Minimally invasive posterolateral hip approach with SPARTAQUUS (Spare the Piriformis And Respect The Active QUadratus femoris and gluteus mediUS) technique

Gérard, Romain; Savéan, Joël; Lefèvre, Christian

doi:10.1016/j.otsr.2020.07.010

Cited by 9 publications

(7 citation statements)

References 36 publications

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“…Recent reports have emphasized the importance of the ischiofemoral ligament and the external rotators in reducing dislocation risk after THA with a posterior surgical approach [ 15 – 17 ]. However, it was unclear which muscle resisted excessive internal hip rotation, especially at 0° and 60° of hip flexion, the ischiofemoral ligament was not stretched.…”

Section: Discussionmentioning

confidence: 99%

Impacts of external rotators and the ischiofemoral ligament on preventing excessive internal hip rotation: a cadaveric study

et al. 2022

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Background This study examined the biomechanics of preventing excessive internal hip joint rotation related to the hip flexion angle. Method An intramedullary nail with a circular plate equipped with a protractor was installed in the femur of nine normal hips. The circular plate was pulled by 3.15 Nm of force in the internal rotation direction. The external rotators were individually resected, finally cutting the ischiofemoral ligament. The cutting order of the external rotators differed on each side to individually determine the internal rotation resistance. The external rotators were resected from the piriformis to the obturator externus in the right hips and the reverse order in the left hips. Traction was performed after excising each muscle and ischiofemoral ligament. Measurements were taken at 0°, 30°, and 60° of hip flexion, and the differences from baseline were calculated. Results For the right hip measurements, the piriformis and ischiofemoral ligament resection significantly differed at 0° of flexion (p = 0.02), each external rotator and the ischiofemoral ligament resections significantly differed at 30° of flexion (p < 0.01), and the ischiofemoral ligament and piriformis and inferior gemellus resections significantly differed at 60° of flexion (p = 0.04 and p = 0.02, respectively). In the left hips, the ischiofemoral ligament and obturator externus, inferior gemellus, and obturator internus resections significantly differed at 0° of flexion (p < 0.01, p < 0.01, and p = 0.01, respectively), as did each external rotator and the ischiofemoral ligament resections at 30° of flexion (p < 0.01). Conclusion The ischiofemoral ligament primarily restricted the internal rotation of the hip joint. The piriformis and obturator internus may restrict internal rotation at 0° and 60° of flexion.

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Section: Discussionmentioning

confidence: 99%

Impacts of external rotators and the ischiofemoral ligament on preventing excessive internal hip rotation: a cadaveric study

et al. 2022

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“…The current study demonstrated that THA via the short external rotator sparing approach causes less damage and decreases perioperative blood loss compared with the standard approach, shortening functional recovery time, maintaining prosthesis stability, and improving pain postoperatively. The corrective posterolateral approach in THA has several advantages, including relatively easy operation, clearly exposed surgical field, minimal injuries to soft tissues, and improved preservation of abductor muscles [19], whereas the standard posterolateral approach damages the continuity between the posterior external rotators and the greater trochanter of the femur, resulting in a higher postoperative dislocation rate compared with the anterior approach [20,21]. However, in this study, patients were restricted to perform activities for 3 months after surgery and the joint anteversion angle was increased during surgery [22], which increased the stability of the hip joint.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Zhou

