Modified Watson-Jones Approach Research Articles

Perioperative Femur Fractures in Muscle Sparing Anterolateral - Modified Watson-Jones Approach to Primary Total Hip Arthroplasty: A Retrospective Cohort Study

Perioperative Femur Fractures in Muscle Sparing Anterolateral - Modified Watson-Jones Approach to Primary Total Hip Arthroplasty: A Retrospective Cohort Study

Does Augmented Reality-based Portable Navigation Improve the Accuracy of Cup Placement in THA Compared With Accelerometer-based Portable Navigation? A Randomized Controlled Trial.

Previous studies reported good outcomes of acetabular cup placement using portable navigation systems during THA. However, we are aware of no prospective studies comparing inexpensive portable navigation systems using augmented reality (AR) technology with accelerometer-based portable navigation systems in THA. (1) Is the placement accuracy of the acetabular cup using the AR-based portable navigation system superior to that of an accelerometer-based portable navigation system? (2) Do the frequencies of surgical complications differ between the two groups? We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. Between August and December 2021, we treated 148 patients who had a diagnosis of osteoarthritis, idiopathic osteonecrosis, rheumatoid arthritis, or femoral neck fracture and were scheduled to undergo unilateral primary THA. Of these patients, 100% (148) were eligible, 90% (133) were approached for inclusion in the study, and 85% (126) were finally randomized into either the AR group (62 patients) or the accelerometer group (64 patients). An intention-to-treat analysis was performed, and there was no crossover between groups and no dropouts; all patients in both groups were included in the analysis. There were no differences in any key covariates, including age, sex, and BMI, between the two groups. All THAs were performed via the modified Watson-Jones approach with the patient in the lateral decubitus position. The primary outcome was the absolute difference between the cup placement angle displayed on the screen of the navigation system and that measured on postoperative radiographs. The secondary outcome was intraoperative or postoperative complications recorded during the study period for the two portable navigation systems. There were no differences between the AR and accelerometer groups in terms of the mean absolute difference in radiographic inclination angle (3° ± 2° versus 3° ± 2° [95% CI -1.2° to 0.3°]; p = 0.22). The mean absolute difference in radiographic anteversion angle displayed on the navigation screen during surgery compared with that measured on postoperative radiographs was smaller in the AR group than that in the accelerometer group (2° ± 2° versus 5° ± 4° [95% CI -4.2° to -2.0°]; p < 0.001). There were few complications in either group. In the AR group, there was one patient each with a surgical site infection, intraoperative fracture, distal deep vein thrombosis, and intraoperative pin loosening; in the accelerometer group, there was one patient each with an intraoperative fracture and intraoperative loosening of pins. Although the AR-based portable navigation system demonstrated slight improvements in radiographic anteversion of cup placement compared with the accelerometer-based portable navigation system in THA, whether those small differences will prove clinically important is unknown. Until or unless future studies demonstrate clinical advantages that patients can perceive that are associated with such small radiographic differences, because of the costs and the unquantified risks associated with novel devices, we recommend against the widespread use of these systems in clinical practice. Level I, therapeutic study.

Is the Anterolateral or Posterolateral Approach More Effective for Early Postoperative Recovery after Minimally Invasive Total Hip Arthroplasty?

Currently, various minimally invasive surgical techniques are applied for total hip arthroplasty (THA). There are few studies comparing the early postoperative clinical outcomes of minimally invasive THA between anterolateral and posterolateral approaches. In this retrospective study, 62 patients underwent minimally invasive THA via either the anterolateral approach with an intermuscular exposure using the modified Watson-Jones approach (MIS-AL, 34 hips) or mini-incision THA with a posterolateral approach (MIS-PL, 28 hips). We analyzed intraoperative data, postoperative hematological data, postoperative radiographic findings, and the postoperative recovery of muscle strength. The mean surgical time was significantly longer in the MIS-PL than in the MIS-AL group. The mean postoperative serum C-reactive protein level was significantly higher in the MIS-PL group than in the MIS-AL group only on postoperative day 3. There were no significant between-group differences in the postoperative recovery rate of muscle strength during hip abduction. The recovery rate of muscle strength during hip extension was better in the MIS-AL group than in the MIS-PL group only on postoperative day 3. In conclusion, we found no obvious advantage in early postoperative recovery between the MIS-AL and MIS-PL approaches. Therefore, the benefit of rapid postoperative recovery was comparable between the MIS-AL and MIS-PL approaches.

