DEVELOPING AN EFFECTIVE SHORT EXTERNAL ROTATOR REPAIR OF THE HIP FOLLOWING POSTERIOR APPROACH FOR TOTAL HIP REPLACEMENT

Abstract

Dislocation is a recognised complication following the posterior approach in total hip arthroplasty. The senior surgeons involved in this study had routinely repaired the short external rotators and capsule by directly suturing ‘tendon to tendon’ and ‘capsule to capsule’ using No 1 Vicryl®. Over a two-year period this had no impact on the incidence of dislocation as compared to “no soft tissue repair” that had been done historically. In order to assess the effectiveness of ‘soft tissue to soft tissue’ repair fifteen patients were assessed using radiographic markers inserted during surgery. In 14 of the 15 patients the repair was found to have failed by the time of the post-operative x-ray which was taken on day 3 to 5. Since then we have changed the repair so that the capsule and rotators are reattached to bone with No 5 Ethibond® using drill holes in the trochanteric region. This modification was evaluated using the same method. Of 15 patients in the second type of repair only 2 showed a failure of repair on the post operative X-ray. This appears to be a more secure form of repair. The impact of this on the incidence of dislocation is being evaluated.