Failure of Capsular Enhanced Short External Rotator Repair After Total Hip Replacement

Stähelin, Thomas; Drittenbass, Lisca; Hersche, Otmar; Miehlke, Wolfgang; Munzinger, U.

doi:10.1097/00003086-200403000-00028

Cited by 71 publications

(61 citation statements)

References 16 publications

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“…The posterior repair may serve as a scaffold for scar between short external rotator tendons and the greater trochanter and eventual maturation of the posterior pseudocapsule. Delayed formation of an organized pseudocapsule and the inability to resolve visually individual elements of the repair, per other studies [9,16,17], may partially explain the dichotomous findings between radiographic studies [9,16,17] reporting high failure rates of the repair and clinical studies [10,11] reporting significant reduction in the incidence of postoperative instability in patients with a posterior soft tissue repair. Progressive muscle atrophy was observed for the piriformis and short external rotator muscles, supporting the prior supposition that the posterior capsule and tendon repairs serve principally as static restraints to posterior THA instability [12].…”

Section: Discussionmentioning

confidence: 92%

“…Despite this observation, skepticism remains regarding the long-term integrity of the repair of the piriformis and short external rotator tendons and the posterior capsule [9,16,17]. Previous investigators [9,[16][17][18], and Pellicci et al [12], have reported disparate shortterm (B 3 months) imaging results of the posterior repair using plain radiographic [9,16,17], ultrasound [18], and MRI techniques [12]. In the study by Pellicci et al [12], measurable deficiencies existed between repaired tendons and bone in approximately 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Past studies have concluded that a posterior repair fails during the early postoperative period based on indirect assessment on plain radiographs [9,16,17]. Prior ultrasound [18] and MRI [12,14] studies have reported more positive results.…”

Section: Discussionmentioning

confidence: 99%

“…If the posterior soft tissues are repaired, the frequency of dislocation after a posterior approach is comparable to other techniques [1,2,10,11]. Despite improved clinical results observed with the posterior soft tissue repair, skepticism remains regarding its long-term integrity [9,16,17]. Pellicci et al [12] reported that while the quadratus femoris and posterior capsule remained intact in more than 90% (27 of 30) of patients at 3 months postoperatively, deficiencies in the native tendon-to-bone attachment occurred in 43% (13 of 30) of piriformis and 57% (17 of 30) of conjoined tendon repairs.…”

Section: Introductionmentioning

confidence: 99%

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Posterior Soft Tissue Repair After Primary THA is Durable at Mid-term Followup: A Prospective MRI Study

McLawhorn

Potter

Cross

et al. 2015

Clin Orthop Relat Res

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Background The enhanced posterior soft tissue repair has reduced the frequency of dislocation after primary THA performed through the posterolateral approach. However, the long-term integrity of the repair is unknown and could influence surgeon choice regarding surgical technique and THA approach. Questions/Purposes We asked: (1) What is the durability of the enhanced posterior soft tissue repair at a minimum of 49 months using MRI to evaluate soft tissue to bone integrity? (2) How does the appearance of the posterior soft tissues change during this time? (3) Are there patient characteristics associated with the long-term imaging appearance of the posterior repair? Methods All patients without a contraindication for MRI who were undergoing unilateral primary uncemented THA through a posterior approach between February and May 2005 were eligible for inclusion. Ninety percent consented to participate (36 of 40 patients), and 30 patients were followed prospectively with MRI postoperatively and again at 3 months; of those, 22 (73%; 12 men, 10 women) completed the study by having another MRI study at a minimum of 49 months (mean, 51 months; range, 49-59 months). Each patient underwent metal-artifact-reduction sequence MRI to evaluate the integrity of the posterior soft tissues, which had been repaired anatomically during primary THA at a minimum of 4 years earlier. The results were compared with those of prior MR images obtained immediately after surgery and at 3 months postoperatively. All patients were given a self-reported modified Harris hip score at the time of the most recent MRI study (maximum score = 81). Results At latest followup, 21 of 22 (96%) patients had a posterior capsule in contact with bone, and 21 of 22 (96%) had an intact quadratus femoris. Twenty-one patients (96%) had soft tissue or a scar from the piriformis and

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posterior Soft Tissue Repair After Primary THA is Durable at Mid-term Followup: A Prospective MRI Study

McLawhorn

Potter

Cross

et al. 2015

Clin Orthop Relat Res

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“…However, the failure rate of surgically repaired short external rotators after posterior THA is as much as 80% [28]. As a result, some authors have modified the posterior approach to preserve some of the short external rotators of the hip [15,17,23].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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Background Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a singleincision modification of this technique in 135 patients. Description of TechniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue. Methods For the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months). Results There were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41°(range, 21°-49°) and anteversion averaged 21°(range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2°varus and 2°v algus alignment, respectively.

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Piriformis and obturator internus morphology: A cadaveric study

Pine

Binns²,

Wright

et al. 2010

Clinical Anatomy

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Preservation of piriformis during exposure of the hip joint via a posterior approach may result in a lower rate of dislocation following total hip arthroplasty. The aim of this study was to identify anatomical variations in the tendons of piriformis and obturator internus which could inform piriformis sparing approaches to the hip. Twenty-nine proximal femora from 15 cadavers, 5 male and 10 female aged 65-79 years, were examined. Tendon crossing angles, location and mode of insertion to the greater trochanter and the extent of fusion between tendons prior to insertion were noted. The mean (and associated standard deviation) of the vertical and horizontal widths of the piriformis tendon were 4.78 ± 1.31 mm and 7.35 ± 1.74 mm, respectively. The mean (and associated standard deviation) of the vertical and horizontal widths of the obturator internus tendon were 6.87 ± 1.61 mm and 5.72 ± 1.38 mm, respectively. The mean distances of the anterior and posterior margins of the piriformis tendon insertion from the posterior limit of the greater trochanter, defined as a percentage of the anteroposterior length of the greater trochanter, were 63.3% ± 9.4% and 43.0% ± 9.4%, respectively. Equivalent mean distances for the obturator internus insertion were 73.0% ± 6.6% and 55.9% ± 7.0%, respectively. On the basis of the relationship between the piriformis and obturator internus tendons in terms of the angle and point at which they cross, in addition to any degree of tendon fusion, four classifications were identified. This study shows that the most posterior margins of the piriformis and obturator internus attachments are located more than one-third of the way along the greater trochanter, suggesting that current osteotomies would not include these external rotators in the majority of cases.

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Failure of Capsular Enhanced Short External Rotator Repair After Total Hip Replacement

Cited by 71 publications

References 16 publications

Posterior Soft Tissue Repair After Primary THA is Durable at Mid-term Followup: A Prospective MRI Study

Posterior Soft Tissue Repair After Primary THA is Durable at Mid-term Followup: A Prospective MRI Study

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Piriformis and obturator internus morphology: A cadaveric study

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