Transosseous ‘over the top’ reconstruction of capsule and tendons in primary total hip arthroplasty using a posterior approach.

Abstract

Background: Dislocation after total hip arthroplasty (THA) remains a devastating complication and a primary cause for revision arthroplasty. Historical data indicate that a posterior approach is associated with a higher dislocation rate. In this study, we present a highly reliable and anatomical reconstruction, based on the biomechanical findings of a previous cadaveric experiment.  Description of Technique: The posterior soft tissues were repaired in 2 layers. First a reattachment of the posterior orbicular ligament is performed at the anterior capsule. Subsequently a transosseous ‘over the top’ reinsertion of both capsule and tendons is performed close to there anatomical insertion.  Patients and Methods: We prospectively collected data of 408 THAs from January 2004 until December 2013, through a posterior approach and with a capsule and tendon reconstruction based on a previous cadaveric study.  Results: There was a low early dislocation rate in primary THA (one of 408 THAs, 0,2%) and no complications related to the technique.  Conclusions: This anatomical reconstruction of both capsule and tendons is associated with a low dislocation rate without complications at the level of the greater trochanter