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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

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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.

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  1. Bottner F, Pellicci PM (2006) Review: posterior soft tissue repair in primary total hip arthroplasty. HSS J 2:7–11

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg Am 64:1295–1306

    Article  PubMed  CAS  Google Scholar 

  3. Robinson RP, Robinson HJ Jr, Salvati EA (1980) Comparison of the transtrochanteric and posterior approaches for total hip replacement. Clin Orthop Relat Res 147:143–147

    Google Scholar 

  4. Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB (2001) A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res 385:95–99

    Article  Google Scholar 

  5. Pellicci PM, Bostrom M, Poss R (1998) Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res 355:224–228

    Article  Google Scholar 

  6. White RE Jr, Forness TJ, Allman JK, Junick DW (2001) Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res 393:163–167

    Article  Google Scholar 

  7. Weeden SH, Paprosky WG, Bowling JW (2003) The early dislocation rate in primary total hip arthroplasty following the posterior approach with posterior soft-tissue repair. J Arthroplast 18:709–713

    Article  Google Scholar 

  8. Stähelin T, Vienne P, Hersche O (2002) Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplast 17:604–607

    Article  Google Scholar 

  9. Stähelin T, Drittenbass L, Hersche O, Miehlke W, Munzinger U (2004) Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res 420:199–204

    Article  Google Scholar 

  10. Khan RJ, Yao F, Li M, Nivbrant B, Wood D (2007) Capsular-enhanced repair of the short external rotators after total hip arthroplasty. J Arthroplast 226:840–843

    Article  Google Scholar 

  11. Kao JT, Woolson ST (1992) Piriformis tendon repair failure after total hip replacement. Orthop Res 21:171–174

    CAS  Google Scholar 

  12. Sioen W, Simon JP, Labey L, VanAudekercke R (2002) Posterior transosseous capsulotendinous repair in total hip arthroplasty: a cadaver study. J Bone Joint Surg Am 84-A:1793–1798

    Article  PubMed  CAS  Google Scholar 

  13. Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 86-A:9–14

    Article  PubMed  Google Scholar 

  14. Kobayashi H, Homma Y, Baba T, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2016) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int Orthop 40:1813–1819

    Article  PubMed  Google Scholar 

  15. Tsai SJ, Wang CT, Jiang CC (2008) The effect of posterior capsule repair upon post-operative hip dislocation following primary total hip arthroplasty. BMC Musculoskelet Disorder 9:29

    Article  Google Scholar 

  16. Prietzel T, Hammer N, Schleifenbaum S, Adler D, Pretzsch M, Köhler L, Petermann M, Farag M, Panzert S, Bauer S, von Salis-Soglio G (2014) The impact of capsular repair on the dislocation rate after primary total hip arthroplasty: a retrospective analysis of 1972 cases. Z Orthop Unfall 152:130–143

    Article  PubMed  CAS  Google Scholar 

  17. Capuano N, Grillo G, Carbone F, Del Buono A (2018) Total hip arthroplasty performed with a tissue-preserving technique using superior capsulotomy. Int Orthop 42:281–287

    Article  PubMed  Google Scholar 

  18. Browne JA, Pagnano MW (2012) Surgical technique: a simple soft-tissue-only repair of the capsule and external rotators in posterior-approach THA. Clin Orthop Relat Res 470:511–515

    Article  PubMed  Google Scholar 

  19. Loiba V, Stucinskas J, Robertsson O, Wingstrand H, Tarasevicius S (2015) The analysis of posterior soft tissue repair durability after total hip arthroplasty in primary osteoarthritis patients. Hip Int 25:420–423

    Article  PubMed  Google Scholar 

  20. Su EP, Mahoney CR, Adler RS, Padgett DE, Pellicci PM (2006) Integrity of repaired posterior structures after THA. Clin Orthop Relat Res 447:43–47

    Article  PubMed  Google Scholar 

  21. Pellicci PM, Potter HG, Foo LF, Boettner F (2009) MRI shows biologic restoration of posterior soft tissue repairs after THA. Clin Orthop Relat Res 467:940–945

    Article  PubMed  Google Scholar 

  22. Ranawat CS, Meftah M, Potter HG, Ranawat AS (2011) The posterior approach in THR: assuring capsular stability. Orthopedics 34:e452–e455

    PubMed  Google Scholar 

  23. McLawhorn AS, Potter HG, Cross MB, Boettner F, Lim W, Lee YY, Pellicci PM (2015) Posterior soft tissue repair after primary THA is durable at mid-term followup: a prospective MRI study. Clin Orthop Relat Res 473:3183–3189

    Article  PubMed  PubMed Central  Google Scholar 

  24. Spaans EA, Spaans AJ, van den Hout JA, Bolder SB (2015) The result of transmuscular versus transosseous repair of the posterior capsule on early dislocations in primary hip arthroplasty. Hip Int 25:537–542

    Article  PubMed  Google Scholar 

  25. Soong M, Rubash HE, Macaulay W (2004) Dislocation after total hip arthroplasty. J Am Acad Orthop Surg 12:314–221

    Article  PubMed  Google Scholar 

  26. Suh KT, Park BG, Choi YJ (2004) A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res 418:162–167

    Article  Google Scholar 

  27. Elisevich K, Cunningham IA, Assis L (1995) Size estimation and magnification error in radiographic imaging: implications for classification of arteriovenous malformations. AJNR Am J Neuroradiol 16:531–538

    PubMed  CAS  Google Scholar 

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Correspondence to Young-Ho Kim.

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The authors declare that they have no conflict of interest.

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

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

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Moon, JK., Kim, Y., Hwang, KT. et al. 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. International Orthopaedics (SICOT) 42, 2049–2056 (2018).

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