EFFICACY OF CAPSULAR REPAIR IN PARTIAL HIP HEMIARTHROPLASTIES: OUTCOME OF 100 CONSECUTIVE CASES

A. Carlet, C. Buono*, L. Scaramuzzi, M. Amendolagine, B. Moretti and G. Solarino

University of Bari “Aldo Moro”- AOU Policlinico Consorziale, Orthopaedic &Trauma Unit

*Correspondence to:
Claudio Buono, MD
School of Medicine,
University of Bari “Aldo Moro”- AOU Policlinico Consorziale,
Department of Translational Biomedicine and Neuroscience,
Orthopaedic &Trauma Unit Policlinico,
Piazza Giulio Cesare 11,
Bari 70124, Italy
e-mail: claudio.buono91@gmail.com

Received: 18 December 2022 Accepted: 15 January  2023

ISSN: 1973-6401 Copyright © by Lab Publishers (2023) This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

In the last years, bipolar hemiarthroplasty has become the gold standard for the treatment of femoral neck fractures in elderly. The role of joint capsule as a passive stabilator of the hip and the importance of its reconstruction after hip replacement is known in the postero-lateral access as one of the key points for the success of the surgery procedure, due to its role as a protection factor from post operative dislocations. The lateral direct approach is burden of less episodes of hip dislocation, nevertheless there is no evidence of the possibility of capsular reconstruction after this procedure. The aim of this study is to compare the incidence of post-operative hip dislocations in patients underwent to bipolar hemiarthroplasty procedure with lateral direct approach with or without capsular reconstruction. We retrospectively analysed all patients underwent to hemiarthroplasty for a femoral neck fracture in our institute from July 2021. Inclusion criteria were bipolar hemiarthroplasty intervention, lateral direct approach to the hip, minimum follow up was 1 year. Incidence of post operative dislocation and the necessity of reintervention have also been calculated. 100 hip hemiarthroplasty with lateral direct approach were performed in patients with medial femoral neck fracture (64 women and 36 men). The mean age is 82.4 years (65-96). The mean duration of the operation was 79 min (20-150). In 50 cases the capsule was preserved (Group B: capsulotomy + capsulorrhaphy), while in the other 50 cases (Group A) only selective capsulectomy was performed. The groups are homogenous in terms of age, sex, duration of surgery and type of implant (monobloc vs modular stem, neck, biarticular cup, cementation ant head size). During the study period under analysis, there were 1 cases of post-operative dislocation, in the group of patients in which capsulorrhaphy was not performed and it was equipped with a modular stem. The dislocation occurs in 75 days; in this case a reduction manoeuvre of the new implant was performed which proved unsuccessful, since the residual instability of the implant made it necessary to undergo partial revision with a dual mobility cup, but leaving the stem and neck in situ. Articular capsule plays a fundamental role in hip hemiarthroplasty performed also with lateral direct access, resulting in a further protective factor against post-operative dislocations.

KEYWORDS: hemiarthroplasty, capsular repair, capsulorrhaphy