A comparison of a less invasive piriformis-sparing approach versus the standard posterior approach to the hip

Abstract

We undertook a randomised controlled trial to compare the piriformis-sparing approach with the standard posterior approach used for total hip replacement (THR). We recruited 100 patients awaiting THR and randomly allocated them to either the piriformis-sparing approach or the standard posterior approach. Pre- and post-operative care programmes and rehabilitation regimes were identical for both groups. Observers were blinded to the allocation throughout; patients were blinded until the two-week assessment. Follow-up was at six weeks, three months, one year and two years. In all 11 patients died or were lost to follow-up. There was no significant difference between groups for any of the functional outcomes. However, for patients in the piriformis-sparing group there was a trend towards a better six-minute walk test at two weeks and greater patient satisfaction at six weeks. The acetabular components were less anteverted (p = 0.005) and had a lower mean inclination angle (p = 0.02) in the piriformis-sparing group. However, in both groups the mean component positions were within Lewinnek's safe zone. Surgeons perceived the piriformis-sparing approach to be significantly more difficult than the standard approach (p = 0.03), particularly in obese patients. In conclusion, performing THR through a shorter incision involving sparing piriformis is more difficult and only provides short-term benefits compared with the standard posterior approach.

Comparison of postoperative effectiveness of less invasive short external rotator sparing approach versus standard posterior approach for total hip arthroplasty

“…Previous studies assessing THA through the posterolateral approach mostly investigated the differences between the mini-incision and standard surgeries (19,20). In addition, operations with external rotator sparing mainly preserved the quadrate muscle of the thigh (8,21,22) or the piriformis muscle (9,11), while those sparing a larger extent of the short external rotator are scarce. In contrast to mini-invasive surgeries pursuing small incisions, muscle sparing operations do not necessarily minimize the incisions, thus having more indications.…”

“…Despite muscle suturing and reconstruction later during surgery, the trauma and in ammatory damage remain more pronounced than observed with the external rotator sparing approach. A randomized, controlled clinical trial of piriform-sparing THA showed that corrective surgery not only has the advantages of conventional posterolateral approach surgeries, but also involves the concept of mini-invasiveness (11). In this procedure, no osteotomy of the greater trochanter or resection of the piriformis muscle was required during the operation, and only piriformis muscle terminations on the articular capsule were dissected, resulting in signi cantly less trauma, reduced postoperative blood loss, and shortened hospital stay (11).…”

“…The surgery sparing the piriformis muscle resulted in longer distance in the six-minute walking test and higher degree of patient satisfaction compared with the standard operation, while the acetabular anteversion angle was not signi cantly different between the two groups; in addition, the corrective group also had advantages such as reduced intraoperative injuries and faster postoperative recovery (8). However, these investigators indicated that the surgery was highly challenging, and suggested the operation was not worth applying, especially in obese patients, for short-term bene ts (9)(10)(11). Additional reports suggested that based on soft tissue and muscle contusions induced by the surgical apparatuses and dilators, corrective surgeries could only provide limited additional bene ts, with no objective clinical evidence supporting their advantages (12)(13)(14).…”

Two Year Average Follow Up of Supercapsular Percutaneously Assisted Total Hip Arthroplasty; Zero Dislocations

“…The short external rotator muscles and Iliotibial band are not violated, the hip is not dislocated, thus theoretically reducing the risk of postoperative dislocation. [38][39][40] The tissuesparing nature of this approach may allow for decreased time to ambulation, length of stay, 30-day readmission rates, in-hospital costs, and blood loss. [41][42][43] The purpose of the current study was to evaluate the incidence of dislocation at minimum one year follow up in a large series of patients undergoing primary, elective THA using the SuperPATH approach.…”

Anatomical basis for surgical approaches to the hip

“…[1] Surgical exposure of the hip joint is required for tumor surgery, treatment of infection in the hip joint, treatment of hip fractures, hemi-arthroplasty as well as primary and revised total hip replacement. [234567] The principles of surgical exposure include a thorough knowledge of anatomy of the region and its variations,[891011] proper patient positioning and adequate incisions. Dissections through natural cleavage planes help to minimize bleeding and disruption of important functional structures.…”