Abstract
Purpose of the study
This study analyzes the incidence on hip dislocation of a posterior minimally invasive approach that combines the suture of the capsular joint and the preservation of the piriformis muscle.
Materials and methods
A first prospective series of 98 patients having undergone hip prosthesis by a posterior minimally invasive approach that combines piriformis preservation and capsular closure is analyzed regarding seven criteria: age, weight, duration of surgery, piriformis integrity and quality of capsular closure at the end of the intervention, radiological position of the implants and rate of dislocation at M12. This series is compared to another consecutive series of 98 hip prostheses performed by the same surgeon, via posterior approach, consisting in capsular resection and cutting of the piriformis reinserted on the trochanter.
Results
The two series were identical regarding patients’ age and weight. The minimally invasive surgery lasted 20 min more than the other intervention. In both surgeries, no effect was observed on the radiological position of the implants. The rate of hip dislocation after 12 months was significantly improved by the capsular closure combined with piriformis preservation (2.9 vs 0%).
Discussion
The restoration of the capsular plane has been the subject of numerous works. The techniques described had some variations, with a related rate of dislocation <1%. Piriformis preservation participates in the joint coaptation. This muscle is stretched out during the first step of the dislocating movement.
Conclusion
The presented series highlights the benefit of combining a capsular flap truly suturable and the preservation of the piriformis muscle aimed at creating a “hammock”, passive and active at the same time, at the upper posterior part of the joint, a strategic area with a high related risk of dislocation.
Similar content being viewed by others
References
Scott RD (1996) Posterior capsulorraphy for hip stabilisation. In: 12th annual current concepts in joint replacement proceedings, December 12–14, Orlando, Florida, pp 87
Pellici PM, Bostom M, Poss R (1998) Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop 355:224–228
Chiu FY, Chen CM (2000) The effect of posterior capsulorraphy in primary total hip arthroplasty. A prospective randomised study. J Arthroplasty 15(2):194–199
Goldstein WM, Gleason TF, Kopplin M, Branson JJ (2001) Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsular capsulotomy and capsulorrhaphy. J Bone Joint Surg Am 83-A(suppl):2–7
Dixon MC, Scott RD, Schai PA, Stamos V (2004) A simple capsulorrhaphy in posterior approach for total hip arthroplasty. J Arthroplasty 19(3):373–376
Swanson TV (2005) Early results of 1,000 consecutive, posterior, single-incision minimally invasive surgery total hip arthroplasty. J Arthroplasty 6(suppl 3):23–26
Mahoney CR, Pellici PM (2003) Complications in primary total hip arthroplasty: avoidance and management of dislocations. Intr Course Lect 52:247–255
White RE, 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
Mihalko WM, Whiteside LA (2004) Hip mechanics after posterior structure repair in total hip arthrosplasty. Clin Orthop Relat Res 420:194–198
Robinson PS, Placid R, Soslowsky LJ, Born CT (2004) Mechanical strength of repairs of the hip piriformis tendon. J Arthroplasty 19(2):204–210
Stahelin T, Drittenbass L, Hershe O et al (2004) Failure of capsular enhanced short external rotator repair after total hip remplacement. Clin Orthop Relat Res 420:199–204
Hitomi Y, Kizati T, Ohno H (2005) Seven skeletal muscles rich in slow muscle fibers may function to sustain neutral position in rodent hindlimb. Comp Biochem Physiol B Biochem Mol Biol 140:45–50
Snijders CJ, Hermans PF, Kleinrensink GJ (2005) Functional aspects of cross-legged sitting with special attention to piriformis muscles and sacroiliac joints. Clin Biomech (Bristol, Avon) 28
Stahelin T, Vienne P, Hershe O (2002) Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplasty 17(5):604–607
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Prigent, F. Incidence of capsular closure and piriformis preservation on the prevention of dislocation after total hip arthroplasty through the minimal posterior approach: comparative series of 196 patients. Eur J Orthop Surg Traumatol 18, 333–337 (2008). https://doi.org/10.1007/s00590-008-0295-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-008-0295-8