (21 men, 15 women) underwent arthroplasty using a standard posterior approach. The posterior capsule and external rotators were repaired as separate layers using nonabsorbable sutures through two drill holes in the greater trochanter. Patients observed postoperative hip precautions for 6 weeks after surgery. All patients underwent initial MRI between postoperative Days 2 and 4. Thirty patients returned for followup MRI 3 months after surgery. At 3 months followup, the posterior capsule remained intact in 27 of 30 patients (90%) and the quadratus femoris repair remained intact in 29 of 30 patients (97%). Thirteen of 30 piriformis tendon repairs (43%) and 17 conjoined tendon repairs (57%) showed a gap between the hypointense tendon end and the greater trochanter greater than 25 mm. Our data show repaired posterior soft tissues provide a biologic scaffold allowing formation of a posterior pseudocapsule.

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Figures

Fig. 1A–B
Fig. 1A–B
Axial MR images obtained 3 months after THA show (A) dehiscence of the proximal posterior capsular repair (arrowhead) and (B) an intact distal repair (arrowhead).
Fig. 2A–F
Fig. 2A–F
(A–C): MR images 3 days following total hip arthroplasty. Coronal image through the posterior soft tissue repair (A) demonstrates the piriformis tendon (black arrows) and the obturator internus tendon (black arrowheads) converging towards the greater trochanter (asterisk). Adjacent coronal image (B) demonstrates the distal margins of the tendons apposing the greater trochanter (asterisk) to form an intact posterior soft tissue repair (white arrow). Axial image (C) demonstrates an intact posterior capsule (white arrowheads) attached to the greater trochanter (asterisk). The intact obturator internus tendon repair (black arrowheads and white arrow) is once again noted. (D–F): MR images 3 months following surgery. Coronal image through the posterior soft tissue repair (D) demonstrates mildly thickened and scarred piriformis tendon (black arrows) and the obturator internus tendon (black arrowheads) converging towards the greater trochanter (asterisk). The adjacent coronal image (E) demonstrates the distal margins of the tendons apposing the greater trochanter (asterisk) where there is progressive soft tissue scarring at the site of an intact posterior soft tissue repair (white arrow). Axial image (F) demonstrates an intact and scarred posterior capsule (white arrowheads) attached to the greater trochanter (asterisk). The intact obturator internus tendon repair (black arrowheads and white arrow) is once again noted.
Fig. 3A–B
Fig. 3A–B
(A) An axial MR image obtained 3 days after THA shows an intact posterior capsular (arrowheads) and obturator internus tendon (black arrow) repair without atrophy of the obturator internus muscle (white arrow). (B) A corresponding MR image obtained 3 months after surgery shows interval dehiscence of the posterior soft tissue repair (asterisk) with scarring of the posterior capsule and obturator internus tendon to the posterior acetabular rim (black arrow) and corresponding marked muscle atrophy of the obturator internus (white arrow). Only a small remnant of the repaired posterior capsule remains attached to the greater trochanter (arrowhead).
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/s11420-005-0134-y', 'is_inner': False, 'url': 'https://doi.org/10.1007/s11420-005-0134-y'}, {'type': 'PMC', 'value': 'PMC2504121', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC2504121/'}, {'type': 'PubMed', 'value': '18751839', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/18751839/'}]}
    2. Bottner F, Pellicci PM. Posterior soft tissue repair in primary total hip arthroplasty. HSS Journal. 2006;2:7–11. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0883-5403(00)90220-1', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0883-5403(00)90220-1'}, {'type': 'PubMed', 'value': '10708085', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10708085/'}]}
    2. Chiu FY, Chen CM, Chung TY, Lo WH, Chen TH. The effect of posterior capsulorrhaphy in primary total hip arthroplasty. J Arthroplasty. 2000;15:194–199. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '11685838', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11685838/'}]}
    2. Goldenstein WM, Gleason TF, Kopplin M, Branson JJ. Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorraphy. J Bone Joint Surg Am. 2001;83(suppl 2):2–7. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/01.blo.0000218750.14989.ef', 'is_inner': False, 'url': 'https://doi.org/10.1097/01.blo.0000218750.14989.ef'}, {'type': 'PubMed', 'value': '16741472', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16741472/'}]}
    2. Iorio R, Specht LM, Healy WL, Tilzey JF, Presutti AH. The effect of EPSTR and minimal incision surgery on dislocation after THA. Clin Orthop Relat Res. 2006;447:39–42. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '1538884', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/1538884/'}]}
    2. Kao JT, Woolson ST. Piriformis tendon repair after total hip replacement. Orthop Rev. 1992;21:171–174. - PubMed

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