Impact of joint capsule reconstruction on the functional prognosis in total hip arthroplasty

LIU Jin-zhao; JIANG Ning; GAO Peng; YU Teng-bo; SUN Kang; QI Chao

doi:10.3969/j.issn.2095-252X.2014.06.003

Abstract：Objective To investigate the impact of joint capsule reconstruction on the functional prognosis in primary total hip arthroplasty ( THA ) by a modiifed direct lateral approach for the patients with fresh femoral neck fractures.Methods From January 2007 to June 2010, the clinical data of 128 patients with fresh femoral neck fractures who underwent primary THA by the modified direct lateral approach were retrospectively analyzed. According to whether the repair of anterior joint capsule was performed, the patients were divided into group A and group B. In group A (n=61 ) the patients underwent the repair of anterior joint capsule, and in group B (n=67 ) the resection of anterior joint capsule was performed. The intraoperative blood loss and drainage volume, early postoperative incidence of hip dislocation, Harris hip score and early and later postoperative hip range of motion ( ROM ) in internal and external rotation were compared and analyzed between the 2 groups.Results The general data were compared between the 2 groups, including the gender, age, cause of fractures, disease course, fracture type, combined medical disorders, prosthesis selection and so on. The results were comparable, but no statistically signiifcant differences existed (P>0.05 ). There were no statistically signiifcant differences in the operation time, intraoperative blood loss or drainage volume between the 2 groups (F=0.78, 0.19, 1.73;P>0.05 ). The Harris hip scores were signiifcantly improved at 6, 24 and 48 weeks after the operation when compared with the preoperative scores in both groups (t=43.08, 48.71, 50.20 in group A;t=41.50, 44.30, 53.28 in group B;P<0.05 ). At 6 and 24 weeks after the operation, the scores in group A were signiifcantly higher than that in group B and the differences between them were statistically signiifcant (F=438.45, 228.70;P<0.05 ). However, no statistically significant differences were noticed at 12 months after the operation (F=3.22,P>0.05 ). There were no statistically significant differences in the hip ROM in internal and external rotation at different time points between group A and group B (F=0.01, 1.47, 0.14;F=0.57, 0.58, 0.24;P>0.05). The differences in the hip ROM in internal and external rotation at 6 and 12 months after the operation and at 6 weeks after the operation were statistically signiifcant (t=28.10, 20.62;t=19.45, 19.82;t=27.22, 20.72;t=17.71, 15.43;P<0.05 ). Conclusions Primary THA by the modiifed direct lateral approach is recommended for the patients with fresh femoral neck fractures, and the Harris hip scores can be improved and the early postoperative hip function can be restored. The joint capsule should be reserved and repaired conventionally during the operation.