Abstract
Introduction
The use of less invasive techniques for total hip arthroplasty (THA) has remained controversial with some studies showing a higher incidence of complications. The technique of performing total hip arthroplasty through a superior capsulotomy was developed to maximally preserve the soft tissue envelope surrounding the hip. The current study assesses the recovery and complications of hips replaced using conventional and tissue preserving techniques.
Methods
206 hips in 191 patients with a mean follow-up of 4.3 ± 1.0 (range, 3.2 – 5.9) years underwent total hip arthroplasty using the superior capsulotomy technique. The mean age at operation was 55.7 ± 12.9 (19 – 85) years and the operation was performed for 106 hips (51%) in men. The surgical technique involves exposing the superior hip joint capsule posterior to the medius and minimus, and anterior to the short external rotators. The femur is prepared with the femoral head in place and then the femoral head is excised without dislocation. These 206 hips were compared to a cohort of 279 hips replaced using the transgluteal exposure (control group). These 2 series were controlled for complexity and demographic factors. Recovery was evaluated using the Merle d'Aubigné score at 6 and 12 weeks postoperatively.
Results
Two of the 206 hips (1%) replaced using the superior capsulotomy have been revised, one for failure of osseointegration of a nonmodular CoCr acetabular component and one for fracture of a ceramic liner at 21 months. In addition, there were 3 surgical complications. These included one intraoperative and one postoperative nondisplaced trochanteric fracture treated nonoperatively and one anterior hip dislocation. Assessment of the control group demonstrated five revisions: one for recurrent dislocation, two for failure of osseointegration of the femoral component, one for malseating of an acetabular liner, and one for fracture of a ceramic liner. Four hips developed trochanteric wafer nonunions of which 2 required repair. There was one intraoperative trochanteric fracture and two postoperative displaced trochanteric fractures requiring repair. Three hips sustained intraoperative femoral cracks that were cerclaged, and one pelvis sustained a posterior wall fracture that was repaired at surgery. There were two arthrotomies, one for treatement of infection and one for suspected infection. The complication rate was significantly higher in the control group than in the study group. Compared to the control group, the hips replaced using the superior capsulotomy technique had significantly higher hip scores at the 1st and 2nd followup: 1st f/u Merle D'Aubigné score of 15.6 ± 1.6 (9 – 18) vs 13.1 ± 1.8 (8 – 18) and 2nd f/u 17.1 ± 1.1 (13 – 18) vs 16.2 ± 1.6 (10 – 18).
Conclusion
These results suggest that the superior capsulotomy technique, with the goal of soft tissue preservation, is a safe and reliable method of performing total hip arthroplasty compared to one conventional THA technique. These results show that the patients recovered quickly and experienced a low incidence of perioperative complications.
