Role of capsular repair on dislocation in revision total hip arthroplasty

Dislocation remains one of the most common complications after revision total hip arthroplasty (THA). In contrast to primary THA the posterior capsule has been routinely excised to provide better visualization, but its role in preventing dislocation has been overlooked. We reviewed 69 patients (79 hips) patients who had revision THA with a posterolateral approach to determine if closing the posterior capsule resulted in a fewer dislocations. We followed the patients for a minimum of 24 months (mean 57 months, range, 24-120 months). Two (2.5%) hips dislocated. Both dislocated anteriorly in the immediate postoperative period. One dislocation was from implant malposition and the other occurred in a high risk patient. There were no posterior dislocations and no patients reported any hip subluxation. The historically high dislocation rates with the posterolateral approach can be reduced by carefully balancing soft tissues, ensuring correct implant alignment, meticulously closing the posterior capsule, and reattaching the external rotators.