title: Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach: a cadaver study.
abstract: Reported rates of dislocation in hip hemiarthroplasty (HA) for the treatment of intra-capsular fractures of the hip, range between 1% and 10%. HA is frequently performed through a direct lateral surgical approach. The aim of this study is to determine the contribution of the anterior capsule to the stability of a cemented HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature, providing ten hip joints for investigation. A Thompson HA was cemented in place via a direct lateral approach. The cadavers were then positioned supine, both knee joints were disarticulated and a digital torque wrench was attached to the femur using a circular frame with three half pins. The wrench applied an external rotation force with the hip in extension to allow the hip to dislocate anteriorly. Each hip was dislocated twice; once with a capsular repair and once without repairing the capsule. Stratified sampling ensured the order in which this was performed was alternated for the paired hips on each cadaver. Comparing peak torque force in hips with the capsule repaired and peak torque force in hips without repair of the capsule, revealed a significant difference between the 'capsule repaired' (mean 22.96 Nm, standard deviation (sd) 4.61) and the 'capsule not repaired' group (mean 5.6 Nm, sd 2.81) (p < 0.001). Capsular repair may help reduce the risk of hip dislocation following HA.
authors.affiliation: Orthopaedic Department, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK.
authors.forename: A W
authors.initials: AW
authors.lastname: Hughes
authors.affiliation: Bristol Royal Infirmary, Upper Maudlin Street, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Clark
authors.affiliation: Severn Postgraduate Medical Education, Deanery House, Unit D Vantage Business Park, Old Gloucester Road, Bristol, BS16 1GW, UK.
authors.forename: W
authors.initials: W
authors.lastname: Carlino
authors.affiliation: Musgrove Park Hospital, Taunton TA1 5DA, UK.
authors.forename: O
authors.initials: O
authors.lastname: Gosling
authors.affiliation: Weston General Hospital, Weston-super-Mare, BS23 4TQ, UK.
authors.forename: R F
authors.initials: RF
authors.lastname: Spencer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000379:methods; D006617:Hip Dislocation / Q000209:etiology / Q000517:prevention & control*; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D019415:Torque
keywords: Capsule; Hip dislocation; Hip fracture