Surgical technique description : Transosseous 'over the top' reconstruction of capsule and tendons in primary total hip arthroplasty using a posterior approach.

Dislocation after total hip arthroplasty (THA) remains a devastating complication and a primary cause for revision arthroplasty. Historical data indicate that a posterior approach is associated with a higher dislocation rate. In this study, we present a highly reliable and anatomical reconstruction, based on the biomechanical findings of a previous cadaveric experiment. The posterior soft tissues were repaired in 2 layers. First a reattachment of the posterior orbicular ligament is performed at the anterior capsule. Subsequently a transosseous 'over the top' reinsertion of both capsule and tendons is performed close to there anatomical insertion. We prospectively collected data of 408 THAs from January 2004 until December 2013, through a posterior approach and with a capsule and tendon reconstruction based on a previous cadaveric study. There was a low early dislocation rate in primary THA (one of 408 THAs, 0,2%) and no complications related to the technique. This anatomical reconstruction of both capsule and tendons is associated with a low dislocation rate without complications at the level of the greater trochanter.