International Orthopaedics

, Volume 42, Issue 9, pp 2049–2056 | Cite as

The incidence of hip dislocation and suture failure according to two different types of posterior soft tissue repair techniques in total hip arthroplasty: a prospective randomized controlled trial

  • Jun-Ki Moon
  • Yeesuk Kim
  • Kyu-Tae Hwang
  • Jae-Hyuk Yang
  • Young-Ho Kim
Original Paper



Although the posterolateral approach for hip arthroplasty is popular and has numerous advantages, it has been known to have a propensity for dislocation. The repair of short external rotator muscles with capsule is important for reducing dislocation. The purpose of this study is to investigate the incidence of suture failure, dislocation, and time to failure for two repair techniques for posterior soft tissue repair during total hip arthroplasty.


In this study of 167 total hip arthroplasties in 159 patients, we reattached the short external rotator tendon with posterior capsule to the greater trochanter transosseously (tendon-to-bone, 87 hips) or the gluteus medius tendon (tendon-to-tendon, 80 hips). Radiopaque markers were attached to each suture side < 1.2 cm apart. The distance between the markers was radiographically measured at variable time points postoperatively. Failure was defined by a distance between markers of ≥ 2.5 cm or marker invisibility. The mean follow-up period was 28.8 (12–45) months.


Suture failure was observed less frequently in the tendon-to-bone group (18.4%) than in the tendon-to-tendon group (65%; p < 0.001). Failure mostly occurred within two weeks post-operatively: 93.8% for tendon-to-bone repair (p < 0.001) and 90.4% for tendon-to-tendon repair (p = 0.025). The dislocation rate was significantly higher in the tendon-to-tendon group (7. vs 1.1%; p = 0.041). A significant correlation was observed between suture failure and dislocation (p = 0.013).


Tendon-to-bone repair is superior to tendon-to-tendon repair based on lower suture failure and dislocation rates.


Total hip arthroplasty Posterior soft tissue Short external rotator Tendon-to-bone repair technique 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from Institutional Review Board of the university hospital prior to conducting this study.

Informed consent

Informed consent was obtained from all patients included in the study.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryHanyang University Guri HospitalGuri citySouth Korea
  2. 2.Department of Orthopedic SurgeryHanyang University HospitalSeoulSouth Korea

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