Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty

Reducing Complications and Enhancing the Functional Outcome of Total Hip Arthroplasty without Increasing Operation Time by Repairing Posterolateral Soft Tissues

Total hip arthroplasty (THA) surgeries are increasing annually. Despite continuous improvements in the surgical technique and prosthetic design, there is still no consensus on whether it is beneficial to reconstruct the posterolateral soft tissue. This paper systematically reviews randomized controlled trials (RCTs) addressing the efficacy and safety of posterolateral soft tissue during total hip replacement to provide evidence-based guidance for clinical practice. We searched PubMed, EMBASE, Cochrane Library, CNKI, and Wanfang databases for RCTs. Experimental results show that repair of the posterolateral soft tissue can reduce complications and improve the function of total hip arthroplasty without increasing operative time.

Capsular repair vs capsulectomy in total hip arthroplasty

BACKGROUND

A major complication of total hip arthroplasty is dislocation. The hip joint capsule can be incised and repaired, or can be excised.

SOURCES OF DATA

We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines focusing on capsular repair and capsulectomy.

AREAS OF AGREEMENT

We identified 31 articles (17 272 patients). Capsular repair produced a lower blood loss (465.2 vs 709.2 ml), and the procedure lasted 102.5 vs 96.08 min in patients who underwent capsulectomy. The patients undergoing capsulectomy experienced a dislocation rate of 3.06%, whereas in the patients undergoing capsular repair, the dislocation rate was 0.65%.

AREAS OF CONTROVERSY

Most studies are retrospective observational studies, with no prospective randomized trials.

GROWING POINTS

Capsular preservation is association with a lower dislocation rate and a lower blood loss. Capsular excision does take statistically less time, but it is uncertain how a 6 min difference is clinically relevant.

AREAS TIMELY FOR DEVELOPING RESEARCH

Appropriately powered randomized clinical trials should be conducted to better define the association between the chosen implants, approach and outcome.

Early dislocation in primary total hip arthroplasty using a posterior approach with repair of capsule and external rotators

OBJECTIVE

To determine the incidence of dislocation after primary total hip arthroplasty using a posterior approach with repair of capsule and transosseous external rotators.

MATERIAL AND METHOD

Historical cohort study between January 2009 and December 2015 of all the cases of dislocation of primary total hip arthroplasty operated using a posterior approach with repair of capsule and transosseous external rotators. Demographic and clinical data concerning the patient, surgery and dislocation were collected and analyzed. A descriptive analysis and a study of survival and risk function were performed by Kaplan Meier's method considering the appearance of a hip dislocation as the final event.

RESULTS

The incidence of dislocation in our study was 1.2% (23 patients). In our study, the highest probability of dislocation occurred in the first 120 days. Forty-three point 5percent of the dislocated patients needed revision surgery.

CONCLUSIONS

Capsular repair and transosseous reattachment of the external rotators can help to reduce the incidence of dislocation in patients undergoing primary total hip arthroplasty through a posterior approach.

Is soft tissue repair a right choice to avoid early dislocation after THA in posterior approach?

Background

Dislocation is the second most common complication after total hip arthroplasty (THA). The effectiveness of soft tissue repair to reduce dislocation rate is still debated and thus a meta-analysis was conducted.

Methods

A systematic search in PubMed, Embase, and Cochrane databases was conducted for this meta-analysis. Inclusion criteria: clinical comparative trials on the use of soft tissue repair including rotators and capsule repair in primary THA. The main data outcome were the incidences of early hip dislocation after primary THA. HSS score, incidence of other complications was also included in the outcomes.

Results

A total of 4816 cases were included for the analysis from ten studies (3 RCTs/7 Retrospective trials). Overall, the soft tissue repair group showed a significant lower early dislocation rate and higher HSS score compared to the no repair group; but no significant difference was observed between the two groups in regards to the early dislocation rate in RCT studies only. The capsule repair group showed a significant lower early dislocation rate than no capsule repair group while no significant difference was observed between the rotators repair group and no rotators repair group. In all included studies, 4 greater trochanter fractures, 2 sciatic nerve palsies and 1 infection were reported in soft tissue repair group while no cases were observed in the no repair group.

Conclusions

The efficacy of soft tissue repair is positive but still not conclusive to reduce the early dislocation rate after primary THA while soft tissue repair may bring more other complications. Capsule repair seems more effective than rotators repair only.

Effectiveness and safety of the posterior approach with soft tissue repair for primary total hip arthroplasty: a meta-analysis

BACKGROUND

Repair of soft tissue in favour of the posterior approach for total hip arthroplasty is still under discussion and few studies are assessing this issue. Therefore, we performed a meta-analysis to compare the effectiveness and safety of the posterior approach for total hip arthroplasty with and without soft tissue repair. We focused on these questions as follows: does primary posterior approach for total hip arthroplasty with soft tissue repair has better result regarding dislocation rate, Harris hip score and the sciatic nerve palsy rate compared with posterior approach without soft tissue repair.

PATIENTS AND METHODS

We conducted electronic literature searches using CENTRAL (Issue 1 of 12, Jan 2014), PUBMED (1980 to Jan 2014), and EMBASE (1980 to Jan 2014). Clinical studies evaluating the posterior approach for total hip arthroplasty with and without soft tissue repair were collected. After independent study selection by 2 authors, data were collected and extracted independently. The methodological quality of the studies was assessed by the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle-Ottawa Scale.

