Wu et al.’s [Citation1] recent publication attempts to retrospectively compare the through-bone (TB) and through-tendon (TT) techniques of soft-tissue-repair for fixing THA re-dislocation. The surgical procedure involves reconstruction of the posterior capsular and external rotator to attach the greater trochanter by drill holes or gluteus tendon. Indexes such as dislocation rate, postoperative pain, hip function, and complications were evaluated statistically, and the authors concluded that TB was superior to TT for dislocation repair.
The following references in the Journal of Investigative Surgery describe experiments that involve repairing abdominal, shoulder and hip lesions, either by platelet plasma, heterotopic bone, soft tissue, or bioabsorbable rivet. For instance, Aliabadi-Wahle et al. [Citation2] used synthetic materials (TMS-1 and TMS-2 vs. polytetrafluoroethylene and polypropylene etc.) to repair abdominal wall fascial defects covered by soft tissue and reaffirmed that fascial closure is preferable only when soft tissue coverage over the repair cannot be achieved. They also found that TMS-2 is well tolerated. In a study published in 2007, Collins et al. [Citation3] conducted a biomechanical study of Bankart lesion fixation comparing biodegradable ArthroRivet tack vs. suture repair and suggested the suitability of the bioabsorbable rivet for use in Bankart repair. This indicated that bioabsorbable fixation is possible and practical in soft tissue procedures performed in the shoulder. In 2011, Klaassen and Pietrzak [Citation4] conducted a retrospective investigation of platelet-rich plasma application and heterotopic bone formation following total hip arthroplasty. They discovered that 21.3% of the control patients developed heterotopic bone compared to 12.9% of the treatment patients after one year, and this difference was not significant. This did not influence the severity of heterotopic ossification, as autologous blood products play less of a role in total hip arthroplasty. However, none of these studies address the topical technique of TB or TT repair, so Wu et al.’s paper raises interesting possibilities.
Although Spaans et al. present data contradicting Wu et al.’s conclusion in Hip Int. [Citation5], the following references support their conclusion that the reliability and effectiveness of TB is superior to TT: In Clin Orthop Relat Res, Suh et al. [Citation6] describe an early dislocation rate of 1% by posterior soft tissue (PST) and 6.4% without PST. In Orthopedics, Tarasevicius et al. [Citation7] found an early dislocation rate of 2% in the TB group whereas the rate was 5% in the TT group. In Clin Orthop Relat Res, Mihalko et al. [Citation8] measured the torsional force and found it was much higher and closer to normal when TB was performed rather than TT. In a study that involved a 2-year follow up published in J Arthroplasty [Citation9], Dixon et al. found that one out of 255 patients had a dislocation. In a biomechanical study published in J Bone Joint Surg Am, Sioen et al. [Citation10] found that the torsion strength of TB was four times as much as no repair and twice that of the TT. In Int Orthop, Moon et al. [Citation11] reported a rate of repair failure of 18.4% in TB and 65% in the TT. The dislocation rate in the TB group was 1.1%, while rate of the TT group was 7%.
Although the available information on early dislocation and drainage volume is more substantial and the other indexes such as hip function, postoperative pain and complications are evaluated using the Harris Hip Scale and visual analog scale, which are more dependent on subjective human judgment and not so reliable, at least they provide references to assist our considerations.
The follow-up time meets the minimal standards, the trial of the matched group and testing groups is scientific, the data is statistically sound, the tables are informative, the figures are clear, and the results showing no significant difference in dislocation rate, lower pain scores, higher patient satisfaction, and no significant correlation between incision complications and repair technique are reliable despite the limited specimen number. Even if this investigation is not so innovative, it provides some evidence-based references for orthopedists and is worth recommending.
Declaration of Interests
The author has no competing interests to declare.
References
- Wu F, Yin P, Yu X, et al. Comparison of two posterior soft tissue repair techniques to prevent dislocation after total hip arthroplasty via the posterolateral approach. [published online ahead of print September 25, 2019]. J Invest Surg. 2021;34(5):513–521. doi:10.1080/08941939.2019.1651922
- Aliabadi-Wahle S, Cnota M, Choe E, et al. Comparison of novel synthetic materials with traditional methods to repair exposed abdominal wall fascial defects. J Invest Surg. 1998;11(2):97–104.
- Collins KJ, Mukherjee DP, Ogden AL, et al. A biomechanical study of bankart lesion fixation - biodegradable ArthroRivet tack vs. suture repair. J Invest Surg. 2007;20(3):157–166.
- Klaassen MA, Pietrzak W. Platelet-rich plasma application and heterotopic bone formation following total hip arthroplasty. J Invest Surg. 2011; 24(6):257–261. doi:10.3109/08941939.2011.589885.
- Spaans EA, Spaans AJ, van den Hout JA, et al. The result of transmuscular versus transosseous repair of the posterior capsule on early dislocations in primary hip arthroplasty. Hip Int. 2015;25(6):537–542. doi:10.5301/hipint.5000279.
- Suh KT, Park BG, Choi YJ. A posterial approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res. 2004;418:162–167. doi:10.1097/00003086-200401000-00026.
- Tarasevicius S, Robertsson O, Wingstrand H. Posterial soft tissue repair in total hip arthroplasty: a randomized controlled trial. Orthopedics. 2010;33(12):871.
- Mihalko WM, Whiteside LA. Hip mechanic after posterior structure repair in total hip arthroplasty. Clin Orthop Relat Res. 2004;420:194–198. doi:10.1097/00003086-200403000-00027.
- Dixon MC, Scott RD, Schai PA, et al. A simple capsulorrhaphy in a posterior approach for total hip arthroplasty. J Arthroplasty. 2004;19(3):373–376. doi:10.1016/j.arth.2003.10.002.
- Sioen W, Simon JP, Labey L, et al. Posterior transosseous capsulotendinous repair in total hip arthroplasty: a cadaver study. J Bone Joint Surg Am. 2002;84(10):1793–1798. doi:10.2106/00004623-200210000-00009.
- Zhou J, Li C, Wang W. The incidence of hip dislocation and suture failure according to two different types of posterior soft tissue repair techniques in total hip arthroplasty: a prospective randomized controlled trial. Int Orthop. 2018;42(9):2049–2056.