The Analysis of Posterior Soft Tissue Repair Durability
Condition: Arthroplasty Complications
Study type: Interventional

Summary: 
      Dislocation after THA usually occurs early after surgery and some go on to disabling
      recurrent dislocations . The posterior surgical approach is frequently used since it provides
      excellent exposure of both acetabulum and femur. However, many series on primary THA have
      reported that dislocation is 2 to 3 times more frequent after the posterior approach as
      compared to other approaches . Dissatisfaction with these dislocation rates resulted in the
      introduction of different posterior soft tissue repair techniques. Many authors have reported
      statistically significant differences in dislocation rates with posterior soft tissue repair
      as compared to without . However, there is still a concern in the literature regarding the
      durability of posterior soft tissue repair.

      The aim of our study was to analyse THA patients with posterior soft tissue repair in terms
      of suture durability of two different suture materials and time of suture failure.
    

Detailed description: 
      A total of 42 consecutive THA patients (20 women,22 men) operated for primary osteoarthritis
      (OA) between 2018 and 2019 were included in the study. All patients were operated by the same
      orthopaedic surgeon under spinal anaesthesia via posterior approach using the same type of
      uncemented Polar stem(Smith and Nephew Inc) with 36 mm head in combination with uncemented
      Ep-Fit acetabular cup (Smith and Nephew Inc). All the patients were randomly divided into two
      groups. The randomization process was done by the odd and even number technique in which the
      patients with even inpatient numbers were assigned in Group A while the odd inpatient number
      patients were allotted in Group B. Patients in whom number 5 Ethibond Excel(Ethicon,
      Somerville, NJ) were used for soft tissue repair were included in Group A (n=22), whereas
      patients treated with number 2 Vicryl (Ethicon, Somerville,NJ)were in Group B (n=20).

      The short external rotators tendons were released from the greater trochanter just at their
      insertion point. The capsule was incised, but not excised. The posterior repair included
      reattaching the piriformis,conjoined tendons and the capsule to the greater trochanter at the
      insertion point through 2, 2 mm drill holes with 2 stitches with non-absorbable no.5 Ethibond
      suture in one group and with absorbable no 2 vicryl suture in the other group after the
      prosthesis had been implanted and the joint reduced. One hemoclip was attached to the
      piriformis tendon and another to the conjoined tendons before pulling the sutures out of the
      drill holes in the trochanter. The suture materials lateral to the drill holes at the
      trochanter were also attached with two hemoclips.(fig 1-2) The postoperative regimen included
      walking with full weight bearing the next day after the surgery with a walking frame and
      without limitations in internal rotation or flexion. Anteroposterior radiographic examination
      was undertaken immediately after the patients returned from the operating theatre to the
      intensive care unit,at the 15th day, at 3 months and 6 months postoperatively (figure 3). The
      detachment of the hemoclips were measured during the follow up period.
    

Intervention name(s): durability of posterior soft tissue repair
Intervention type(s): Other
Intervention description(s): how durable is the posterior soft tissue repair after total hip arthroplasty in primary osteoarthiritis patients?
Intervention model: Single Group Assignment
Intervention model description: prospective randomised trial
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: posterior soft tissue repair