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The incidence of hip dislocation after posterior approach primary total hip arthroplasty: comparison of two different posterior repair techniques

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Total hip arthroplasty (THA) remains one of the most successful orthopedic surgical procedures. The posterior approach is associated with a higher incidence of post-operative dislocations than others. Adequate posterior soft tissue repair techniques, including capsulorrhaphy and transosseous bone sutures in the greater trochanter effectively reduce the dislocation rate. Post-operative “posterior hip precautions” were historically believed to reduce dislocation risks, although not clearly proven. The first protocol consists of capsulorrhaphy with the prescription of post-operative posterior hip precautions (TT) and the second, transosseous bone sutures without precautions (TB). This study aims to determine the optimal protocol to decrease the dislocation rate following posterior approach primary THA.

Materials and methods

A 10-year retrospective case–control chart review analyzed demographic, pre-, intra-, and post-surgical parameters. Primary outcomes were the difference in dislocation and revision surgery rates between protocols. Secondary outcomes included the incidence of recurrent dislocations and the identification of predictors of dislocation.

Results

2,242 THAs were reviewed and 26 (1.2%) resulted in dislocation. Increased age (p = 0.04) ASA score (p = 0.03) and larger acetabular cup size (p < 0.001) were associated with heightened risk. Tendon to tendon (TT) repair saw a 1.62% dislocation rate versus 0.98% for tendon-to-bone (TB) repair, although statistically insignificant (p = 0.2). Transosseous repair resulted in recurrent dislocations for 8/16 (50%) patients compared to 6/10 (60%) in the suture group (p ≤ 0.001). No significance was found for prescription of posterior hip precautions.

Conclusions

To our knowledge, this is the first study to perform a direct comparison of TT repair with posterior precautions to TB repair without posterior precautions. Similarity in dislocation rate, decreased recurrent events and the alleviated patient burden from precautions leads the authors to recommend the TB repair without precautions for a successful THA.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Medicine, Laval University, Quebec City, QC, Canada

    E. Dimentberg

  2. McGill Orthopedic Surgery, McGill University Health Centre, Montreal, Canada

    B. Barimani

  3. Department of Surgery, Division of Orthopaedic Surgery, St-Mary’s Hospital, 3830 Avenue Lacombe, Montréal, QC, H3T 1M5, Canada

    M. Alqahtani, B. Tayara & A. Albers

  4. St-Mary’s Hospital Research Center, St-Mary’s Hospital, 3830, avenue Lacombe, Bureau/Room 2304, Montréal, QC, H3T 1M5, Canada

    E. Belzile

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  1. E. Dimentberg
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Correspondence to A. Albers.

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Approved by Review Ethics Board at St-Mary’s Hospital Center.

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In accordance with hospital policy and provincial regulations for retrospective studies, informed consent was not required for this study.

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Appendix

Appendix

See Tables 1, 2, 3, 4, 5.

Table 1 Demographic parameters
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Table 2 Clinical and surgical criteria
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Table 3 Multivariate logistic regression for dislocation by protocol
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Table 4 Parameters by protocol
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Table 5 Number of dislocations experienced per patient
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Dimentberg, E., Barimani, B., Alqahtani, M. et al. The incidence of hip dislocation after posterior approach primary total hip arthroplasty: comparison of two different posterior repair techniques. Arch Orthop Trauma Surg 143, 3605–3612 (2023). https://doi.org/10.1007/s00402-022-04609-9

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