Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach

Abstract

Reported rates of dislocation in hip hemiarthroplasty (HA) for the treatment of intra-capsular fractures of the hip, range between 1% and 10%. HA is frequently performed through a direct lateral surgical approach. The aim of this study is to determine the contribution of the anterior capsule to the stability of a cemented HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature, providing ten hip joints for investigation. A Thompson HA was cemented in place via a direct lateral approach. The cadavers were then positioned supine, both knee joints were disarticulated and a digital torque wrench was attached to the femur using a circular frame with three half pins. The wrench applied an external rotation force with the hip in extension to allow the hip to dislocate anteriorly. Each hip was dislocated twice; once with a capsular repair and once without repairing the capsule. Stratified sampling ensured the order in which this was performed was alternated for the paired hips on each cadaver. Comparing peak torque force in hips with the capsule repaired and peak torque force in hips without repair of the capsule, revealed a significant difference between the 'capsule repaired' (mean 22.96 Nm, standard deviation (sd) 4.61) and the 'capsule not repaired' group (mean 5.6 Nm, sd 2.81) (p < 0.001). Capsular repair may help reduce the risk of hip dislocation following HA.

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

“…We believe that, in general, not enough attention is paid to the breaking and removal of certain structures in hip replacement surgery and also in post‐operative rehabilitation. For example, the decision to perform a capsulectomy may be based on the surgeon's personal choice according to experience, on the surgical path (which is essential in the postero‐lateral pathway) and the need for wider exposure 26‐29 …”

“…The tendon must be preserved without any damage, due to its essential mechanical functions, 40 but low innervation may demonstrate the lesser role of this structure as pain generator. As regards the capsule, Hughes et al 29 suggest maintaining the capsular structure as well, improving proprioception and relieving pain, especially during the first postsurgery weeks. However, our results confirm that capsulectomy in hip replacement surgery does not particularly influence patients' pain, matching the results of Gáspár et al 10 who evaluated 22 joint capsules excised after arthroplasty surgery.…”

Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty

“…To our knowledge, no studies have examined the stability augmented by capsular repair of THA performed through the DAA, however, Hughes et al examined the effect of capsular repair in cadavers following hip hemiarthroplasty through a direct lateral approach and found that capsular repair required a 4-fold higher peak torque force to dislocate anteriorly [22]. Infection reduction in capsular repair has also not been directly evaluated, however, preserving additional anatomic layers might assist in microbial blockade.…”

Arthroscopic Capsular Reconstruction of the Hip With Acellular Dermal Extracellular Matrix: Surgical Technique

“…8 It has been previously shown that capsular repair may reduce the risk of dislocations after hemiarthroplasty and total hip arthroplasty. 12,13 Several other studies also have shown that the hip capsule influences biomechanical and clinical stability in patients after total hip arthroplasty. [14][15][16][17] Cooper et al 18 found that the thickest parts of the capsule in the acetabular origin are posterosuperior and superolateral and anterior at the femoral insertion.…”

“…Capsular Reconstruction (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) 7. Preparing the capsular surface comprises 2 procedures: debridement of the scar tissue where the capsule once was and decortication of the acetabular and femoral beds for a better graft incorporation.…”