TY - JOUR
T1 - The Posterior Capsular Ligamentous Complex Contributes to Hip Joint Stability in Distraction
AU - Takao, Masaki
AU - Otake, Yoshito
AU - Fukuda, Norio
AU - Sato, Yoshinobu
AU - Armand, Mehran
AU - Sugano, Nobuhiko
N1 - Funding Information:
The authors gratefully acknowledge the contributions of Takeshi Ogawa, Keisuke Uemura, Ryota Nakaya, Kazunori Tamura, and Kazuma Takashima (Osaka University, Japan); Futoshi Yokota, Yuki Suzuki, and Yuta Hiasa (Nara Institute of Science and Technology, Japan); Robert B. Grupp, Amirhossein Farvardin, Ryan Murphy, Stephen Belkoff, and Demetries Boston (Johns Hopkins University, USA); and Chavarin Amarase and Prof. Aree Tanavalee (Churalongkorn University, Thailand) in the cadaver experiments and the advice and criticism of Takashi Sakai and Hidetoshi Hamada (Osaka University, Japan)
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/3
Y1 - 2018/3
N2 - Background: Laxity of soft tissues after total hip arthroplasty is considered to be a cause of accelerated wear of bearing surfaces and dislocation. The purpose of the present study was to assess the contribution of the anterior and posterior capsular ligamentous complexes and the short external rotators, except the quadratus femoris, on the stability of the hip against axial traction. Methods: The study subjects comprised 7 fresh cadavers with 12 normal hip joints. In 6 hips, soft tissues surrounding the hip joint were resected in the following order to simulate the anterior approach: anterior capsule, posterior capsule, piriformis, conjoined tendon, and external obturator. In the remaining 6 hips, soft tissues were resected in the following order to simulate the posterior approach: piriformis, conjoined tendon, external obturator, posterior capsule, and anterior capsule. Soft tissue tension was measured by applying traction amounting to 250 N with joints in the neutral position. Results: The separation distance between the femoral head and acetabulum during axial leg traction significantly increased from 4.0 mm to 14.5 mm on average after circumferential resection of the capsule via the anterior approach. Subsequent resection of the short external rotators increased the separation distance up to 19.0 mm, but the differences did not reach statistical significance. Resection of the short external rotators via the posterior approach did not significantly increase the separation distance; it significantly increased from 6.0 mm to 11.4 mm after the resection of the anterior capsule and further to 20.5 mm after the resection of the posterior capsule. Conclusion: The posterior capsule, in addition to the anterior capsule, significantly contributes to hip joint stability in distraction regardless of whether the short external rotators, except the quadratus femoris, were preserved or resected.
AB - Background: Laxity of soft tissues after total hip arthroplasty is considered to be a cause of accelerated wear of bearing surfaces and dislocation. The purpose of the present study was to assess the contribution of the anterior and posterior capsular ligamentous complexes and the short external rotators, except the quadratus femoris, on the stability of the hip against axial traction. Methods: The study subjects comprised 7 fresh cadavers with 12 normal hip joints. In 6 hips, soft tissues surrounding the hip joint were resected in the following order to simulate the anterior approach: anterior capsule, posterior capsule, piriformis, conjoined tendon, and external obturator. In the remaining 6 hips, soft tissues were resected in the following order to simulate the posterior approach: piriformis, conjoined tendon, external obturator, posterior capsule, and anterior capsule. Soft tissue tension was measured by applying traction amounting to 250 N with joints in the neutral position. Results: The separation distance between the femoral head and acetabulum during axial leg traction significantly increased from 4.0 mm to 14.5 mm on average after circumferential resection of the capsule via the anterior approach. Subsequent resection of the short external rotators increased the separation distance up to 19.0 mm, but the differences did not reach statistical significance. Resection of the short external rotators via the posterior approach did not significantly increase the separation distance; it significantly increased from 6.0 mm to 11.4 mm after the resection of the anterior capsule and further to 20.5 mm after the resection of the posterior capsule. Conclusion: The posterior capsule, in addition to the anterior capsule, significantly contributes to hip joint stability in distraction regardless of whether the short external rotators, except the quadratus femoris, were preserved or resected.
KW - hip capsular ligament
KW - hip joint stability
KW - short external rotators
KW - total hip arthroplasty
KW - traction
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U2 - 10.1016/j.arth.2017.10.026
DO - 10.1016/j.arth.2017.10.026
M3 - Article
C2 - 29137900
AN - SCOPUS:85033602684
SN - 0883-5403
VL - 33
SP - 919
EP - 924
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 3
ER -