The Effect Of Articular Capsule Repair Through Anterolateral Approach On The Postoperative Dislocation Of Primary Artificial Hip Replacement

In recent years, with the progress of the material of hip prosthesis, manufacture andinstallation, especially improvements in cement technology, diversification andserialization of prosthesis, and continuous update on installation tools, the indication forartificial hip replacement (AHR) constantly expands. Meanwhile the postoperativecomplications of AHR are also growing. The artificial hip joint’s dislocation is one of theserious complications, so how to prevent it has become the focus of attention.The causes of postoperative dislocation are numerous, generally can be divided intothree categories: preoperative, intraoperative and postoperative factor. The hip soft tissueimbalance in intraoperative factors is one of the main causes of zhe postoperative jointdislocation, and it has already be identified with by the academic circles. In recent years,many Chinese and foreign scholars pay more attention to the effect of postoperativedislocation of primary AHR with posterior articular capsule and short external rotatorsrepair, but they pay less attention to the effect of anterior articular capsule repair on thepostoperative dislocation through anterolateral approach.The study retrospectively analyzed the early postoperative dislocation rate of primaryartificial hip replacement (AHR), which including total hip replacement (THR) andartificial femoral head replacemen (AFHR), with articular capsule repair, and comparedwith the result of primary AHR without articular capsule repair. Our objective is not onlyto explore the feasibility of this repair method in AHR, but also to investigate whether therepair method can reduce postoperative dislocation rate and its possible mechanism.Objective1. To explore whether this repair method of anterior soft tissue can be used inanterolateral approach to primary AHR;2. To determine whether the anterior soft tissue structures repair skill affectsdislocation rate. Methods We retrospectively analyzed the292cases of primary AHR with anteriorarticular capsule repair in our hospital from June2007to February2013. And these casescompared with the505cases without articular capsule repair in the same period. The caseswith anterior articular capsule repair include group of A1(THR):137cases [65males and72females were followed-up, the mean age of the patients was63.7(ranged from37to75).Preoperative hip diseases were combined with103cases of fresh femoral neck fractures,6cases of delayed femoral neck fractures,20cases of femoral head necrosis,5casesosteoarthritis,3cases of acetabular dysplasia, among which1patients underwent bilateralartificial hip replacement] and group of A2(AFHR):155cases [74males and81femaleswere followed-up, the mean age of the patients was78.1(ranged from62to90).Preoperative hip diseases were combined with120cases of fresh femoral neck fractures,5cases of delayed femoral neck fractures,28cases of femoral head necrosis,2casesosteoarthritis, among which1patients underwent bilateral artificial hip replacement]. Inthe same way, the cases without anterior articular capsule repair are divided into controlgroup of B1(THR):248cases [121males and127females were followed-up, the mean ageof the patients was64.5(ranged from41to76). Preoperative hip diseases were combinedwith183cases of fresh femoral neck fractures,6cases of delayed femoral neck fractures,48cases of femoral head necrosis,6cases osteoarthritis,5cases of acetabular dysplasia,among which2patients underwent bilateral artificial hip replacement] and control group ofB2(AFHR):257cases (123males,134females, the mean age was78.9(ranged from65to94). Preoperative hip diseases were combined with206cases of fresh femoral neckfracture,9cases of delayed femoral neck fractures,36cases of femoral head necrosis,6cases osteoarthritis, among which2patients underwent bilateral artificial hip replacement).The average duration of follow-up was3.75years, ranged from6months to5years. Thereis no significant difference in the mean age, gender, diseases and duration of follow-upbetween the two groups (P>0.05).Results In the cases with articular capsule repair, the duration of follow-up rangedfrom6months to5years (mean3.8years). Meanwhile the duration ranged from6monthsto5years (mean3.7years) in the cases without articular capsule repair. In group of A1,1of137hips with primary total hip replacement (0.8%) underwent early dislocation. Incontrol group of B1,13of248hips with primary total hip replacement (5.2%) underwent early dislocation. The difference between the two groups was statistically significant(P<0.05). In group of A2,1of155hips with primary artificial femoral head replacement(0.8%) underwent early dislocation. In control group of B2,5of257hips with primaryartificial femoral head replacement (1.9%) underwent early dislocation. The differencebetween the two groups was no statistically significant (P>0.05).There is no latedislocation intermediately the all groups.Conclusion1. This repair method of anterior soft tissue can be used in anterolateral approach toprimary AHR;2. Repair anterior articular capsule through anterolateral approach can effectivelyprevent postoperative early dislocation in primary THR;3. There is no need to repair articular capsule through anterolateral approach inprimary AFHR.