MESH group
CREST, DECUBITUS
The operation was performed under general anaesthesia. The patient was placed in the lateral decubitus position. The operation was performed through the posterolateral approach (appoximately 15 cm in length). The piriformis tendon and conjoined tendon (both obturator and both gemellus muscles) were detached near their insertions. The tendons were pulled posteriorly to expose the posterior capsule. Then, the posterior capsule was detached from the femoral neck and turned over to the acetabular labrum. The femoral head was dislocated posteriorly from the acetabulum. A proper uncemented acetabular cup and femoral stem were implanted. Based on the preoperative digital templating, the acetabular cup was placed at 20° ± 5° of anteversion and 40° ± 5° of abduction, and the stem was placed at 15° of anteversion. Hip stability was tested with the hip and knee flexed at 90° and the leg internally rotated by 25°. The combined anteversion of the implants was assessed with the Ranawat sign [The hydrophilic three-dimensional mesh (15 cm × 10 cm; TET1510, Parietex, COVIDIEN, USA) was folded into a V-shaped pattern. We made two or three drillholes (1 cm apart) in the trochanteric crest of the great trochanter. With the hip flexed at 90°, the two ends of the mesh were tensioned and sutured to the posterior capsular attachment using nonabsorbable sutures (MB66, Ethibond, USA) passed through the drillholes. The apex of the V-shaped mesh was sutured to the greater trochanter using MB66 nonabsorbable suture. The spare mesh was removed with scissors. After acceptable hip motion and stability were confirmed, the external pronator and piriformis muscles were transferred over the mesh and sutured to the greater trochanter using MB66 sutures (Fig. The posterior soft tissue was separated along the black dashed line (