Abstract
BackgroundThe anterolateral muscle-sparing total hip arthroplasty (THA) in the supine position is advantageous owing to the very low-dislocation rate and excellent leg length discrepancy control. However, femur exposure is challenging. Although the conjoined external rotators tendon (CERT) release is effective in improving femoral access, the effects on clinical outcomes remain unclear. The purpose of this study was to evaluate the clinical and radiographic results of CERT release in the anterolateral muscle-sparing THA approach.MethodsThe study was performed as a retrospective cohort study and included 85 hips in 85 patients who underwent primary anterolateral THA. Clinical and radiographic outcomes were investigated 6 months and 1 year after THA (CERT-preserved and non-released patients). The Japanese Orthopaedic Association (JOA) hip score, JOA Hip-disease Evaluation Questionnaire (JHEQ), forgotten joint score (FJS), and the 36 short-form questionnaires (SF-36 mental and physical) were evaluated. The leg length discrepancy, cup inclination and stem orientation were evaluated with radiographs.ResultsAmong all the included hips, 37 patients (43.5%) retained the CERT, and 48 patients (56.5%) included the released CERT. There were no significant differences in the JOA hip scores, JHEQ, FJF-12 and SF-36 between the released and non-released groups. There were significant differences in sagittal stem alignments between groups.ConclusionThe CERT release in anterolateral muscle-sparing THA has a limited effect on post-operative clinical outcomes. The CERT release improved the femur exposure and is more invasive than the preserved CERT. We infer that the CERT should be maintained in patients with a wide range of motions, and release the CERT in inadequate femur canal preparation cases.
Highlights
Total hip arthroplasty (THA) provides pain relief and restoration of functionality in osteoarthritic hips and leads to the improvement of the patients’ quality of life [1]
The Japanese Orthopaedic Association (JOA) hip score, all JOA Hip-disease Evaluation Questionnaire (JHEQ) scores, and Physical component summary (PCS) score of the 36-Item. Short-Form Health Survey (SF-36) were significantly improved without the Mental component summary (MCS) score (Table 3)
There were no significant differences in the JOA hip score, JHEQ, forgotten joint score (FJF)-12, and SF-36 between the non-released group and released groups (Tables 4, 5)
Summary
Total hip arthroplasty (THA) provides pain relief and restoration of functionality in osteoarthritic hips and leads to the improvement of the patients’ quality of life [1]. The anterior or anterolateral minimally invasive technique is reported as muscle-sparing THA, the surgeons sometimes need additional soft tissue release for canal preparation of the femur, such as the capsular ligament or the insertion of muscles around the hip including the CERT. These releases enable good canal preparation, insertion of broaches, and trials. The purpose of this study was to evaluate the clinical and radiographic results of CERT release in the anterolateral muscle-sparing THA approach
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