Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty

Amanatullah, Derek F.; Masini, Michael; Roger, Douglas J.; Pagnano, Mark W.

doi:10.1302/0301-620x.98b8.37178

Cited by 40 publications

(26 citation statements)

References 39 publications

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“…The lateral approach, a commonly used extramedullary approach for intertrochanteric fractures, could provide direct access to the vastus lateralis muscle; however, it has the disadvantage of limited exposure, long surgery time, and substantial bleeding. The direct anterior approach (DAA), first described by Hunter [25], is a modified Smith-Peterson approach with less soft-tissue damage, shorter surgery duration, and less bleeding than traditional lateral and posterior-lateral approaches [26]. However, DAA has some drawbacks such as a long learning curve [27], difficulty in femur exposure, and the possibility of lateral femoral cutaneous nerve (LFCN) and lateral femoral circumflex artery (LFCA) injury.…”

Section: Discussionmentioning

confidence: 99%

Investigation of a novel implant design for the treatment of reverse oblique femoral intertrochanteric fractures

Zhang¹,

Wang²,

Luo³

et al. 2019

Preprint

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Objective: To evaluate the biomechanical properties of intramedullary fixation, lateral plate, medial buttress plate and bilateral plate for fixing reverse oblique intertrochanteric fractures. Methods: Twenty-four synthetic femoral bone models (Synbone) were divided into four groups [proximal femoral nail anti-rotation (PFNA), proximal femoral medial buttress plate (PFMBP), proximal femoral locking compression plate (PFLCP) and proximal femoral medial buttress plate + proximal femoral locking compression plate (PFMBL+PFLCP)], and an unstable, reverse oblique femoral intertrochanteric fracture was made. After fixation, each model underwent axial load testing, torsion testing, and axial load-to-failure testing. The stiffness of axial and torsion, the torque of different torsion angles and the failure load of every model were recorded. Results: The bilateral plate showed the best performance in axial load, torsion, and load-to-failure testing. The stiffness of axial and torsion in the PFMBP was superior to the PFNA [162.05±22.05 N/mm vs. 119.13±29.14 N/mm in axial, (1.36±0.32) N × mm/deg vs. (1.10±0.13) N × mm/deg in torsion, P<0.05], whereas there was no significant difference between PFMBP, PFLCP and PFLCP+PFMBP in torsion stiffness [(1.36±0.32) N × mm/deg, (1.45±0.44) N × mm/deg, (1.45±0.18) N × mm/deg, P>0.05]. Conclusion: Our newly designed medial buttress plate achieved greater stiffness in axial load and torsion than PFNA and PFLCP to fix reverse oblique intertrochanteric fractures in biomechanical research, whereas the bilateral plate showed better stiffness than PFMBP.

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Section: Discussionmentioning

confidence: 99%

Investigation of a novel implant design for the treatment of reverse oblique femoral intertrochanteric fractures

Zhang¹,

Wang²,

Luo³

et al. 2019

Preprint

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“…The direct superior (DS) approach for total hip arthroplasty (THA) is a minimally invasive posterior approach that enables preservation of the iliotibial band, short external rotators (specifically the quadratus femoris and obturator externus muscles), and hip abductors 1,2 .…”

Section: Introductory Statementmentioning

confidence: 99%

“…Rationale: The DS approach to the hip differs from the traditional posterior and mini-posterior approaches because it preserves the iliotibial band, quadratus femoris muscle, and obturator externus tendon 1 , potentially suppressing dislocation. The DS approach to the hip causes less soft-tissue destruction, especially to the gluteus minimus and tensor fasciae latae muscles, compared with the direct anterior approach to the hip, suggesting DS-THA may enhance postoperative mobility 1,3,[14][15][16] . DS-THA is extensile by extending the incision distally, incising the iliotibial band, and releasing the quadratus femoris muscle.…”

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confidence: 99%

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Direct Superior Approach to the Hip for Total Hip Arthroplasty

