Enhanced soft tissue repair using locking loop stitch after posterior approach for hip hemiarthroplasty

Hemiarthroplasty of the hip for displaced fracture of the femoral neck (including Austin-Moore and Thompson arthroplasties) frequently is performed by orthopaedic surgeons. The posterior approach is used despite the slight increase in risk of postoperative dislocation. The outcome after dislocation can be disastrous. We tried to prevent this complication by repairing the posterior capsule and the short external rotators (piriformis, superior and inferior gemellus, obturator internus, and upper part of quadratus femoris) using locking loop stitch as described by Krackow. From January 1998 to April 1999, 205 hips were operated on and followed up for >3 months; no dislocation was found. Using the past records as the comparative group, 28 posterior dislocations (1.9%) were found in 1,483 hip hemiarthroplasties using the posterior approach (P <.05 using exact probability test). Enhanced soft tissue repair with locking loop stitch is an effective way to reduce the incidence of dislocation after hip hemiarthroplasty using the posterior approach.