Lateral Femoral Cutaneous Nerve Injury Using an Anterior-Based Muscle-Sparing Approach to the Hip: A Clinical and Cadaveric Analysis with Review of Literature

AbstractThe alternative anterior hip approach between the tensor fascia lata and gluteus medius (the modified Watson-Jones approach, Röttinger approach, anterior-based muscle-sparing [ABMS] approach, and ABLE approach) may decrease the risk of lateral femoral cutaneous nerve (LFCN) palsy. A retrospective case study, systematic literature review, and cadaveric study were performed to assess the risk for LFCN palsy with the ABMS compared with the direct anterior (DA) approach. Consecutive patients who underwent total hip arthroplasty (THA) using ABMS were identified and assessed for LFCN palsy. A systematic review of LFCN injury with ABMS and DA approaches was conducted. In four fresh cadavers (eight hips), ABMS and DA approaches were performed and the LFCN identified. The proximity of the LFCN to the fascial incision was measured and compared between ABMS and DA approaches. In 64 consecutive ABMS THA (mean age: 57.3 ± 13.5 years, 42% female, mean body mass index: 30.2 ± 5.3 kg/m2), two hips (3.2%) had an LFCN palsy. In combination with the systematic literature review, the risk of LFCN palsy was less with ABMS (0.3%, 7/2,609 hips) compared with DA (3.1%, 638/20,402 hips, p &lt; 0.001). In eight cadaveric hip dissections, the LFCN was significantly further away from the ABMS fascial incision (mean: 67.6 ± 9.1 mm), compared with the fascial incision of the DA approach (mean: 18.5 ± 3.5 mm, p &lt; 0.0001). The risk of LFCN palsy was found to be 10-fold greater with the DA approach compared with the ABMS approached in this combined retrospective case series and systematic literature review. The anatomic location of the ABMS fascial incision was significantly farther from the LFCN, contributing to the decreased risk of LFCN injury.

Clinical Outcomes of Total Hip Arthroplasty With the Anterolateral Modified Watson-Jones Approach for Displaced Femoral Neck Fractures

ObjectiveIn recent years, many studies have reported good results with total hip arthroplasty (THA) for displaced femoral neck fractures (FNFs). However, no study has reported the clinical outcomes of the anterolateral modified Watson–Jones THA (MWJ-THA) for displaced FNFs. This study aimed to investigate the clinical results of THA for displaced FNFs at our hospital and to discuss the advantages of MWJ-THA over THA with other approaches for displaced FNFs.MethodsForty-three patients who underwent MWJ-THA for displaced FNFs were included in this study. Patient characteristics, preinjury walking ability, activities of daily living, implants used, walking ability (at 1, 3, and 6 months after surgery), cup placement angle, clinical hip score, surgical complications, revision surgery, and death within 1 year after surgery were investigated.ResultsThe mean age of the 43 patients was 63.3 years, and the mean body mass index (kg/m2) was 21.1. Regarding the heads used, 28-mm heads were used in 4 patients, 32-mm heads were used in 32 patients, and 36-mm heads were used in 7 patients. The cups were placed in the Lewinnek safety zone (93.0%). Four patients had stem sinkage of a few millimeters. 6 months postoperatively, 38 patients walked unaided, and 4 patients walked with a cane. The Harris Hip Score averaged over 90 points at all time points. No postoperative dislocation was observed. Two patients died within 1 year postoperatively.ConclusionIn this study, MWJ-THA was performed for displaced FNFs and resulted in no postoperative dislocations. Furthermore, more than 90% of the patients regained their preinjury walking ability at 6 months postoperatively. MWJ-THA has great dislocation control and is effective in treating displaced FNFs.