RESULT

Seven clinical trials with 4594 hips using the posterior approach for total hip arthroplasty were included. The pooled data indicated a lower rate of dislocation (OR: 0.14, 95% CI: 0.08-0.26, P<0.00001) and higher Harris hip score (1.75, 95% CI: 1.19 to 2.32, P<0.00001, I(2)=26%) after the posterior approach to total hip arthroplasty using soft tissue repair than without using soft tissue repair. There was no statistical difference in sciatic nerve palsy between the use of soft tissue repair and without it in posterior approach to total hip arthroplasty (OR: 5.34, 95% CI: 0.25-112.25, P=0.28).

DISCUSSION

Our meta-analysis included data from more studies than were previously available and demonstrated that the use of soft tissue repair and without it in posterior approach to total hip arthroplasty are similar in safety. Using repair resulted in a lower dislocation rate and higher Harris hip score than without repair.

LEVELS OF EVIDENCE

Level 2 meta-analysis of low-powered prospective randomised trial.

An unreported cause of early postoperative dislocation following total hip revision: massive intra-capsular oedema related to inferior vena cava filter thrombosis

Inferior vena cava (IVC) filters are widely used to prevent pulmonary embolism (PE) in patients with an absolute or relative contraindication for anticoagulants, during the peri-operative period of trauma or total joint replacement. No complication specific to the orthopaedic's aspect of this practice has been described. We report the case of a patient who had major femoral head/cup separation mimicking dislocation following revision total hip arthroplasty related to massive intra-capsular oedema produced by IVC filter thrombosis. The patient could be successfully treated non-operatively. Orthopaedic surgeons should identify and refer patients with a complicated IVC filter, to identify any migration or occlusion, and also be aware that removable filters must not be kept in situ, once the high-risk phase of developing PE is past.

MR imaging and ultrasound correlation of hip pathologic conditions

Magnetic resonance (MR) imaging has become the workhorse in the imaging evaluation of the painful or clinically abnormal hip. It provides an excellent anatomic overview and demonstration of the bony structures, articular surfaces, and surrounding soft tissues. Conversely, sonography can also demonstrate superficial intraarticular structures and the periarticular soft tissues, is quickly performed, allows dynamic evaluation of tendons and muscles, and can guide percutaneous procedures. These two modalities are complementary, and this article concentrates on the MR imaging-sonographic correlations of several entities about the hip.

Effect of femoral head size on polyethylene wear and synovitis after total hip arthroplasty: a sonographic and radiographic study of 39 patients

BACKGROUND AND PURPOSE

The role of synovitis and high fluid pressure in the loosening process after total hip arthroplasty has gained increasing attention. We investigated the correlation between head size, polyethylene wear, and capsular distention.

PATIENTS AND METHODS

We analyzed 39 unrevised, radiographically stable hips that had been operated with 28 or 32 mm femoral heads 10 years earlier because of osteoarthritis. We evaluated radiographic signs of loosening, linear and volumetric polyethylene wear, body mass index, activity level, and age. Sonographic examination was performed to measure capsular distance i.e. the distance between the prosthetic femoral neck and the anterior capsule.

RESULTS

Linear wear was 0.09 mm/year and 0.18 mm/year in the 28 mm and 32 mm groups, respectively (p < 0.001). The volumetric wear was 51 mm(3)/year and 136 mm(3)/year (p < 0.001) and the capsular distance was 13 mm and 17 mm, respectively (p < 0.001). There was a correlation between linear wear (r = 0.54), volumetric wear (r = 0.62), and capsular distance (p < 0.001).

INTERPRETATION

Wear was greater for the larger femoral head and was correlated to capsular distension.

Diagnostic procedures and surgical treatment of craniodorsal coxofemoral luxation in calves

OBJECTIVE

To report use of ultrasonographic examination of the coxofemoral joint, a surgical technique for repair of craniodorsal coxofemoral dislocation, and outcome.

STUDY DESIGN

Clinical case reports.

ANIMALS

Calves (n=4) with coxofemoral luxation.

METHODS

Craniodorsal coxofemoral luxation was diagnosed by physical examination, radiographic, and ultrasonographic findings. Open surgical reduction of the femoral head was performed using a modified caudal approach.

RESULTS

Craniodorsal luxation of the femoral head and the presence of an intact femoral neck were confirmed by ultrasonography. All luxations were successfully reduced and reluxation did not occur. At follow-up, 1 heifer had calved and 1 was 5 months pregnant. One calf died of bronchopneumonia 6 days after surgery. One calf had severe coxofemoral degenerative joint disease diagnosed (ultrasonography, radiography, and arthrocentesis) 3 months after surgery and confirmed by necropsy.

CONCLUSION

Ultrasonography proved to be a simple and effective non-invasive technique for diagnosis of coxofemoral luxation. Immediate surgical intervention in hip dislocation in calves is necessary to avoid unnecessary trauma to subchondral structures. In calves, open instead of closed surgical reduction appears preferable because it allows access to the acetabular cavity for removal of debris.

CLINICAL RELEVANCE

Ultrasonography should be considered a supplementary but not an alternative to radiographic examination for diagnosis of coxofemoral luxation and for follow-up examinations after reduction.