Comparison of Two Posterior Soft Tissue Repair Techniques to Prevent Dislocation after Total Hip Arthroplasty via the Posterolateral Approach

Abstract

Background Although the posterolateral approach is considered to carry a higher early dislocation rate after total hip arthroplasty, posterior soft tissue repair techniques make up for this limitation. Through-bone and through-tendon repair techniques are the two most commonly used techniques. This study aimed to comprehensively compare these techniques and give more evidence-based references for orthopedists. Methods: This retrospective study enrolled 87 patients who underwent posterior soft tissue repair with total hip arthroplasty via the posterolateral approach. The posterior capsular and external rotators were reconstructed to the greater trochanter through drill holes (through-bone, n = 46) or gluteus medius tendon (through-tendon, n = 41). Early dislocation rate, repair-related complications, postoperative pain (visual analog scale, VAS), hip joint function (Harris Hip Scale, HHS), patient satisfaction, and operation-related indexes were evaluated. Results: The discrepancy in early dislocation between the two cohorts was not statistically significant. Operation-related indexes were not significantly different between the two cohorts, except for the postoperative drainage volume (229.46 mL vs. 172.07 mL, p=.013). No patient sustained greater trochanteric fracture and sciatic nerve injury. Each group achieved significant improvements in HHS and VAS scores compared with preoperative values. No statistically significant discrepancy was found in HHS scores between the two groups at the same period, while VAS scores were significantly lower in the through-bone group at 1 week (4.93 vs. 5.68, p=.026) and 1 month (1.72 vs. 1.99, p=.038) after surgery. Higher patient satisfaction was observed in the through-bone group. Conclusions: Although no statistical discrepancy in the early dislocation rate between through-bone and through-tendon repair techniques was observed, lower pain scores and higher patient satisfaction supported the former. We recommend that through-bone repair technique should be chosen first by orthopedists when performing reconstruction of the posterior soft tissue in total hip arthroplasty via a posterolateral approach.

Keywords

• posterior soft tissue repair
• dislocation
• total hip arthroplasty
• posterolateral approach
• through-tendon repair
• through-bone repair