title: Posterior transosseous capsulotendinous repair in total hip arthroplasty : a cadaver study.
abstract: BACKGROUND
  While recent clinical articles have reported a dramatic reduction in rates of total hip dislocation after posterior transosseous repair, we are not aware of any published biomechanical data to support this finding. The objectives of this study were to investigate the functional anatomy of the posterior transosseous repair and its effect on stability after total hip replacement.
  
  
  METHODS
  Six total hip prostheses were implanted into three fresh cadavera. Three different repair situations (no repair, soft-tissue repair, and transosseous fixation) were then consecutively tested on each hip. Values for torque resistance and the angular range of motion at dislocation were recorded. Each repair was tested twice, yielding a total of thirty-six torque values and thirty-six angles of rotation.
  
  
  RESULTS
  The transosseous repair was superior with regard to both torsion strength (four times stronger than that after no repair [p = 0.0002] and more than twice as strong as that after soft-tissue repair [p = 0.002]) and the magnitude of the angle of rotation observed prior to dislocation (an increase of 83% in comparison with that after no repair [p = 0.0005] and an increase of 46% in comparison with that after soft-tissue repair [p = 0.004]).
  
  
  CONCLUSIONS
  In a cadaver model, posterior transosseous repair provides superior stability of a total hip replacement. Optimal surgical technique with a slightly modified approach allows greater retention of capsule and tendon length and a more anatomical reinsertion of the soft tissues.
authors.affiliation: Department of Orthopaedics, University of Louvain, Louvain, Belgium. wouter.sioen@skynet.be
authors.forename: W
authors.initials: W
authors.lastname: Sioen
authors.forename: J P
authors.initials: JP
authors.lastname: Simon
authors.forename: L
authors.initials: L
authors.lastname: Labey
authors.forename: R
authors.initials: R
authors.lastname: Van Audekercke
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006617:Hip Dislocation / Q000209:etiology / Q000517:prevention & control*; D006622:Hip Prosthesis; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D013710:Tendons / Q000601:surgery*