Soft-Tissue Balancing in Total Hip Arthroplasty

Boe, Richard; Selemon, Nicolas A.; Eachempati, Krishna Kiran; Paprosky, Wayne G.; Sheth, Neil P.

doi:10.2106/jbjs.rvw.20.00116

Cited by 9 publications

(4 citation statements)

References 39 publications

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“…Martin et al concluded that the anatomy is better restored in a DAA when using fluoroscopy, compared to the posterior approach [ 23 ]. Moreover, Boe et al stated that using hip templating, restoring the anatomy and biomechanics can be achieved, and in combination with adequate soft-tissue balancing, a stable and ideal arthroplasty can be the result [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Follet¹,

Verhelst²,

Ghijselings³

et al. 2023

JOCR

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Introduction: We present a case report of a total hip arthroplasty (THA) in a patient with ipsilateral knee arthrodesis. The direct anterior approach (DAA) was used, and to our knowledge, this has never been described previously in the literature. The purpose of this report is to highlight pre-, per-, and post-operative challenges using the DAA in these rare cases. Case Report: This case report presents the case of a 77 year old female patient with degenerative hip disease in the presence of an ipsilateral arthrodesis of the knee. The patient was operated using the DAA. No complications were found and the patient had an excellent follow-up with a forgotten joint score of 93.75 at 1 year. The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy. Using pre-operative templating on X-rays, intraoperative fluoroscopy and the posterior femoral neck the hip biomechanics could be restored. Conclusion: We believe that THA in presence of an ipsilateral knee arthrodesis can be safely performed through a DAA. Keywords: THA, DAA, knee arthrodesis.

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Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Follet¹,

Verhelst²,

Ghijselings³

et al. 2023

JOCR

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“…It is important to conduct these releases systematically and titrate them as needed based on soft-tissue tightness; each release does have implications for soft-tissue balancing after hip reconstruction. 6 Again, it is imperative to understand that the soft tissues about the hip joint will stress relax during the procedure, which will result in continued enhanced acetabular exposure.…”

Section: Anterior Femoral Translation: Another 6 Stepsmentioning

confidence: 99%

Systematic Exposure in Revision Total Hip Arthroplasty: The Posterior Approach

Tran

Paprosky

et al. 2023

J Am Acad Orthop Surg

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As indications for total hip arthroplasty (THA) continue to expand, and patients continue to live longer with more active lifestyles, the incidence of revision THA is expected to rise. General orthopaedic surgeons are now beginning to consider doing revision THA surgery because of the increased revision burden being experienced nationwide. While classical approaches to the hip can be used for simple revisions, extensile exposure techniques in conjunction with selective soft-tissue releases are often required for adequate visualization for more complex revision cases. This review provides a systematic approach to surgical exposure for revision THA using the posterior approach. The surgeon should follow a stepwise progression to obtain safe, adequate, and reproducible visualization of both the acetabulum and the proximal femur.

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“…On the other hand, in patients with the problem of compression of soft tissues with osteophytes which is difficult to diagnose abductor muscle weakness, muscle-tendon contractures related to surgical operations, bone deformations, length difference in the lower limbs, and bone protrusions and osteophytes that hinder the movement of the joint negatively affect the results of the surgery [6][7][8][9]. In these cases, great importance is attached to corrective procedures -excision of osteophytes that cause bone compression, restoration of abductor muscle strength, the balance of the joint center and provision of soft tissue balance in contracture muscles [10,11]. The ideas of Sir John Charnley, who first proposed and published the term "soft tissue balance", were later adopted by Dorr L.D.…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Excision of Compressive Osteophytes and Muscle Contractures at Total Hip Arthroplasty Surgery Due to Dysplastic Coxarthrosis on Joint Range of Motion, Clinical Functional Indicators, and Providing Soft Tissue Balance

