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Posterior Transosseous Capsulotendinous Repair in Total Hip Arthroplasty

A Cadaver Study

Investigation performed at the Department of Orthopaedics, University of Louvain, Louvain, Belgium

W. Sioen, MD
J.P. Simon, MD, PhD
Department of Orthopaedic Surgery, Pellenberg Orthopaedic Hospital, University of Louvain, Weligerveld, 1, B-3212 Pellenberg, Belgium. E-mail address for W. Sioen: wouter.sioen{at}skynet.be

L. Labey, Ir
R. Van Audekercke, MSc, PhD
Division of Biomechanics and Engineering Design, Celestijnenlaan, 200A, B-3001 Heverlee, Belgium

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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Background: While recent clinical articles have reported a dramatic reduction in rates of total hip dislocation after posterior transosseous repair, we are not aware of any published biomechanical data to support this finding. The objectives of this study were to investigate the functional anatomy of the posterior transosseous repair and its effect on stability after total hip replacement.

Methods: Six total hip prostheses were implanted into three fresh cadavera. Three different repair situations (no repair, soft-tissue repair, and transosseous fixation) were then consecutively tested on each hip. Values for torque resistance and the angular range of motion at dislocation were recorded. Each repair was tested twice, yielding a total of thirty-six torque values and thirty-six angles of rotation.

Results: The transosseous repair was superior with regard to both torsion strength (four times stronger than that after no repair [p = 0.0002] and more than twice as strong as that after soft-tissue repair [p = 0.002]) and the magnitude of the angle of rotation observed prior to dislocation (an increase of 83% in comparison with that after no repair [p = 0.0005] and an increase of 46% in comparison with that after soft-tissue repair [p = 0.004]).

Conclusions: In a cadaver model, posterior transosseous repair provides superior stability of a total hip replacement. Optimal surgical technique with a slightly modified approach allows greater retention of capsule and tendon length and a more anatomical reinsertion of the soft tissues.

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