Key Takeaways & Executive Findings
- •• Anatomical biomimetic reconstruction of the external rotators combined with zona orbicularis repair significantly improves postoperative hip function and range of motion compared to conventional suture methods. • The technique reduces intraoperative blood loss and incision length, with no significant increase in surgical time or complication rates. • The approach restores the anatomical position of the external rotators, minimizing dead space and promoting better joint stability and healing. • This novel technique offers a safe, economical, and effective alternative for posterior soft tissue reconstruction in artificial femoral head replacement.
Abstract
BACKGROUND: The current focus of related research on surgical techniques for elderly hip fractures has shifted from mechanical structural repair to biomechanically precise reconstruction based on the principles of bionic medicine. Although the theory of anatomical reduction and repair is widely accepted, how to achieve an optimal balance between repair stability and joint range of motion through personalized treatment plans still requires further investigation. OBJECTIVE: To investigate the application effect of anatomical bionic reconstruction of the external rotator muscles combined with repair of the zona orbicularis in unilateral artificial femoral head replacement. METHODS: A retrospective cohort study was conducted, including 124 elderly patients with unilateral femoral neck fractures admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from June 2021 to March 2023. All patients underwent artificial femoral head replacement via the posterolateral approach. Based on comprehensive analysis of clinical data and preoperative doctor-patient communication, patients were divided into two groups: the experimental group (65 cases) received anatomical biomimetic reconstruction of the external rotators combined with repair of the zona orbicularis, while the control group (59 cases) received conventional suture method (fixing the joint capsule and external rotator tendon to the greater trochanter). Surgical time, intraoperative blood loss, incision length, incision healing, hospital stay, complication rate, and readmission rate were recorded for both groups. Postoperative visual analog scale (VAS) scores, Harris scores, hip flexion-extension range of motion, and internal-external rotation range of motion were compared between the two groups to evaluate the clinical value of the anatomical biomimetic reconstruction technique. RESULTS AND CONCLUSION: (1) There were no significant differences in general data between the two groups (P > 0.05). (2) Perioperative indicators: The experimental group and control group had 1 and 2 cases of grade B wound healing, respectively, which healed well after active anti-infection and regular dressing changes. The experimental group had significantly better intraoperative blood loss and incision length than the control group (P < 0.05). The surgical time in the experimental group was longer than that in the control group, but the difference was not statistically significant (P > 0.05). There were no significant differences in incision healing and hospital stay between the two groups (P > 0.05). (3) There was no significant difference in the time to full weight-bearing activity between the two groups (P > 0.05). Compared with the control group, the experimental group had significantly better postoperative VAS scores (except at 1 month postoperatively), Harris scores, hip flexion-extension range of motion, and internal-external rotation range of motion, indicating that the long-term prognosis of the experimental group was significantly better than that of the control group. (4) There was no significant difference in postoperative acetabular abduction angle between the two groups (P > 0.05). However, the postoperative anteversion angle in the experimental group was significantly larger than that in the control group (P < 0.05). (5) During regular follow-up, no prosthesis loosening, periprosthetic infection, or fracture occurred in either group. No dislocation occurred during hospitalization, but after discharge, 1 case in the experimental group and 3 cases in the control group experienced dislocation, which were corrected by closed reduction under anesthesia; the difference was not statistically significant. (6) The results indicate that anatomical biomimetic reconstruction can not only ensure joint stability but also achieve better functional outcomes, providing a new reference dimension for clinical surgical selection.
1. Introduction
Artificial femoral head replacement is the gold standard for treating displaced femoral neck fractures and end-stage hip joint diseases in the elderly [1-2]. Although the posterior approach remains the mainstream surgical approach worldwide due to its excellent acetabular exposure, protection of the abductor muscles, and ease of operation, it inevitably damages the short external rotators and posterior joint capsule [3-6]. The destruction of these posterior stabilizing structures is significantly associated with postoperative dislocation, which has become the second most common complication leading to revision after hip arthroplasty, with an incidence ranging from 1.1% to 10.7% [7-15]. Existing evidence indicates that meticulous repair of these structures can effectively restore the posterior biomechanical function of the hip joint and reduce the risk of dislocation.
Currently, mainstream clinical methods for repairing the external rotators, such as bone-tendon repair, anchor repair, and soft tissue-to-soft tissue repair, can reduce the dislocation rate to some extent, but inevitably have problems such as avulsion fractures due to excessive tension, secondary rupture, and high costs. Some scholars have previously reported a technique of intraoperative suturing of the iliofemoral ligament, but lacked clinical data validation, and various new repair techniques have emerged subsequently. However, the lack of standardization of various reconstruction techniques and the insufficient mechanical integrity of repaired tissues remain key factors leading to persistent dislocation, highlighting the urgent need for more reliable and standardized reconstruction techniques for the posterior capsule-external rotator complex [16-18]. This study focuses on the management strategy of the short external rotators and joint capsule, which are key stabilizing structures in artificial femoral head replacement. Its core feature is the proposal and validation of an innovative technique aimed at achieving 'in situ anatomical reconstruction', allowing the external rotators to restore their anatomical position to the greatest extent, reducing the cavity around the piriform fossa, reducing tissue hematoma and effusion, and making the joint capsule a complete cylinder again. This study is not limited to simple tissue repair, but emphasizes fine reconstruction to restore the natural anatomical structure and biomechanical environment of the posterior hip joint.
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MA Zaichao, Maimaitiyibubaji·Abudukadier, LYU Qing, YANG Zengqiang, LI Biao, CUI Yong (2026). Application of anatomical biomimetic reconstruction of the external rotators combined with repair of the zona orbicularis in unilateral artificial femoral head replacement. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21618
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Frequently Asked Questions
What is anatomical biomimetic reconstruction of the external rotators?
Anatomical biomimetic reconstruction is a surgical technique that aims to restore the anatomical position and function of the external rotator muscles and the posterior joint capsule during hip arthroplasty, using principles of bionic medicine to achieve biomechanical precision and improve joint stability and function.
How does this technique compare to conventional suture methods?
Compared to conventional suture methods that fix the capsule and tendons to the greater trochanter, anatomical biomimetic reconstruction results in less intraoperative blood loss, smaller incision length, and better postoperative hip function and range of motion, without increasing complication rates.
What are the potential benefits of this technique?
The technique reduces dead space, minimizes tissue trauma, restores the anatomical integrity of the posterior structures, and may lower the risk of dislocation while improving functional outcomes, making it a safe and effective option for elderly patients undergoing femoral head replacement.
Are there any drawbacks or limitations?
The surgical time may be slightly longer, but the difference is not statistically significant. The technique requires careful surgical dissection and precise reconstruction, which may have a learning curve. Long-term outcomes need further validation with larger studies.
Who can benefit from this surgical approach?
This approach is particularly beneficial for elderly patients with displaced femoral neck fractures undergoing unilateral artificial femoral head replacement via the posterolateral approach, especially those at higher risk of dislocation or with compromised soft tissue quality.
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