Clinical Effect Observation On Total Hip Replacement By Retaining Posterior Articular Capsule

Objective : To evaluate the curative effect of two different cutting and repairing articular capsule approaches for first total artificial hip replacement in elderly femoral neck fracture.Methods: A total of 189 patients with unilateral femoral neck fracture treated between Jan. 2013 and Sep. 2015 were enrolled in this study. 92 cases were cut by "∩" shape and repairing articular capsule from side of acetabulum were included in the treatment group, and 97 cases were cut by “U” shape and repairing articular capsule were included in the control group. Analysis and comparison were carried out for data of patients between two groups. Evaluation was conducted by comparing the operative time, blood loss and drainage volume after operation, the instant stability of hip joint in the operation, the rate of hip joint dislocation within 6 months, the rate of hip infection, the external rotation strength between the affected side and the contralateral,hip joint Harris score after 6 months of operation.Results: The difference of operation time and amount of intra-operative bleeding has no statistical significance(P>0.05) between treatment group and control group. But the drainage volume in the treatment group is less than that of control group 48 hours after operation. The difference has statistical significance(P<0.05). When the hip joint is bending to 120°while the hip joint is rotated at a neutral position prior to intra-operative closing articular capsule in the treatment group, there are 27 implants appearing the displacement, sliding and dislocation at the lining frictional interface while only 9 case after closing articular capsule, the rate of hip joint dislocation in treatment and control study are 10% and 16%. The difference has statistical significance(P<0.05). Bilateral hip joints’ external rotator strength is measured 6months after operation in a same patient in the treatment group. The difference has no statistical significance(P>0.05). None of the cases were infected. 2cases in control sduty happened to hip joint dislocation in early time and 1 cases did in treatment study.The difference has no statistical significance(P>0.05). The Harris score of control study is 93.2±3.7 after 6 months and the treatment study is 94.1±4.3, the treatment study is better but the difference has no statistical significance(P>0.05).Conclusion: Repairing articular capsule from side of acetabulum has mainly recovered the integrity of biomechanics of rear soft tissue at axle so as to increase the stability of posterior hip joints and increase the range of motion the prosthesis. It can effectively prevent postoperative disclocation of hip joints.