POSTERIOR APPROACH WITH POSTERIOR SOFT TISSUE REPAIR IN REVISION TOTAL HIP ARTHROPLASTY

Abstract

Introduction: Despite the advances in total hip arthroplasty (THA), a dislocation after THA remains a disturbing complication. Dislocation after revision hip arthroplasty has been an underemphasized cause of failure in revision hip arthroplasty despite its higher dislocation rate than after primary THA. The effectiveness of posterior soft tissue repair in the posterior approach has been determined in primary THA. However, to the best of our knowledge, there are no reports dealing specifically with the effectiveness of posterior soft tissue repair in the posterior approach in revision hip arthroplasty. We investigated the influence of the posterior approach with soft tissue repair in revision hip arthroplasty by evaluating the rate of early posterior dislocation.

Material and Method: Ninety-one patients (96 hips) who had undergone revision hip arthroplasty through the posterior approach were observed for 1 year or until dislocation occurred. Fifty-six revision hip arthroplasties were performed using the posterior approach with soft tissue repair technique. The results of these procedures were compared with those of 40 revision hip arthroplasties that had been performed using the posterior approach without soft tissue repair.

Results: The dislocation rate of 10.0% in 40 hips using the posterior approach without soft tissue repair was reduced to 1.9% in 56 hips using the posterior approach with soft tissue repair.

Discussion: Considering the results, it is clear that the posterior soft tissue repair in revision hip arthroplasty is clinically important for achieving a lower dislocation rate after revision hip arthroplasty. We suggest that to prevent dislocation after revision hip arthroplasty when a posterior approach is used, the posterior soft tissue, including the capsule and short external rotators, should be preserved and repaired as much as possible.