Une petite taille et une faible distance entre le rebord acétabulaire antérieur et le nerf fémoral sont des facteurs de risque de paralysie du nerf fémoral après une arthroplastie totale de hanche primaire par l’approche modifiée de Watson-Jones

BackgroundNerve palsy following total hip arthroplasty (THA) critically impacts patient clinical function. However, few studies have focused on femoral nerve palsy (FNP) following THA via the modified Watson-Jones approach. Previous reports have suggested that THA, regardless of the approach, is associated with several FNP risk factors, including female gender, hip dysplasia, revision surgery, and short stature. Magnetic resonance imaging (MRI) has suggested that a shorter distance between the femoral nerve and the anterior acetabular edge (dFN) is related to FNP after THA. The purposes of this study were: 1) to determine the presumed risk factors through a retrospective investigation of FNP clinical courses; and 2) to identify the relationships between FNP occurrence and the short dFN following primary THA via the modified Watson-Jones approach. HypothesisShort stature is a risk factor for femoral nerve palsy following THA, i.e. a significant difference in dFN exists between patients with and without FNP. Patients and methodsThis retrospective case-control study was performed at a single university hospital. From January 2016 to December 2020, 676 THAs were performed via the modified Watson-Jones approach at our institution. These included 495 THAs performed in the supine position and 181 in the lateral position. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test<grade 3) with or without sensory disturbance over the anteromedial aspect of the thigh. The incidence of FNP was calculated. Patient background factors (age, sex, preoperative diagnosis, surgical position, height, weight, body mass index, surgeon experience, type of components, the method of anesthesia, leg lengthening during the surgery, and operation time) were compared between the FNP group and a non-FNP control group. The dFN was measured in T1-weighted MRI axial images at the level of the hip center. The distance between the femoral nerve and the anterior acetabular edges, where retractors are commonly placed during surgery, was also measured and compared between the FNP group and the non-FNP control group. The FNP group and non-FNP control group were extracted by 1:4 matching of patient height and weight. All data were statistically evaluated using the Mann-Whitney U test, and p-values less than 0.05 were considered statistically significant. ResultsFNP occurred in 6 out of 676 joints (0.88 %) following primary THA via the modified Watson-Jones approach. In all 6 cases, the motor deficit recovered completely within a year. Patient height was significantly shorter in the FNP group than in the non-FNP control group (148.4±3.3cm vs. 155.4±8.1cm (p=0.01)). The dFN was significantly shorter in the FNP group (16.3±4.1mm vs. 21.5±4.0mm (p=0.034)). ConclusionShort stature and short dFN are risk factors for FNP after THA using the modified Watson-Jones approach. Level of evidenceIII, case-control study.

Short stature and short distance between the anterior acetabular rim to the femoral nerve are risk factors for femoral nerve palsy following primary total hip arthroplasty using the modified Watson-Jones approach

BackgroundNerve palsy following total hip arthroplasty (THA) critically impacts patient clinical function. However, few studies have focused on femoral nerve palsy (FNP) following THA via the modified Watson-Jones approach. Previous reports have suggested that THA, regardless of the approach, is associated with several FNP risk factors, including female gender, hip dysplasia, revision surgery, and short stature. Magnetic resonance imaging (MRI) has suggested that a shorter distance between the femoral nerve and the anterior acetabular edge (dFN) is related to FNP after THA. The purposes of this study were: 1) to determine the presumed risk factors through a retrospective investigation of FNP clinical courses, and 2) to identify the relationships between FNP occurrence and the short dFN following primary THA via the modified Watson-Jones approach. HypothesisShort stature is a risk factor for femoral nerve palsy following THA. i.e. a significant difference in dFN exists between patients with and without FNP. Patients and methodsThis retrospective case-control study was performed at a single university hospital. From January 2016 to December 2020, 676 THAs were performed via the modified Watson-Jones approach at our institution. These included 495 THAs performed in the supine position and 181 in the lateral position. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test<grade 3) with or without sensory disturbance over the anteromedial aspect of the thigh. The incidence of FNP was calculated. Patient background factors (age, sex, preoperative diagnosis, surgical position, height, weight, body mass index, surgeon experience, type of components, the method of anesthesia, leg lengthening during the surgery, and operation time) were compared between the FNP group and a non-FNP control group. The dFN was measured in T1-weighted MRI axial images at the level of the hip center. The distance between the femoral nerve and the anterior acetabular edges, where retractors are commonly placed during surgery, was also measured and compared between the FNP group and the non-FNP control group. The FNP group and non-FNP control group were extracted by 1:4 matching of patient height and weight. All data were statistically evaluated using the Mann-Whitney U test, and p values less than 0.05 were considered statistically significant. ResultsFNP occurred in 6 out of 676 joints (0.88%) following primary THA via the modified Watson-Jones approach. In all 6 cases, the motor deficit recovered completely within a year. Patient height was significantly shorter in the FNP group than in the non-FNP control group (148.4±3.3cm vs. 155.4±8.1cm [p=0.01]). The dFN was significantly shorter in the FNP group (16.3±4.1mm vs. 21.5±4.0mm [p=0.034]). ConclusionShort stature and short dFN are risk factors for FNP after THA using the modified Watson-Jones approach. Level of evidenceIII, case-control study.

