A more stable posterior approach for hemiarthroplasty of the hip

The dislocation rate following the insertion of a hemiarthroplasty of the hip via the posterior approach is variously quoted as between 8 per cent and 15 per cent. We set out to determine if this could be reduced by preserving the labrum and capsular structures at the time of surgery. We used a modification of the posterior approach, in which the labrum and capsule are preserved which appears not to have been widely reported. This increases the stability of the joint by adding to the depth of the acetabulum. We look prospectively at a series of 150 patients who were treated with an Austin Moore hemiarthroplasty using this technique. There were only two dislocations within 1 year of surgery in the series (one of these being in a patient with a dysplastic acetabulum) making our dislocation rate 1.3 per cent. We conclude that preserving the labrum significantly increases the stability of a hemiarthroplasty when it is inserted via a posterior approach.