Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;10(Suppl 1):S247-S251.
doi: 10.1016/j.jcot.2019.03.014. Epub 2019 Mar 22.

A novel single myocapsular sleeve (SMS) repair technique to reduce dislocation in posterior approach to the hip: A clinico-radiographic study

Chandra Shekhar Yadav  1 , Samarth Mittal  1 , Swapnil Singh  1 , Shivanand Gamanagatti  2 , Sumit Anand  1 , Ashok Kumar  3
Affiliations

A novel single myocapsular sleeve (SMS) repair technique to reduce dislocation in posterior approach to the hip: A clinico-radiographic study

Chandra Shekhar Yadav et al. J Clin Orthop Trauma. 2019 Oct.

Erratum in

  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1169-1171. doi: 10.1016/j.jcot.2020.09.032. Epub 2020 Sep 26. J Clin Orthop Trauma. 2020. PMID: 33013141 Free PMC article.
  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Orthop Trauma. 2021 Aug 5;21:101556. doi: 10.1016/j.jcot.2021.101556. eCollection 2021 Oct. J Clin Orthop Trauma. 2021. PMID: 34414070 Free PMC article.

Abstract

Background: To assess a new modification of posterior approach to the hip and its effect on stability and functional outcome in total hip arthroplasty.

Material & methods: A comparative retrospective study was done to assess the functional outcome and rate of dislocation among 233 hips (Group A) operated by conventional posterior approach and 567 hips (Group B) by our novel modified posterior approach. In this technique, 2-3 stay sutures are applied in external rotators, then a single conjoint-myocapsular sleeve is raised linearly over the capsule with adherent fibers of gluteus minimus to piriformis tendon, short rotators and part of quadratus for exposure of femoral head. After inserting the definite prosthesis, upper part of sleeve (capsule, piriformis tendon) is sutured at the lower part of tip of greater trochanter & lower part with lateral trochanteric bone. Fifty patients, using randomised tables, in group B underwent MRI to evaluate the efficacy of the repair at 1 and 12 weeks postoperatively.

Results: Average Harris hip score at minimum 3.9 year follow up was 83.2 in Group A & 88.7 in Group B. Group B had only one dislocation (0.176%) while Group A had 12 dislocations (5.15%). MRI showed intact repair in 47 patients (94%); fibrous continuity in 2 patients (6%) in group B patients.

Conclusion: Intermediate results shows that this technique provides enhanced stability and improved functional outcome. But more prospective and randomised controlled studies with long term followup are required to confirm its role in prevention of hip dislocations.

Keywords: Dislocation; Hip arthroplasty; Posterior hip approach; SMS technique; Single myocapsular sleeve.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Clinical Image showing non absorbable ethibond no. 5 being tied to gluteus minimus, piriformis tendon, superior gamellus, obturator internus, inferior gamellus and some part of quadratus femoris.
Fig. 2
Fig. 2
Clinical image showing lifting of the tagged structures after using a electro cautery to dissect the tissues in a single myocapsular sleeve.
Fig. 3
Fig. 3
Clinical image showing status of single myocapsular sleeve after placement of total hip implant.
Fig. 4
Fig. 4
Clinical image showing needle of first suture (containing capsule, piriformis tendon, upper part of short external rotators and part of gluteus minimus) after being passed through the tip of greater trochanter.
Fig. 5
Fig. 5
Clinical image showing needle of subsequent sutures containing lower part of short external rotators of the hip and superior part of quadratus femoris after being passed through the postero lateral border of greater trochanter.
Fig. 6
Fig. 6
Clinical image showing completed repair of deep posterior structures.
Fig. 7
Fig. 7
Axial MR image following THA showing an intact myocapsular repair {posterior capsule (arrows) and obturator internus tendon (block arrow)}.
Fig. 8
Fig. 8
Axial MR image following THA showing dehiscence of the proximal posterior capsular repair as shown by fluid collection (arrow).
See this image and copyright information in PMC

References

    1. Pellicci P.M., Potter H.G., Foo L.F., Boettner F. MRI shows biologic restoration of posterior soft tissue repairs after THA. Clin Orthop. Apr. 2009;467(4):940–945. - PMC - PubMed
    1. Vasilakis I., Solomou E., Vitsas V., Fennema P., Korovessis P., Siamblis D.K. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA. Orthopedics. Dec. 2012;35(12):e1684–e1691. - PubMed
    1. Gibson A. Posterior exposure of the hip joint. J Bone Joint Surg Br Vol. May 1950;32-B(2):183–186. - PubMed
    1. Fackler C.D., Poss R. Dislocation in total hip arthroplasties. Clin Orthop. Sep. 1980;151:169–178. - PubMed
    1. McCollum D.E., Gray W.J. Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop. Dec. 1990;261:159–170. - PubMed