Мамедов

2024

Хирургия. Восточная Европа

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Введение. Наряду с диспластическим коксартрозом (ДКА) тазобедренного сустава, сдавлением мягких тканей остеофитами и слабостью отводящих мышц, трудно диагностируемой клинически и рентгенологически, нередко наблюдаются мышечно-сухожильные контрактуры вследствие перенесенных хирургических операций, деформации костей, разница в длине нижних конечностей, костные выступы, затрудняющие движение сустава, которые отрицательно влияют на результаты хирургического вмешательства. В этих случаях акцент делается на корригирующие мероприятия – иссечение остеофитов, вызывающих компрессию кости, восстановление силы отводящих мышц, обеспечение баланса суставного центра и мягких тканей. Цель. Изучение влияния иссечения компрессирующих остеофитов и устранения мышечных контрактур при тотальной пластике тазобедренного сустава по поводу ДКА на объем движений сустава, клинико-функциональные показатели и обеспечение баланса мягких тканей. Материалы и методы. В отделении артропластики и артроскопии НИИТО Минздрава Азербайджанской Республики в 2017–2019 гг. при тотальной пластике тазобедренного сустава у 135 пациентов (125 женщин) с ДКА в среднем возрасте 50,9±0,9 года в 92 случаях хирургически устранены компрессия кости и мышечные контрактуры, чем обеспечен баланс мягких тканей. Объем движений тазобедренного сустава до и после операции оценивали по методу Merle d´Aubigne Postel, клинические жалобы оценивали по индексу остеоартрита WOMAC, функциональное состояние сустава измеряли по тазобедренной шкале Harris. В I группе (контрольная группа, 43 пациента) выполнена тотальная пластика тазобедренного сустава, во II (92 пациента) – дополнительно тенотомия и иссечение остеофитов для обеспечения баланса мягких тканей. Результаты. Объем движений в суставе до операции по методике Merle d´Aubigne Postel в I группе составлял 10±0,3, во II – 9,4±0,2, а после операции – 16,4±0,2 и 16,3±0,2 балла соответственно; уровень клинических жалоб до операции составил 63,1±1,7 в I группе, 62,7±1,4 во II группе по WOMAC, 6,54±1,2 и 11,1±1,4 балла после операции соответственно. Функциональный индекс сустава по шкале Harris в I группе составил 44,5±2,0, а во II – 42,1±1,5, после операции – соответственно 85,3±1,3 и 82,7±1,0 балла. Заключение. Наряду с тотальной пластикой тазобедренного сустава по поводу ДКА, удаление компрессирующих остеофитов, дополнительных костных выступов в суставе и околосуставной зоне и устранение мышечных контрактур приводят к значительному уменьшению или исчезновению клинических жалоб у пациентов в короткие сроки, увеличению объема движений и функциональности сустава, снижению сроков медико-социальной реабилитации и восстановлению трудовой деятельности. Introduction. Along with dysplastic coxarthrosis of the hip joint, compression of soft tissues by osteophytes and abductor muscle weakness that is difficult to diagnose clinically and radiologically, muscle-tendon contractures due to surgical operations, bone deformations, length difference in the lower limbs and bone protrusions that hinder joint movement, osteophytes adversely affect the results of surgery. In these cases, great importance is attached to corrective procedures – excision of osteophytes that cause bone compression, restoration of abductor muscle strength, the balance of the joint center and balance of soft tissue in muscle contactures. Purpose. Study the effect of excision of compressive osteophytes and elimination of muscle contractures during total hip arthroplasty for dysplastic coxarthrosis on range of motion of the joint, clinical functional indicators and providing of soft tissue balance. Materials and methods. Bone compression during 92 surgeries in the hip joint of 135 patients (125 women) with mean age of 50.9±0.9 at the Arthroplasty and Arthroscopy Department of the Scientific Research Institute of Traumatology and Orthopedics of the Ministry of Health of the Republic of Azerbaijan between 2017–2019 soft tissue balance was ensured by surgical removal of bone compression and the results of these surgeries were studied. The range of motion of the hip joint was evaluated using the Merle d’Aubigne Postel method, clinical complaints were evaluated using the WOMAC osteoarthritis index, and the functional level of the joint was measured using the Harris Hip Scale. In group I (control group, 43 patients) total hip arthroplasty was performed, and in group II (92 patients), tenotomy and excision of osteophytes were also performed to ensure soft tissue balance. Results. According to the method of Merle d’Aubigne Postel, before surgery, the range of motion of the joint in group I was 10±0.3, and in group II was 9.4±0.2, and after surgery, it was 16.4±0.2 and 16.3±0,2 respectively; The levels of clinical complaints before surgery were 63.1±1.7 in group I, 62.7±1.4 in group II, 6.54±1.2 and 11.1±1.4 after surgery according to WOMAC, respectively. According to the Harris functional scale, before the surgery, the functional index of the joint in group I was 44.5±2.0, and in group II it was 42.1±1.5. After the surgery, it was 85.3±1.3 and 82.7±1.0, respectively. Conclusion. Removal of osteophytes, bony protrusions, muscle contractures in the joint and around the joint along with total hip joint replacement surgery due to hip joint disease helps to the reduction or disappearance of patients’ clinical complaints in a short period, increase the range of motion and functionality of the joint, medical and social rehabilitation, including the shortening of labor activity periods.

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Soft-Tissue Balancing in Total Hip Arthroplasty

Cited by 9 publications

References 39 publications

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Systematic Exposure in Revision Total Hip Arthroplasty: The Posterior Approach

The Effect of the Excision of Compressive Osteophytes and Muscle Contractures at Total Hip Arthroplasty Surgery Due to Dysplastic Coxarthrosis on Joint Range of Motion, Clinical Functional Indicators, and Providing Soft Tissue Balance

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