A Posterior Approach to Primary Total Hip Arthroplasty With Soft Tissue Repair

Suh, Kuen Tak; Park, Byung Guk; Choi, Young Jun

doi:10.1097/00003086-200401000-00026

Cited by 128 publications

(110 citation statements)

References 19 publications

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“…Multiple studies have shown improvement in postoperative hip stability when the short external rotators are repaired after THA using a posterior approach [11,14,22,29]. However, the failure rate of surgically repaired short external rotators after posterior THA is as much as 80% [28].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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Background Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a singleincision modification of this technique in 135 patients. Description of TechniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue. Methods For the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months). Results There were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41°(range, 21°-49°) and anteversion averaged 21°(range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2°varus and 2°v algus alignment, respectively.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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“…Thus, prevention is more important than treatment. We performed careful preoperative planning, postoperative precautions designed to prevent dislocation, intraoperative stability testing, and used a posterior soft tissue repair technique [29] that helps maintain adequate soft tissue tension to decrease the risk for postoperative dislocation in patients with neuromuscular diseases. Special effort is required to prevent intraoperative and postoperative dislocations as stability is a concern for patients with neuromuscular disease who have THAs [7].…”

Section: Discussionmentioning

confidence: 99%

“…Barnes et al [1] reported no difference in dislocation rates between surgical approaches for bipolar HAs. The reported dislocation rate after THA using the posterior approach with adequate soft tissue repair is not high [16,19,26,29,30]. Because we used the posterior approach in all patients, comparison with another approach is needed.…”

Section: Discussionmentioning

confidence: 99%

“…All patients received preoperative antibiotics to prevent postoperative infection, and an antiembolic stocking. Bipolar HA was performed using the posterolateral approach with enhanced soft tissue repair, with the patients in the lateral decubitus position [29]. The same surgeon (KTS) performed all surgeries in all patients.…”

Section: Methodsmentioning

confidence: 99%

“…All bipolar acetabular components had a mobile inner polyethylene liner in a cobalt-chromium metal shell (Multipolar; Zimmer). We used the posterior soft tissue repair technique [29], which attaches the articular capsule and conjoined tendon to the greater trochanter, in all patients to regain soft tissue tension. During the posterolateral approach, the piriformis and conjoined tendon including the obturator internus were detached with electrocautery as close as possible from their insertion to obtain a wide flap.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Is the Dislocation Rate Higher after Bipolar Hemiarthroplasty in Patients with Neuromuscular Diseases?

Suh

Kim

Lee

et al. 2012

Clinical Orthopaedics &Amp; Related Research

Self Cite

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Background Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear. Questions/purposes We therefore (1) asked whether the incidence of postoperative dislocation after bipolar hemiarthroplasty was greater in patients with neuromuscular disease than for those without, and (2) whether function differed between the two groups, and (3) explored potential risk factors for dislocation in two groups.

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Piriformis and obturator internus morphology: A cadaveric study

Pine

Binns²,

Wright

et al. 2010

Clinical Anatomy

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Preservation of piriformis during exposure of the hip joint via a posterior approach may result in a lower rate of dislocation following total hip arthroplasty. The aim of this study was to identify anatomical variations in the tendons of piriformis and obturator internus which could inform piriformis sparing approaches to the hip. Twenty-nine proximal femora from 15 cadavers, 5 male and 10 female aged 65-79 years, were examined. Tendon crossing angles, location and mode of insertion to the greater trochanter and the extent of fusion between tendons prior to insertion were noted. The mean (and associated standard deviation) of the vertical and horizontal widths of the piriformis tendon were 4.78 ± 1.31 mm and 7.35 ± 1.74 mm, respectively. The mean (and associated standard deviation) of the vertical and horizontal widths of the obturator internus tendon were 6.87 ± 1.61 mm and 5.72 ± 1.38 mm, respectively. The mean distances of the anterior and posterior margins of the piriformis tendon insertion from the posterior limit of the greater trochanter, defined as a percentage of the anteroposterior length of the greater trochanter, were 63.3% ± 9.4% and 43.0% ± 9.4%, respectively. Equivalent mean distances for the obturator internus insertion were 73.0% ± 6.6% and 55.9% ± 7.0%, respectively. On the basis of the relationship between the piriformis and obturator internus tendons in terms of the angle and point at which they cross, in addition to any degree of tendon fusion, four classifications were identified. This study shows that the most posterior margins of the piriformis and obturator internus attachments are located more than one-third of the way along the greater trochanter, suggesting that current osteotomies would not include these external rotators in the majority of cases.

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A Posterior Approach to Primary Total Hip Arthroplasty With Soft Tissue Repair

Cited by 128 publications

References 19 publications

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Is the Dislocation Rate Higher after Bipolar Hemiarthroplasty in Patients with Neuromuscular Diseases?

Piriformis and obturator internus morphology: A cadaveric study

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