Abstract
IntroductionIn total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate.MethodsWe evaluated muscle strength recovery by measuring the maximum width of the internal obturator muscle on CT images (GE-Healthcare Discovery CT 750HD). We compared the maximum width of the muscle belly preoperatively versus 10 days and 6 months postoperatively. As clinical evaluations, we also investigated the range of motion of the hip joint, hip joint function based on the Japanese Orthopaedic Association hip score (JOA score), and the dislocation rate 6 months after surgery.ResultsThe width of the internal obturator muscle increased significantly from 15.1 ± 3.1 mm before surgery to 16.4 ± 2.8 mm 6 months after surgery. The JOA score improved significantly from 50.8 ± 15.1 points to 95.6 ± 7.6 points. No dislocations occurred in this study.ConclusionsWe cut only the posterosuperior articular capsule and protected the internal obturator muscle to preserve muscle strength. We repaired the entire posterosuperior and anterior articular capsule. These treatments increase joint stability in the early postoperative period, thus reducing the dislocation rate.Level of evidenceTherapeutic, Level IV.
Highlights
In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement
If we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach
Damage to the posterior muscle tissue and articular capsule can result in posterior dislocation, which is an important complication of total hip arthroplasty [10]
Summary
In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. In 1980, Keggi used the term ‘direct anterior approach’ to describe minimally invasive surgery via an anterior approach [4] This approach is intermuscular and internervous, and many studies have shown that it allows early recovery of muscle strength and improved walking ability in the early postoperative period [5,6,7]. We aim to prevent early dislocation and to promote early muscle strength recovery Imaging methods, such as a computed tomography (CT) and magnetic resonance imaging (MRI), are considered the most accurate methods for in vivo quantification of body composition on the tissue level, and skeletal muscle can be compartmentalized into individual muscle. If there is little soft tissue injury to the posterior element, we can evaluate recovery of this muscle as an indicator of early recovery of muscle strength and improved walking ability in the early postoperative period and of joint stability, especially in the posterior direction
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