There are a number of popular surgical methods for maintaining reduction of coxofemoral luxations - use of 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 stability, and especially for long-term 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 surgical method 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, 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 is perhaps partially responsible for the logic and popularity of the method.
Different suture material and sizes are used based on the surgeon’s preference. IMEX® customers use both monofilament and braided suture material. Braided material is popular with customers who desire strength and knot security and tends to bend acutely around anchors or toggles better than monofilament suture material. Typical sizes include #2 and #5. Monofilaments are popular with customers who desire a relatively inert material; common examples include monofilament fishing leader and Prolene®.