Barrett

Ezzibdeh

Horst

et al. 2019

JBJS Essential Surgical Techniques

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Background: Traditional posterior approaches to the hip, posterolateral and mini-posterior, violate the iliotibial band and the short external rotators, specifically the quadratus femoris and obturator externus muscles 1-4. The direct anterior approach does not violate the iliotibial band or the quadratus femoris, resulting in earlier ambulation and lower dislocation rates 1,5-9. The direct superior (DS) is a posterior approach that spares the iliotibial band, obturator externus tendon, and quadratus femoris muscle. The goal of minimally invasive surgery (MIS) is to disrupt the least amount of tissue necessary to adequately expose the hip and correctly place implants. Although MIS total hip arthroplasty (THA) has not lived up to all of its promises 10-13 , MIS-THA may enable early ambulation and decrease length of stay 14-16. Description: The patient is positioned in the lateral decubitus position. An 8 to 10-cm incision is made at a 60°oblique angle starting from the posteriorproximal corner of the greater trochanter. Only the gluteus maximus fascia is incised; the Iliotibial band is completely spared. The gluteus maximus muscle is split bluntly, exposing the gluteus medius muscle, piriformis tendon, and triceps coxae (the obturator internus and superior and inferior gemellus muscles). The piriformis and conjoined tendon are released from the greater trochanter and tagged. The gluteus minimus is elevated, exposing the posterior hip capsule. An arthrotomy is performed prior to dislocating the hip with flexion, adduction, internal rotation, and axial compression. The femoral neck is resected, the acetabulum is reamed, and components or trials are impacted into position. Hip stability is assessed. Final implants are placed. The posterior capsule, piriformis, and obturator internus tendons are repaired anatomically. The fascia and skin are closed. Alternatives: • Posterolateral approach. • Mini-posterior approach. • Direct lateral approach. Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the

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“…Consequently, there have been efforts to understand which approaches cause less muscle damage and minimize the adverse effects after surgery. The extent of muscle damage can be estimated by levels of serum and inflammatory markers [19], Magnetic Resonance Image (MRI) analysis [20], or surgical techniques in cadaveric studies [21,22] Many conducted studies include intraoperative evaluations such us blood loss, operative time, days of hospitalization, anesthetic methods, possible complications etc. which are collated with different approaches.…”

Section: Introductionmentioning

confidence: 99%

Muscle Damage in Different Approaches in Total Hip Arthroplasty According to Serum Markers

Tottas¹,

Fiska²,

Kougioumtzis³

et al. 2019

TOORTHJ

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Background:Total Hip Arthroplasty (THA) is the final treatment of end-stage hip osteoarthritis. Nowadays, THA has become very common, cost- effective and one of the most successful orthopaedic procedures. Recently, surgeons have shifted their interest to approaches according to Minimally Invasive Surgery (MIS). These approaches are either modifications of conventional approaches or they are designed from the beginning as MIS approaches. Muscle damage and soft tissue damage are issues that concern researchers who perform studies on THA.Objective:The aim of this study is to review the literature concerning studies by comparing different approaches using serum and inflammatory markers for muscle and soft tissue damage.Methods:We searched the PubMed database in the English language systematically for clinical studies or reviews, comparing muscle damage according to serum markers between two or more approaches in primary total arthroplasty.Results:In total, twenty-one studies were included in this review. Although the results are controversial, it seems that MIS approaches in most of the studies were related to lower levels of inflammation markers contrasting with conventional approaches. Nevertheless, this difference in muscle damage is not correlated with a difference in functional scores or other perioperative data and clinical outcomes in all studies.Conclusion:The existing literature does not lead to a safe consensus about the superiority of any approach. Therefore, there is still a need for further research with well-designed studies.

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Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty

Cited by 40 publications

References 39 publications

Investigation of a novel implant design for the treatment of reverse oblique femoral intertrochanteric fractures

Investigation of a novel implant design for the treatment of reverse oblique femoral intertrochanteric fractures

Direct Superior Approach to the Hip for Total Hip Arthroplasty

Muscle Damage in Different Approaches in Total Hip Arthroplasty According to Serum Markers

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