Difference in tapered wedge stem alignment between supine and lateral position in cementless total hip arthroplasty via modified Watson-Jones anterolateral approach.

Whether different body positions during surgery affect postoperative stem alignment in total hip arthroplasty (THA) remains unclear. The purpose of this study was to clarify differences in tapered wedge stem alignment between supine and lateral positions in THA under the modified Watson-Jones anterolateral approach. We reviewed 242 consecutive, primary cementless THAs performed with ceramic-on-cross-linked polyethylene via the modified Watson-Jones approach in either supine or lateral positions between 2009 and 2015 (supine group: 113 cases; lateral group: 129 cases). No specific reasons to select supine or lateral positions for the surgery were given during the study period. Computed tomography was performed pre- and postoperatively to measure preoperative femoral anteversion and postoperative stem anteversion, respectively. Stem alignment in coronal and sagittal planes was also evaluated. Mean difference in stem anteversion and femoral anteversion was 8.6±9.4 in the supine position and 13.0±11.4 in the lateral position (p = 0.0013). Although no significant difference was seen between groups for stem alignment in the coronal plane, flexed implantation was more likely in the supine group (46/113, 40.7%) than in the lateral group (20/129, 15.5%). A significant correlation was found between femoral anteversion and stem anteversion in both the supine and lateral groups (r = 0.68, p <0.0001 and r = 0.52, p <0.0001, respectively). Although stem anteversion was more strongly correlated with femoral anteversion in the supine position than in the lateral position, neutral position in the sagittal plane was more likely to be found with the lateral position than with the supine position. Surgeons can achieve ideal stem positioning by considering these results in the modified Watson-Jones approach in both the supine and lateral positions.

Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement.

Purpose:Muscle-sparing approaches for total hip replacement (THR) involve learning curves. This study aimed to clarify changes in invasiveness and infection rate with changes in approach.Methods:One surgeon changed the approach of THR from Dall’s approach (Dall) to anterolateral modified Watson-Jones approach (OCM). Another changed from Dall to a direct anterior approach (DAA). Another 3 surgeons changed from posterolateral approach (PL) to OCM. Subjects were 150 cases, comprising the last 25 cases with conventional approaches and the first 25 cases with new approaches (Dall to OCM: 25 + 25; Dall to DAA: 25 + 25; PL to OCM: 25 + 25 cases). Differences in operative time, bleeding volume, hospital stay, haemoglobin (Hb), white blood cell count, lymphocyte count, creatine kinase (CK) and C-reactive protein (CRP) were investigated.Results:In the change from Dall to OCM, only hospital stay decreased. In the change from Dall to DAA, hospital stay and CRP decreased, but bleeding volume increased. In the change from PL to OCM, operative time, CRP and CK decreased, but Hb also decreased. Cases with lymphocyte count <1000/μL or lymphocytes comprising <10% of total white blood cells at around day 4 after surgery were defined as latent infection cases. In these cases, operative time was longer, Hb was lower and CK was higher.Conclusion:Introducing muscle-sparing approaches improved many markers of invasiveness, but some items deteriorated. In the early stages of introducing a new approach, choosing cases without obesity and without high muscle volume may reduce the risk of infection.

