Name: Posterior Capsule Reconstruction in Revision Hip Surgery
Uploaded: 2017-05-04T00:00:00Z
Channel: Arthrex
Description: Amar Ranawat, MD, (New York, NY) highlights the utilization of ArthroFLEX ® * dermal allograft during reconstruction of the posterior capsule in hip revision arthroplasty. *ArthroFLEX is a registered trademark of LifeNet Health.

Amar Ranawat, MD, (New York, NY) highlights the utilization of ArthroFLEX®* dermal allograft during reconstruction of the posterior capsule in hip revision arthroplasty.
*ArthroFLEX is a registered trademark of LifeNet Health.

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VPT1-00811-EN | B | Posterior Capsule Reconstruction in Revision Hip Surgery

Amar Ranawat

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Posterior Capsule Reconstruction in Revision Hip Surgery

My name is Amar Ranawat. I'm an associate professor of orthopedic surgery from the hospital for Special Surgery. And I'm going to talk today about a case of revision. Total hip replacement for instability using a posterior capsular reconstruction. The case is a 69 year old male who had a right total hip replacement five years ago. He suffered an early dislocation at six weeks that was closed, reduced, but then went on to have a stable hip that was quite functional for the next five years. He, unfortunately then suffered a late dislocation at that point, and we had the discussion regarding doing further surgery to stabilize his hip during this time, though, he had been ambulating normally. He did have some occasional pain in the hip, but led quite an active lifestyle for a 69 year old, hiking quite frequently, and was active in downhill skiing. These are his preoperative x rays, which show components that are in good position and good reconstruction of his leg length and offset. We felt that his component were such that we would not change them, and given his age, we put emphasis on the fact that a constrained liner would probably solve his problem. As we obtained a pre-operative MRI, we were able to acknowledge that he had a significantly deficient posterior capsule, and it was our challenge at that point to try to reconstruct the posterior capsule in an effort to share load with the constrained liner, so that he wouldn't have late failure of that device. So when we got into the operating room, sure enough, the posterior capsule was completely deficient. We were staring right at the implants after we opened up the fascia. He was easily converted to a constrained liner, and then we proceeded to define his posterior capsule remnant and reconstruct his posterior capsule using ArthroFLEX, which is a cadaveric dermal allograft that has been denuded of its DNA and provides excellent structural support, and has been used extensively in the shoulder. Here's an example of the graft, as it has been sutured to the posterior capsule remnant. And then you'll see the anterior sutures that are being pulled up through the greater trochanter. And this graft will then be sutured all the way around and secured to make up for the deficient posterior capsule. Here's the final reconstruction. The sutures tied through drill holes in the greater trochanter, secured to the posterior capsule remnant, and with superior and inferior sutures as well. You can see the tension in the graft, and how this would limit internal rotation and share load with the constrained liner. Here are post-operative X-rays showing the constraint liner in place and AP and false profile views of the same. We have been so confident with this technique that our hope is that we'll be able to demonstrate its efficacy and that in the future, find cases where we can avoid the use of using constrained liners, and just use this posterior capsule reconstruction to solve the problem of instability.

Posterior Capsule Reconstruction in Revision Hip Surgery

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Posterior Capsule Reconstruction in Revision Hip Surgery

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Orthobiologics

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