et al. 2021

J Orthop Surg Res

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Background Most of the studies assessing the corrective posterior total hip arthroplasty (THA) mainly focused on the mini-incision approach. Studies exploring the short external rotator sparing approach are rare. Therefore, this study aimed to compare the effectiveness of standard posterior approach and short external rotator sparing approach. Methods This prospective observational study included 126 patients who underwent THA in June 2017–June 2018. Patients were assigned to standard (standard posterior approach) and corrective (short external rotator sparing approach) groups based on the surgical method. Surgical data were recorded postoperatively. Postoperative hip joint recovery was assessed using the times to ambulation and independent stair use, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris score, and Oxford hip score (OHS) at 2 and 8 postoperative weeks. The visual analog scale (VAS) was used for postoperative pain assessment. Results Postoperative changes of creatine kinase (CK), myoglobin, CRP, and prosthesis position were similar in both groups (P > 0.05). However, intraoperative blood loss (P < 0.001) and postoperative 6-h drainage volume (P = 0.03), hospital stay, blood transfusion rate, and times to ambulation and independent stair use were significantly reduced in the corrective group. Postoperatively, Oxford, and WOMAC scores significantly decreased in both groups. After surgery, the VAS score was more overtly decreased in the corrective group compared with the standard group. Conclusions This study concluded that the less invasive short external rotator sparing approach for THA caused less damage, reducing perioperative blood loss, shortening functional recovery time, maintaining prosthesis stability, and improving postoperative pain.

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“…In recent years, the importance of not only the ischiofemoral ligament but also external rotators in reducing the risk of dislocation after THA performed with a posterior surgical approach have been reported [12,20,21]. External rotators include the piriformis, superior gemellus, obturator internus, inferior gemellus, and obturator externus.…”

Section: Discussionmentioning

confidence: 99%

“…The obturator externus inserts on the medial face of the greater trochanter [19]. The piriformis and conjoint tendons were demonstrated to be crucial for stabilization of THA in the posterior approach [20][21][22]. External rotators were mainly attached in three places; however, it was unclear which muscle resisted the dislocation of THA and how much compared to the ischiofemoral ligament, especially at 0°and 60° of hip exion, where the ischiofemoral ligament was not most stretched.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of External Rotators and Ischiofemoral Ligament for the Prevention of Hip Dislocation in Hip Flexion Position: A Cadaveric Study

Baba¹,

Chiba²,

Mori³

et al. 2021

Preprint

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BackgroundThe purpose of this study was to examine the magnitude of the impact of each external rotator muscle and ischiofemoral ligament on prevention of joint dislocation, depending on the hip flexion angle.MethodNine normal hips were studied; the pelvis was fixed in the lateral decubitus position. An intramedullary nail was inserted into the femur and fixed using screws. A circular plate with a protractor was fixed on the nail. The circular plate was pulled by 3.15 Nm force in the direction of internal rotation, and this angle was defined as the baseline angle. External rotators of the right hip were resected stepwise using the posterior approach; in contrast, external rotators of the left hip were resected stepwise in the reverse order, and finally the ischiofemoral ligament was cut. After each muscle and ischiofemoral ligament resection, the increase in the angle by the traction of was measured at the neutral and 30° and 60° hip flexion positions.ResultsIn posterior approach, there was a significant difference between measurements after piriformis and ischiofemoral ligament resection at 0° of flexion (p=0.02). At 30° of flexion, there were significant differences between measurements after each external rotator and ischiofemoral ligament resection (p<0.01). At 60° of flexion, there were significant differences between ischiofemoral ligament resection and piriformis or inferior gemellus resection (p=0.04, p=0.02, respectively). In the reverse order of the posterior approach, there were significant differences between ischiofemoral ligament resection and the obturator externus, inferior gemellus, or obturator internus at 0° of flexion (p<0.01, p<0.01, p=0.01, respectively). At 30° of flexion, there was a significant difference between the ischiofemoral ligament and each external rotator (p<0.01). ConclusionThe ischiofemoral ligament is the main restrictor of posterior dislocation. The combination of the piriformis and obturator internus may restrict internal rotation at 0°and 60° of flexion.

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Minimally invasive posterolateral hip approach with SPARTAQUUS (Spare the Piriformis And Respect The Active QUadratus femoris and gluteus mediUS) technique

Cited by 9 publications

References 36 publications

Impacts of external rotators and the ischiofemoral ligament on preventing excessive internal hip rotation: a cadaveric study

Impacts of external rotators and the ischiofemoral ligament on preventing excessive internal hip rotation: a cadaveric study

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

The Effectiveness of External Rotators and Ischiofemoral Ligament for the Prevention of Hip Dislocation in Hip Flexion Position: A Cadaveric Study

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