Using mesh in capsule anatomical reconstruction to enhance the stability of high- dislocation-risk hip arthroplasty: a randomized controlled trial

Abstract

Abstract Background: Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA. Methods: This was a prospective, randomized controlled study of consecutive patients. 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indexes were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indexes included Harris hip score (HHS), complications, satisfaction. Results: 106 patients completed the follow-up and the average follow-up time was 19±3.1 and 18±3.3 months. The operation time of mesh group was longer than conventional group (P < 0.001). There were minor differences in acetabularanteversion and abduction angle, and the other data had no differences. MRI results showed the successful rate of capsular repair was higher in mesh group (50 hip, 98%) than in conventional group (37 hips, 67%) (P < 0.001) and the others failed the repair. Three dislocations occurred in conventional group while none in the mesh group. The preoperative HHS (30 points) and postoperative HHS (82 points) of mesh group were similar to those (35 points, 83points) of the conventional group (P = 0.164, P = 0.328). The satisfaction showed no difference (P=0.532). Conclusions: Compared to conventional repair, mesh reconstruction can effectively maintain the capsular integrity and decrease dislocation risk after THA without increasing the complications. Level of Evidence: Therapeutic study, Level IA