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. 2012 Feb;470(2):511-5.
doi: 10.1007/s11999-011-2113-6.

Surgical technique: a simple soft-tissue-only repair of the capsule and external rotators in posterior-approach THA

James A Browne  1 , Mark W Pagnano
Affiliations

Surgical technique: a simple soft-tissue-only repair of the capsule and external rotators in posterior-approach THA

James A Browne et al. Clin Orthop Relat Res. 2012 Feb.

Abstract

Background: Posterior soft tissue repair after posterior THA reportedly decreases the risk of dislocation. Previously described techniques often require drill holes through the greater trochanter, do not include both the short external rotators and the capsule, or require a complex series of multiple sutures. We therefore describe a technique to address these issues.

Description of technique: The posterior soft tissues were repaired with a single nonabsorbable suture passed through the external rotators and posterior capsule and then through the capsule and posterior border of minimus in a figure-of-eight pattern. This repair remains pliable and obliterates the dead space.

Methods: We retrospectively reviewed 165 patients who underwent 178 primary THAs through a mini-posterior THA and also underwent soft tissue repair using our technique. We determined the rate of dislocation and complications associated with this technique. The minimum clinical followup was 1 year (mean, 23 months; range, 12-37 months).

Results: This repair was associated with a low risk of dislocation at 1 year (one of 178 hips, 0.56%) and no apparent complications related to the technique.

Conclusions: This soft tissue to soft tissue repair technique after posterior-approach THA is technically straightforward and reliable with a low associated dislocation rate.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–F
Fig. 1A–F
(A) The repair begins by passing a Number 5 Ethibond® suture from outside to inside through the piriformis tendon and posterior-superior hip capsule. (B) The suture is then passed from the inside of the anterior-superior capsule through the posterior-superior edge of the gluteus minimus tendon. (C) The second pass is started 1 cm more distally and passed from outside to inside through the gemelli and posterior-inferior capsule. (D) The final pass is from the inside of the anterior-superior capsule through the posterior-superior edge of the gluteus minimus tendon. (E) The suture forms a figure-of-eight pattern and is tied. (F) The final repair demonstrates elimination of any dead space between the metal prosthetic head and the posterior capsule.
See this image and copyright information in PMC

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