Incidence of tensor fascia lata muscle atrophy after using the modified Watson-Jones anterolateral approach in total hip arthroplasty.

Post-operative tensor fascia lata (TFL) muscle atrophy due to superior gluteal nerve (SGN) injury during total hip arthroplasty (THA) can affect patients' post-operative hip function. This study aimed to determine the incidence of TFL muscle atrophy in THA performed via the modified Watson-Jones anterolateral approach and the risk factors for TFL atrophy. We reviewed pre- and post-operative magnetic resonance imaging (MRI) data of 164 patients who underwent cementless THA via the modified Watson-Jones approach at one institution. TFL atrophy was defined as worsening of ≥ 2 grades in the Goutallier classification or > 40% decrease in the cross-sectional area (CSA) of the TFL on post-operative MRI compared to that on preoperative MRI. Patients' backgrounds were compared between those with or without TFL atrophy to determine the risk factors of TFL atrophy. Fatty atrophy grade and CSA of the gluteus minimus and medius were also evaluated. Thirteen (8.0%) cases of TFL atrophy were detected. The mean body mass index (BMI) in the cases with TFL atrophy was significantly higher than in those without TFL atrophy (p = 0.012). The fatty atrophy grade was worse post-operatively than preoperatively; moreover, the CSA of the gluteus minimus decreased. We found a low incidence of TFL atrophy due to SGN injury after THA using the modified Watson-Jones approach. High BMI can be a risk factor for nerve injury. The gluteus minimus can be injured directly during surgery. We suggest that overexposure of the surgical site should be avoided, especially in patients with high BMI.

Décubitus dorsal versus décubitus latéral pour le positionnement de la cupule par voie de Watson-Jones modifiée dans l’arthroplastie totale de hanche : étude randomisée en simple insu

BackgroundThe orientation of the acetabular cup is a critical factor for prevention of various postoperative complications in total hip arthroplasty (THA). Although most patients are treated in either supine or lateral position during surgery, it is still unclear which position is superior to achieve more accurate cup positioning. Our study was conducted in order to answer the following questions: (1) does the supine position provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach? (2) is there any difference in the distribution of cup position between the two positions? HypothesisOur hypothesis was that the supine position would provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach. Patients and MethodsA single-center prospective randomized study (registration number: UMIN000021627) was conducted between May 2016 and December 2017. We recruited a total of 60 participants undergoing unilateral primary cementless THA using modified Watson-Jones anterolateral approach based on the result of the sample size calculation. They were randomly assigned to either supine position (n=29) or lateral position (n=31). The cup alignment was targeted using a goniometer during surgery. The radiographic cup inclination was targeted to 40° and the radiographic cup anteversion was targeted considering the femoral stem anteversion during surgery. Postoperative cup alignment was measured by plain radiography and computed tomography. We defined the difference between postoperative and target cup angle as “target error” and our primary outcome was the absolute value of the target angle. As secondary outcome, the distribution of the target error was evaluated. The target errors of each inclination and anteversion were divided into 3 groups; neutral (−3°≤the target error≤3°), positive error (3°<the target error), and negative error (the target error<−3°). ResultsThe assessment of primary outcome for all recruited patients showed that supine group was significantly more accurate than lateral group in terms of radiographic inclination (2.4° vs. 4.5°, respectively, mean difference 2.1°; 95% confidence interval, 0.7 to 3.5; p<0.01). There was no significant difference in terms of radiographic cup anteversion (5.6° vs. 5.2°, mean difference 0.4°; 95% confidence interval, −1.8 to 2.6; p=0.69). The rate of positive error of anteversion in supine and lateral group was larger than that of negative value of anteversion (51.7% vs. 10.3% and 48.4% vs. 12.9%, respectively). Any acute complication (dislocation, fracture, and infection) was not found in both groups during postoperative 3 months. DiscussionIn this randomized-controlled trial, higher accuracy of acetabular cup inclination was provided by supine position than by lateral position in THA. On the other hand, there was no significant difference between both groups in terms of cup anteversion. In both groups, most cups were placed with larger anteversion than we targeted. Modified Watson-Jones approach in both positions should be performed considering these results. Study registration numberUMIN000021627. Level of evidenceII, randomised controlled study (population-limited).

