A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach

Abstract

BackgroundDislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach. MethodsFrom September of 2008 to August of 2019, we evaluated 841 THAs performed by a single surgeon using a posterior approach. Before November of 2015, the capsule was repaired to the greater trochanter (group 1, 605 patients). Starting November 2015, the posterior capsule was repaired in a side-to-side fashion (direct soft-tissue repair) (group 2, 236 patients). There was a mean follow-up of 31.1 months (range, 2.5-122.5 months). A multivariable logistic regression model was constructed to assess the impact of baseline patient and operative factors on the dislocation rate. ResultsThere were 22 dislocations, all of which occurred in group 1. There were no dislocations in group 2. After adjusting for patient and operative factors, the direct soft-tissue repair had a large impact on the overall multivariable model as indicated by its effect likelihood ratio of 10.33 (P = .001); however, the odds ratio was not calculable for this factor, given that there were no dislocations in hips with direct soft-tissue repair. Increasing age was associated with an increased odds of dislocation (odds ratio, 1.04, P = .017), with an effect likelihood ratio of 6.25 (P = .012). ConclusionsSwitching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.