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*Stephen Murphy - New England Baptist Hospital - Boston, USA*Email: stephenbmurphymd@gmail.comProspective Comparison Of Total Hip Arthoplasty Performed Using Conventional AndTissue-Preserving Techniques: A Minimum 2-year Outcome StudyS.D. Steppacher, M. Tannast, S.B. MurphyNew England Baptist Hospital, 125 Parker HillAvenue, 02120 Boston, USAIntroduction. The use of less invasive techniques for total hip arthroplasty (THA) has remainedcontroversial with some studies showing a higher incidence of complications. The technique ofperforming total hip arthroplasty through a superior capsulotomy was developed to maximallypreserve the soft tissue envelope surrounding the hip. The current study assesses the recoveryand complications of hips replaced using conventional and tissue preserving techniques.Methods. 206 hips in 191 patients with a mean follow-up of 4.3 ± 1.0 (range, 3.2 – 5.9) yearsunderwent total hip arthroplasty using the superior capsulotomy technique. The mean age atoperation was 55.7 ± 12.9 (19 – 85) years and the operation was performed for 106 hips (51%)in men. The surgical technique involves exposing the superior hip joint capsule posterior to themedius and minimus, and anterior to the short external rotators. The femur is prepared with thefemoral head in place and then the femoral head is excised without dislocation. These 206 hipswere compared to a cohort of 279 hips replaced using the transgluteal exposure (control group).These 2 series were controlled for complexity and demographic factors. Recovery wasevaluated using the Merle d’Aubigné score at 6 and 12 weeks postoperatively.Results. Two of the 206 hips (1%) replaced using the superior capsulotomy have been revised,one for failure of osseointegration of a nonmodular CoCr acetabular component and one forfracture of a ceramic liner at 21 months. In addition, there were 3 surgical complications. Theseincluded one intraoperative and one postoperative nondisplaced trochanteric fracture treatednonoperatively and one anterior hip dislocation. Assessment of the control group demonstratedfive revisions: one for recurrent dislocation, two for failure of osseointegration of the femoralcomponent, one for malseating of an acetabular liner, and one for fracture of a ceramic liner.Four hips developed trochanteric wafer nonunions of which 2 required repair. There was oneintraoperative trochanteric fracture and two postoperative displaced trochanteric fracturesrequiring repair. Three hips sustained intraoperative femoral cracks that were cerclaged, and onepelvis sustained a posterior wall fracture that was repaired at surgery. There were twoarthrotomies, one for treatement of infection and one for suspected infection. The complicationrate was significantly higher in the control group than in the study group. Compared to thecontrol group, the hips replaced using the superior capsulotomy technique had significantlyhigher hip scores at the 1st and 2nd followup: 1st f/u Merle D’Aubigné score of 15.6 ± 1.6 (9 –18) vs 13.1 ± 1.8 (8 – 18) and 2nd f/u 17.1 ± 1.1 (13 – 18) vs 16.2 ± 1.6 (10 – 18).Conclusion. These results suggest that the superior capsulotomy technique, with the goal of softtissue preservation, is a safe and reliable method of performing total hip arthroplasty comparedto one conventional THA technique. These results show that the patients recovered quickly andexperienced a low incidence of perioperative complications.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]