Enhanced anterior capsular repair: A very low dislocation rate in a population at risk with standard implants

Femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) are at high risk for dislocation. While several techniques have been studied in attempts to address this increased risk, there is a scarcity of literature describing the efficacy of capsular management through anterior approach-based surgeries. In this study, we describe our institutional experience with an enhanced capsular repair (ECR) technique, where the capsule is sutured to the gluteus minimus. We hypothesize that this technique will enhance stability and decrease dislocation rate.

Seventy-nine patients who underwent primary THA for FNF between January 1, 2017-March 30, 2022, with a minimum of one-year follow-up were identified. These patients underwent an anterior approach-based operation where the ECR was performed. All operations were performed by a single fellowship trained arthroplasty surgeon. Primary outcomes included dislocation, revision surgery, and infection rates. Ambulatory status, radiographic parameters, and the Charlson Comorbidity Index (CCI) were also obtained.

A total of 79 patients were included with zero dislocations observed. There were two revisions for aseptic loosening and traumatic periprosthetic fracture. Two superficial surgical site infections were successfully treated non-operatively. The average CCI was 3.89 and the average head size was 34 mm. The radiographic parameters postoperatively demonstrated an average abduction angle of 41.6° and average leg length change of +2.33 mm.

We found that performing an ECR after an anterior approach THA for FNF achieved adequate stability with the use of conventional implants. No significant leg lengthening or changes to ambulatory status were observed post-operatively.