title: Direct Repair of the Superior Band of Bigelow's Ligament After Hip Arthroplasty: a Surgical Technique.
abstract: BACKGROUND
  The posterolateral approach is one of the most common approaches used during hip arthroplasty. A posterior soft tissue repair is necessary to limit the risk of postoperative dislocation. For a trapezoidal capsulotomy, the proximal limb divides the superior band of the iliofemoral ligament (Bigelow's ligament). A transosseous repair frequently leaves a defect in this region, which may elevate the risk for dislocation. The purpose of this article is to describe a simple, rational technique for reinforcing the posterior capsular repair.
  
  
  METHODS
  A meticulous exposure of the hip capsule is performed during the posterolateral surgical approach. A trapezoidal capsulotomy is performed. After implantation of the arthroplasty implants, retractors are placed to expose the superior capsule. Prior to transosseous repair of the capsule and short external rotator tendons, the proximal limb of the capsulotomy is reapproximated anatomically and repaired with non-absorbable sutures. If anatomical repair is not possible, leg length and femoral offset should be reassessed carefully.
  
  
  CONCLUSIONS
  The described modification may further minimize the risk of dislocation following hip arthroplasty, as the superior band of Bigelow's ligament is an additional checkrein to internal and external rotation. This repair provides a secondary intraoperative assessment of leg length and femoral offset to ensure proper biomechanical reconstruction of the hip joint. It is the authors' preferred technique of all hip hemiarthroplasties and total hip arthroplasties, whenever possible.
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Christ
authors.affiliation: Department of Orthopedic Surgery, Bone & Joint Hospital of Queens, New York Hospital Queens, Flushing, NY 11355 USA.
authors.forename: Peteris
authors.initials: P
authors.lastname: Dzenis
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
keywords: hemiarthroplasty; hip dislocation; hip replacement arthroplasty; joint capsule; ligaments, articular