Supine versus lateral position for accurate positioning of acetabular cup in total hip arthroplasty using the modified Watson-Jones approach: A randomized single-blind controlled trial

BackgroundThe orientation of the acetabular cup is a critical factor for prevention of various postoperative complications in total hip arthroplasty (THA). Although most patients are treated in either supine or lateral position during surgery, it is still unclear which position is superior to achieve more accurate cup positioning. Our study was conducted in order to answer the following questions: (1) does the supine position provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach? (2) is there any difference in the distribution of cup position between the two positions?Hypothesis Our hypothesis was that the supine position would provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach. Patients and methodsA single-center prospective randomized study (registration number: UMIN000021627) was conducted between May 2016 and December 2017. We recruited a total of 60 participants undergoing unilateral primary cementless THA using modified Watson-Jones anterolateral approach based on the result of the sample size calculation. They were randomly assigned to either supine position (n=29) or lateral position (n=31). The cup alignment was targeted using a goniometer during surgery. The radiographic cup inclination was targeted to 40° and the radiographic cup anteversion was targeted considering the femoral stem anteversion during surgery. Postoperative cup alignment was measured by plain radiography and computed tomography. We defined the difference between postoperative and target cup angle as target error and our primary outcome was the absolute value of the target angle. As secondary outcome, the distribution of the target error was evaluated. The target errors of each inclination and anteversion were divided into 3 groups; neutral (−3°≤the target error≤3°), positive error (3°<the target error), and negative error (the target error<−3°). ResultsThe assessment of primary outcome for all recruited patients showed that supine group was significantly more accurate than lateral group in terms of radiographic inclination (2.4° vs. 4.5°, respectively, mean difference 2.1°; 95% confidence interval, 0.7 to 3.5; p<0.01). There was no significant difference in terms of radiographic cup anteversion (5.6° vs. 5.2°, mean difference 0.4°; 95% confidence interval, −1.8 to 2.6; p=0.69). The rate of positive error of anteversion in supine and lateral group was larger than that of negative value of anteversion (51.7% vs. 10.3% and 48.4% vs. 12.9%, respectively). Any acute complication (dislocation, fracture, and infection) was not found in both groups during postoperative 3 months. DiscussionIn this randomized-controlled trial, higher accuracy of acetabular cup inclination was provided by supine position than by lateral position in THA. On the other hand, there was no significant difference between both groups in terms of cup anteversion. In both groups, most cups were placed with larger anteversion than we targeted. Modified Watson-Jones approach in both positions should be performed considering these results. Study registration numberUMIN000021627.Level of evidence II, randomised controlled study (population-limited).

Surgical Approach May Influence Survival of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty: A 6- to 10-Year Follow-Up Study.

Large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA) has lost popularity because of metal allergy or ALTRs (adverse local tissue reactions) in the past decade. Whether the surgical approach may influence the survival of LDH-MoM-THA has not been reported. From 2006 to 2009, we performed 96 LDH-MoM-THAs on 80 patients using an in situ head-neck assembly technique through a modified Watson-Jones approach. With a mean follow-up of 8.4 years (range, 6.3–10.1 years), the implant survival rate was 100%. All patients were satisfied with the results and the Harris Hip Score improved from 52 points to 98 points. No ALTRs were found, but 17.7% of the 96 hips (17 adverse events) experienced adverse events related to the cup, including 5 cases of outlier cup malposition, 11 cases of inadequate cup seating, and 1 acetabular fracture. The tissue tension that was improved by a muscle-sparing approach might lessen the chance of microseparation or edge-loading that is taken as the major risk for early implant failure. Further investigation of whether these LDH-MoM-THAs would fail or not would require a longer follow-up or even retrieval analysis in the future.

A 10-Year Follow-Up of Two-Incision and Modified Watson-Jones Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head.

Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total hip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head (ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters, and functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent a modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more blood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (p < 0.05 for all four) than the modified WJ approach. The Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) increased significantly from the period preoperatively to 6 weeks postoperatively and thereafter up to the last follow-up in both groups. However, there were no significant differences in terms of radiographic parameters and functional outcomes between the two groups throughout the study period. Both the two-incision and the modified WJ approach provided satisfactory results and survival rates at a mean follow-up of 10.8 years. A prospective, randomized, large-scale cohort study is still warranted for evidence-based recommendations.

Functional recovery after muscle sparing total hip arthroplasty in comparison to classic lateral approach - A three years follow-up study.

The muscle sparing total hip arthroplasty had generated a distinguishable interest, in both the patients and the surgeons, but its benefits are still often questioned. The main idea of this study was to compare the functional clinical outcome of the patients operated by the anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach), and the patients operated by modified direct lateral approach without the muscle-sparing technique (Bauer/Hardinge approach). The patients (N=130) were divided into two groups: 68 in a standard method group (STAND) and 62 patients in a muscle sparing surgery group (MSS). The hip flexibility, mobility, the strength of the hip abduction, the pain scale, Harris hip scores, the duration of the hospital stay and the overall satisfaction were measured seven days, three months, one year and three years (in 80 patients) after the surgery. There were no differences in any of the parameters between the groups prior to the procedure. The statistically significant differences in first three follow-ups (up to one year) were determined between the groups in passive and active hip flexion ability but the hip abduction strength, which is a crucial parameter for functional recovery, and 50m walk test remained better in MSS group even after three years. Patients, who underwent MSS suffered also less pain, stayed in hospital shorter and were more satisfied with the operation outcome. The functional recovery in patients treated with muscle sparing method was faster than in patients operated with conventional lateral approach. Based on the results, we could recommend anterolateral muscle sparing approach for a total hip replacement for its faster and fuller functional recovery.

Postoperative Changes In The Tensor Fascia Lata Muscle After Using The Modified Anterolateral Approach For Total Hip Arthroplasty

The modified Watson-Jones approach to the hip has been described as a minimally invasive approach with the potential for fewer postoperative complications than the traditional approach. Because the approach relies on an intermuscular rather than an internervous plane, there is potential for injury to the superior gluteal nerve. The aim of this study was to evaluate incidence of tensor fascia lata (TFL) denervation in patients undergoing this approach. Twenty-six patients underwent total hip arthroplasty (THA) using a modified anterolateral approach. Postoperative MRIs were analyzed for signs of muscle denervation including atrophy, hypertrophy and fat replacement. At a median follow-up of 9.3months, 74% of patients exhibited either atrophy or hypertrophy of the TFL and 42% exhibited fat replacement on MRI.

Acetabular Liner Revision Using an Anterolateral Approach

Total hip arthroplasty (THA) is recognized as a successful treatment for degenerative hip joint disease. An epidemiological study using the National Hospital Discharge Survey in the United States reported that the number of primary THAs increased from 119,000 in 1990 to 193,000 in 2002. According to nationwide inpatient sample data, the demand for primary THA was estimated to increase from 208,600 in 2005 to 572,000 (174%) in 2030 in the United States. The number of revision THAs in the United States has subsequently increased and is projected to increase from 40,800 in 2005 to 96,700 in 2030. Because revision THAs have a higher incidence of dislocation than primary THAs, preserving the soft tissue, including the gluteus medius muscle, is more necessary at revision THA. However, to our knowledge, few studies have reported soft tissue damage at revision THA. An anterolateral modified Watson-Jones approach, which is between the hip abductor and the tensor fascia lata, preserves the abductor muscles.This article describes 2 cases in which acetabular liner revision was performed through an anterolateral modified Watson-Jones approach. The anterolateral approach provided an excellent surgical field at acetabular liner revision, with no major complications, and has the possibility of being a useful for acetabular liner revision.

