Purpose
To evaluate the effect of capsulotomy size and subsequent repair on the biomechanical
stability of hip joint kinematics through external rotation of a cadaveric hip in
neutral flexion.
Methods
Eight fresh-frozen cadaveric hip specimens were used in this study. Each hip was tested
under torsional loads of 6 N·m applied by a servohydraulic frame and transmitted by
a pulley system. The test conditions were (1) neutral flexion with the capsule intact,
(2) neutral flexion with a 4-cm interportal capsulotomy, (3) neutral flexion with
a 6-cm capsulotomy, and (4) neutral flexion with capsulotomy repair. Soft tissue was
retained during all interventions. Measures indicating joint kinematics (range of
motion [ROM], hysteresis area [HA], and neutral zone [NZ]) were obtained for each
condition.
Results
For all hip specimens, the average ROM, HA, and NZ were calculated relative to the
intact capsular state (100%) and expressed in terms of percentage (± SD). The findings
for ROM were as follows: intact, 100%; 4 cm, 107.42% ± 5.69%; 6 cm, 113.40% ± 7.92%;
and repair, 99.78% ± 3.77%. The findings for HA were as follows: intact, 100%; 4 cm,
108.30% ± 9.30%; 6 cm, 115.30% ± 13.92%; and repair, 99.47% ± 4.12%. The findings
for NZ were as follows: intact, 100%; 4 cm, 139.61% ± 62.35%; 6 cm, 169.25% ± 78.19%;
and repair, 132.03% ± 64.38%. Statistically significant differences in ROM existed
between the intact and 4-cm conditions (P = .039), the intact and 6-cm conditions (P < .0001), the 4-cm and repair conditions (P = .033), and the 6-cm and repair conditions (P < .0001). There was no statistically significant difference between the intact and
repair conditions (P > .99) or between the 4- and 6-cm conditions (P = .126).
Conclusions
Under laboratory-based conditions, larger-sized capsulotomies were accompanied by
increases in all 3 measures of joint mobility: ROM, HA, and NZ at time zero. Complete
capsular closure effectively restored these measures when compared with the intact
condition.
Clinical Relevance
Cadaveric models consisting of the hip joint with surrounding soft tissue were used
under laboratory testing conditions to investigate potential iatrogenic joint instability
resulting from expansive capsulotomies, showing that complete capsular closure leads
to reconstitution of original joint stability properties at time zero.
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Article info
Publication history
Published online: May 17, 2016
Accepted:
January 21,
2016
Received:
April 17,
2015
Footnotes
The authors report the following potential conflict of interest or source of funding: S.H.S. receives support from Rush University. Funding to present this study at a research conference. H.D.M. receives support from Smith & Nephew and Pivot Medical. R.C.M. receives support from KNG Health Consulting, Pivot Medical, Smith & Nephew, and Stryker. Paid consultant. M.J.S. receives support from Smith & Nephew. S.J.N. receives support from Editorial Board for Frontiers, review board for American Journal of Sports Medicine, review board for Clinical Orthopaedics and Related Research, and review board for Arthroscopy. Stryker and Ossur. Paid consultant. Pending grant application submitted to Arthroscopy Association of North America (AANA). Current grant under way with Stryker. Current grant under way with AANA. 2014 OREF Resident Grant awarded. Allosource, Arthrex, Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith & Nephew, and Stryker.
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
