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Friday, March 2, 2001

Capsulotomy procedure reduces dislocation

Reports of dislocations after total hip replacement have been reported to be 1-9 percent through the posterior approach. Advocates of capsulorraphy, including repair of the external rotators, have reported a decrease in postop dislocation. Scientific exhibit 55 demonstrates with video the technique of capsulotomy, exposure and repair. The incidence of dislocation decreased from 2.8 percent to 0.6 percent (p value=.017).

"This technique differs from those that suture the capsule or external rotators and posterior capsule to the greater trochanter (some through drill holes)," the investigators say. "This may lead to external rotation contracture that is often a clinical problem."

They studied 1,000 cementless or hybrid primary total hips through a posterior approach. Group 1: retrospective study of 500 total hips with posterior capsulectomy and partial anterior capsulotomy with closure of only the external rotators to the abductor tendon. Group 2: prospective study of 500 primary total hips with a technique using a posterior approach, partial anterior and full posterior capsulotomy using special posterior capsular retractors for exposure. The posterior capsule was incised like a double door and the anterior capsule was cut through its anterosuperior sector.

At closure, the capsule was sutured and the anterior capsular flap was advanced and sutured to the posterior flap. External rotators were sewed to the gluteus medius tendon. Patients were followed for a period of one year before classified a success.

Results: There were 14 dislocations (13 posterior, one anterior) in Group 1. All of these were recurrent. Seven patients have been revised. There were three dislocations (three anterior) in Group 2. Two of these were recurrent and were revised.

Coauthors of the study are Wayne M. Goldstein, MD; Thomas F. Gleason, MD; Matthew Kopplin, MD; Daniel Ocel, MD; and Jill J. Branson, BSN, all of the Illinois Bone and Joint Institute, Park Ridge, Ill.

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2001 Academy News March 2 Index C

Last modified 15/February/2001 by IS