The Effect Of Posterior Capsulorrhaphy In Total Hip Arthroplasties:A Meta-analysis

BackgroundTotal hip arthroplasty(THA)has been a mature surgical method for the treatment of hip joint disease after decades of development.Its therapeutic effect is widely recognized by orthopedic surgeons and patients.The times are improving,and the requirements of physicians and patients are also increasing.The purpose is to pursue better and faster postoperative efficacy and fewer complications.Common complications after THA include prosthesis loosening,dislocation,infection,and periprosthetic fractures,among which the dislocation of joint prosthesis is a catastrophic complication for orthopedists and patients.Prosthesis dislocation not only greatly reduces the patient's quality of life,but also accompanied by hip swelling and pain,joint activity is limited,resulting in prolonged bed rest,especially in elderly patients,complications such as hemorrhoids,fall Pneumonia,pulmonary embolism,etc.The movements of the hip joint include adduction,flexion,and internal rotation.When the above activities occur,the hip prosthesis neck collides with the acetabular anterior edge,and the posterior structural instability caused by intraoperative destruction is a consequence.This leads to displacement of the femoral head prosthesis from the acetabular liner.This is the mechanism of the dislocation of the hip prosthesis,and the removal of the posterior joint capsule during the operation is an important cause of the posterior structural instability.At present,in the total hip arthroplasty at the lateral or posterolateral approach at home and abroad,it is very common to excise the posterior joint capsule and destroy the joint capsule ligament without repair.The consequences of this will destroy the stability of the posterior hip joint structure.This leads to postoperative hip instability,and the resulting series of complications have increasingly caught the attention of clinical orthopedic surgeons.According to relevant research reports,if the repair of the posterior joint capsule is enhanced and the posterior structure is reconstructed during total hip arthroplasty,the posterior structure of the hip can be significantly increased and the probability of dislocation of the prosthesis can be reduced.For this reason,one of the important measures to effectively prevent joint dislocation after total hip arthroplasty is to maintain the balance between the soft tissue tension and the force around the joint.However,many orthopedic surgeons routinely excise the posterior joint capsule in clinical practice,which is believed to allow better exposure of the operative field and facilitate operation.Some scholars believe that the failure rate after intraoperative joint capsule repair is high,and there is no obvious correlation between postoperative dislocation and whether the posterior joint capsule is sutured and repaired.Based on this,there is currently no consensus on whether it is necessary to repair the posterior joint capsule in THA surgery,and there are few reports on relevant evidence-based medical literature based on randomized controlled trials.In this study,the author aims to use meta-analysis methods to evaluate THA.The effect of repairing and resurging the posterior joint capsule on the postoperative efficacy provides a basis for clinical work.PurposeMeta-analysis was used to evaluate the difference in the efficacy of repairing and resecting the posterior joint capsule in an artificial total hip arthroplasty.MethodsEnglish databases for computer searches include: Pubmed,Cochrane Library,Embase,Chinese databases including: Sino Med,Wanfang Database,CNKI,search date to March 2018,collecting information on labor The literature of randomized controlled trials of repairing and resecting the posterior joint capsule in hip replacement surgery.A rigorous evaluation was performed on the methodological quality of the included studies,followed by the extraction of data and data using Rev Man 5.3 statistical software.ResultA total of 6 randomized controlled trials were included.A total of 703 operations were performed.Using the modified Jadad scoring criteria,the risk of bias assessment was moderate.Meta-analysis showed that the joint capsule repair group could effectively reduce postoperative bleeding(P=0.003)and the incidence of hip dislocation(P=0.02),operation time(P=0.70),intraoperative bleeding(P=0.15),joint function The Harris score(P=0.82)and good rate(P=0.53)were not statistically different.ConclusionRepairing the posterior joint capsule during primary hip replacement can effectively reduce the risk of postoperative hip dislocation,and can reduce postoperative bleeding and promote early rehabilitation,which is worthy of clinical promotion.