Effect of systematic soft-tissue repair on functional outcomes following posterior approach total hip arthroplasty

Background: Posterior approach total hip arthroplasty (THA) is widely used but historically has been associated with a higher dislocation risk. Systematic posterior soft-tissue repair (capsule and external rotator reconstruction) can mitigate this instability. However, few studies have assessed this technique alongside validated functional outcomes in routine secondary-care settings. Methods: In a prospective consecutive case series at rural secondary-care centres in India, 150 patients (age 40-85) undergoing primary posterior-approach THA with systematic posterior capsule and external rotator repair were enrolled (Jan-Dec 2024). All surgeries used a standard Kocher-Langenbeck posterior approach by one surgeon. Functional outcomes were measured preoperatively and at 6 weeks, 3 months, 6 months, and 12 months. Patients were followed for 12 months postoperatively, and all complications were recorded. Results: Of 150 patients, 138 (92%) completed the 12-month follow-up. Mean Harris Hip Score (HHS) improved from 35.9 preoperatively to 84.7 at 12 months (mean gain ≈49 points). Mean Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) improved from 60.1 to 18.0 (mean reduction ≈42 points). Notably, there were no hip dislocations. The overall complication rate was 13.0% (18/138), predominantly minor (hematoma 6.5%, intraoperative fracture 2.9%), with no major complications. Conclusions: Systematic posterior soft-tissue reconstruction in posterior-approach THA produced substantial improvements in hip function and effectively prevented dislocation in this series. The favourable outcomes and low complication rate support the efficacy and safety of this technique in routine THA practice, even in secondary-care settings.