Modified Watson-Jones approach versus modified Hardinge approach for total hip arthroplasty

Objective To compare clinical results of modified Watson-Jones minimally invasive approach and modified Hardinge approach in total hip arthroplasty(THA).Methods This study reviewed 90 patients who had undergone THA from January 2005 through February 2008.The modified Watson-Jones approach was used in 44 patients(group A),20 men and 24 women,with an average age of 68.2 ±8.0 years; the modified Hardinge approach was used in 46 patients(group B),21 men and 25 women,with an average age of 69.1 ± 9.2 years.The causes of THA were mostly femoral neck fracture(23 cases in group A and 21 cases in group B)and femoral head necrosis(9 cases in group A and 6 cases in group B).All the operations were performed by the same group of surgeons.Clinical evaluation involved the Harris hip scores and Barthel indexes at 3 months and the final follow-up.Radiographs were evaluated to examine the acetabular abduction angle.Complications in both groups were recorded.Results The patients had an average follow-up of 50.9 ± 10.1 months.Group A were significantly superior to group B in incision length,blood loss and ambulant patients within 3 days postoperation(P ＜ 0.05).There was no significant difference between the 2 groups in the acetabular abduction angle.At 3 months postoperation,the mean Harris hip score(82.4 ±3.3)and Barthel index(85.4±3.8)were significantly higher in group A than in group B(72.3 ±3.7 &77.2 ± 5.4)(P ＜ 0.05),but such significant differences between the 2 groups were not observed at the final follow-up(P ＞ 0.05).Complications,such as wound infection,hip dislocation,vascular and neural lesions,and deep vein thrombosis,did not occur in either group.Conclusion Both modified Watson-Jones minimally invasive approach and modified Hardinge approach can be successfully used for total hip replacement,but the former can lead to better functional recovery at 3 months after operation. Key words: Arthroplasty, replacement, hip; Femoral neck fractures; Femur head necrosis; Surgical procedures, minimally invasive

Little Clinical Advantage of Modified Watson-Jones Approach Over Modified Mini-Incision Direct Lateral Approach in Primary Total Hip Arthroplasty

This study compared the clinical outcomes of total hip arthroplasty using a minimally invasive anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach) and the modified mini-incision direct lateral approach. We randomly assigned 102 patients to the muscle-sparing group (n = 52) or the mini-incision direct lateral group (n = 50). Muscle strength recovery of hip abduction at 6 weeks after surgery was better, and creatine kinase level at 1 day after surgery was lower in the muscle-sparing group than in the mini-incision direct lateral group ( P < .01). However, there was no difference in the Harris hip score, pain visual analog scale, the Western Ontario and McMaster Universities Osteoarthritis Index, and Medical Outcomes Study Short Form 36 score between the 2 groups throughout the 1-year study period.

Minimally Invasive Compared with Traditional Transgluteal Approach for Total Hip Arthroplasty

Minimally invasive total hip arthroplasty is purported to allow an improved and faster rehabilitation in the immediate postoperative period because of reduced soft-tissue damage compared with total hip arthroplasty performed with use of a standard approach. In the present study, a minimally invasive approach was compared with a traditional standard approach in terms of the effect on gait kinematics as demonstrated with gait analysis and electromyography. Twenty randomized patients who underwent a primary total hip replacement with use of a minimally invasive modified Watson-Jones approach (minimally invasive group) were compared with a group of twenty patients who underwent a total hip arthroplasty with use of a standard transgluteal Hardinge approach (standard group). All patients received the same cementless implant, inserted with use of standard instruments, and all operations were performed by a single, experienced surgeon. The patients were evaluated with use of three-dimensional gait analysis and dynamic electromyograms at three time points: preoperatively, ten days postoperatively, and twelve weeks postoperatively. Temporospatial and joint-kinematic parameters were evaluated. There were no significant differences between the two groups with regard to the temporospatial variables of velocity, cadence, step length, and stride length at any tested time point. With regard to the range of motion of the operatively treated hip, the minimally invasive group had a smaller decrease at the ten-day time point in comparison with the standard group. However, this finding was not significant. The reduction in the range of motion was mainly caused by reduced hip extension. A compensatory increase in the pelvic tilt was observed in both groups. One patient in the standard group showed a positive Trendelenburg gait ten days postoperatively; it had disappeared completely at the twelve-week time point. With regard to gait kinematics in the early postoperative period (three months), the present study showed no significant benefit for patients who underwent a total hip arthroplasty through a minimally invasive Watson-Jones approach in comparison with those who were managed with a standard transgluteal approach.