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MRI Evaluation of Posterior Capsular Dehiscence After Posterior Approach Total Hip Arthroplasty

Allegra, Paul R. MD; Nuño, Ane U. MD; Barrera, Carlos M. BS; McNamara, Colin A. MD; Cohen-Levy, Wayne B. MD; Rizzo, Michael G. Jr MD; Ezuddin, Nisreen MD; Alba, Jaime A. C. MD; Jose, Jean DO

Journal of the American Academy of Orthopaedic Surgeons: December 1, 2019 - Volume 27 - Issue 23 - p e1052-e1058
doi: 10.5435/JAAOS-D-18-00655
Research Article

Introduction: To our knowledge, no previous study has evaluated the use of MRI to diagnose posterior capsule dehiscence after posterior approach total hip arthroplasty (THA) with capsular repair and its association with postoperative posterior hip dislocation.

Methods: A retrospective chart review of patients who underwent posterior approach THA with capsulotomy repair was performed. Patients were identified who subsequently underwent MRI, and these studies were evaluated for signs of posterior capsular disruption. Each chart was then evaluated for episodes of postoperative hip dislocation.

Results: Six hundred seventy-five patients were included in the retrospective review. Thirty-two patients (17 women [aged 37 to 78 years] and 15 men [aged 34 to 80 years]) met the inclusion criteria. Fifteen patients of 32 (48.4%) developed posterior capsule dehiscence after repair (group 1). Seventeen patients of 32 (51.6%) did not have MRI evidence of posterior capsule dehiscence (group 2). In group 1, 2 patients of 15 (13.3%) experienced a posterior hip dislocation. No group 2 patients experienced a posterior hip dislocation. Overall, only 2 patients of 32 (6.3%) developed posterior hip dislocations. In group 1, 12 patients of 15 (80%) developed dehiscence at the lateral capsule margin at the greater trochanter suture repair site. The two patients in group 1 with posterior hip dislocations displayed MRI evidence of capsular dehiscence in this region. Two patients of 15 (13.3%) in group 1 demonstrated dehiscence at the central third of the posterior capsule, whereas 1 patient of 15 (6.6%) in group 1 demonstrated dehiscence at the medial/acetabular margin. No significant difference was found between the dislocation rates between groups 1 and 2 (P = 0.212). The distribution of capsular dehiscence (lateral, middle, and medial capsule) in group 1 was significant (P = 0.0006).

Discussion: MRI can effectively diagnose capsular dehiscence in patients who have undergone posterior THA. Most repaired capsules failed in the lateral repair region. MRI offers the potential to identify patients with a higher risk of implant dislocation.

Level of Evidence: Therapeutic level III

From the Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, FL (Dr. Allegra, Dr. McNamara, Dr. Cohen-Levy, Dr. Rizzo, and Dr. Alba), Department of Radiology, Hospital Universitario Donostia, Donostia-SAN Sebastián, Spain (Dr. Nuño), University of Miami Miller School of Medicine (Mr. Barrera), and the Department of Radiology, University of Miami Miller School of Medicine (Dr. Ezuddin, Dr. Jose), Miami, FL.

Correspondence to Dr. Rizzo:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Allegra, Dr. Nuño, Barrera, Dr. McNamara, Dr. Cohen-Levy, Dr. Rizzo, Dr. Ezuddin, Dr. Alba, and Dr. Jose.

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Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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