Der Einfluss der Kapselrekonstruktion auf die Luxationsrate nach primärer Hüftendoprothetik: eine retrospektive Analyse von 1972 Fällen

Abstract

Preservation and repair of the hip joint capsule causes an 88-%-reduction of the dislocation rate in primary THA in this large series including 1972 cases, operated via the Bauer or the anterolateral approach. Several authors reported comparable results after THA using similar techniques of soft tissue and capsular repair through the posterior or posterolateral approach. Sparing and reconstructing the hip joint capsule therefore seems to reduce the dislocation rate after primary THA by one order of magnitude regardless of the surgical approach and, especially, if the acetabular origin is preserved. Capsule-related specific complications such as an increased revision rate, malfunction or pain were neither recorded in our study nor by others. Thus, careful preservation and reconstruction of the hip joint capsule may be expressly recommended in primary THA.

The impact of capsular repair on the risk for dislocation after revision total hip arthroplasty – a retrospective cohort-study of 259 cases

“…Thus, according to these preliminary results, an estimated reduction of hip dislocations around 86% can be achieved if capsular repair is applied in combination with Bauer’s lateral transgluteal approach in R-THA in contrast to the conventional technique with capsular resection via the anterolateral Watson-Jones-approach, similar to our findings in primary THA [13]. …”

“…Connective tissues in the plane of the hip joint capsule are incised in an inverted T-shape manner, preserving its acetabular origin completely [13]. In most cases the capsule was additionally incised cranially longitudinally, forming a U-flap of its ventrocranial section.…”

“…After the implantation and reduction of the prosthesis, both longitudinal capsular incisions (ventral and cranial) were closed by sutures (Fig. 2), while the transverse incision near the femoral neck base remained unclosed and served for insertion of a Redon drain [13]. After reconstruction of the muscles, the fascia and the subcutaneous layer the skin was routinely closed by a resorbable intracutaneous suture, so that no removal of suture material was necessary.

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“…Nevertheless, quite a few surgeons routinely excised it during R-THA. Current literature suggests that capsular repair [13, 14] and the use of larger prosthetic heads [15, 16] decrease the risk of THA dislocation.…”

“…In addition to the typical partial detachment and reconstruction of the ventral part of the iliotrochanteric muscles this procedure was focused on capsular repair, preserving the acetabular origin of the hip joint capsule. This modified technique has been shown to reduce dislocation rates by 88% in primary THA [13]. Since 10/2005 the technique has also been used in R-THA.…”