There are a number of currently popular surgical methods for maintenance of reduction of coxofemoral luxations that include: the toggle pin method, ilio-femoral sutures to limit external rotation of the hip, and caudo-distal transposition of the greater trochanter. Each of these methods depends on the joint capsule and associated muscles for acute and especially for long-term maintenance of joint stability. If the joint capsule is severely traumatized and not conducive to primary repair, some surgeons elect to perform a capsulorrhaphy or dorsal suture augmentation of the joint capsule. With any of the just mentioned surgical methods for stabilization of hip luxations, it is important to remember that the use of sutures and anchors must be considered temporary solutions until the joint capsule and periarticular soft tissue can heal. As such, patients with poor hip conformation are not good candidates for these methods of repair and should be considered for salvage procedures, such as FHNE or THR.
The toggle pin method of maintenance of coxofemoral luxations has been around many years. Commercially available toggle pins, IMEX™ Polypropylene Suture Buttons, and the IMEX™ Universal Aiming Device have simplified the method and increased its popularity. This method places a strand (or multiple strands) of suture material in a location that mimics the normal origin and insertion of the round ligament of the femoral head, which is torn when the hip is traumatically luxated. This anatomic positioning of suture material is relatively straightforward and visually demarcated in the hip, and perhaps is partially responsible for the logic and popularity of the method. Different suture materials and sizes are used based on the surgeon’s preference. IMEX™ customers use both monofilament and braided suture materials. Braided material is popular with customers who desire strength and knot security. Typical sizes include #2 and #5. Prolene®, Ethilon® and monofilaments are popular with customers who desire a relatively inert material, and common examples include monofilament fishing leader in 40 lb., 60 lb., and 80 lb. tests.
