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The posterior approach in THR: assuring capsular stability.

Chitranjan S Ranawat1, Morteza Meftah, Hollis G Potter

  • 1Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.

Orthopedics
|September 10, 2011
PubMed
Summary

The internal rotation test accurately assesses posterior capsule healing after total hip replacement (THR). A positive test indicates good healing, while a negative test suggests incomplete tendon healing and muscle atrophy.

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Area of Science:

  • Orthopedic Surgery
  • Musculoskeletal Imaging

Background:

  • Posterior capsule repair is crucial for reducing dislocation risk after total hip replacement (THR).
  • Predictive physical findings for assessing capsular integrity post-THR are lacking.
  • The internal rotation test is a proposed clinical assessment tool.

Purpose of the Study:

  • To evaluate the reliability of the internal rotation test in assessing posterior capsule and tendon healing after posterior-approach THR.
  • To correlate clinical findings from the internal rotation test with magnetic resonance imaging (MRI) results.

Main Methods:

  • Twenty-three patients who underwent posterior-approach THR were assessed using the internal rotation test postoperatively.
  • Magnetic resonance imaging (MRI) was performed to evaluate posterior capsule integrity, tendon scarring, and muscle atrophy.

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  • A blinded radiologist reviewed MRI scans for specific indicators of healing and muscle condition.

    • Main Results:

    • Positive internal rotation tests correlated with intact posterior capsules and scarred tendons on MRI, with no significant muscle atrophy.
    • Negative internal rotation tests were associated with incomplete tendon healing and severe muscle atrophy.
    • The internal rotation test demonstrated 100% sensitivity and 93% specificity for tendon/scar healing.

    Conclusions:

    • The internal rotation test is a simple, reproducible clinical tool for evaluating posterior capsule and tendon healing after THR.
    • A positive internal rotation test strongly correlates with successful capsule and tendon healing.
    • This test can help identify patients at risk for complications due to poor healing.