Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

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Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

10.21203/rs.2.14815/v3 ◽

2020 ◽

Author(s):

Gongyin Zhao ◽

Ruixia Zhu ◽

Shijie Jiang ◽

Nanwei Xu ◽

Hongwei Bao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Joint ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Prospective Trial ◽

Direct Anterior Approach ◽

Anterior Capsule ◽

Total Hip ◽

Group A ◽

Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

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Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3035-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Gongyin Zhao ◽

Ruixia Zhu ◽

Shijie Jiang ◽

Nanwei Xu ◽

Hongwei Bao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Joint ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Harris Hip Score ◽

Anterior Capsule ◽

Total Hip ◽

Group A ◽

Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. Results LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. Trial registration ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

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Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2019.02.008 ◽

2019 ◽

Vol 105 (3) ◽

pp. 445-452 ◽

Cited By ~ 11

Author(s):

Gautier Bon ◽

Elias Ben Kacem ◽

Pierre Marie Lepretre ◽

Thierry Weissland ◽

Patrice Mertl ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Prospective Trial ◽

Direct Anterior Approach ◽

Total Hip ◽

Randomized Prospective Trial

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Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty

Reconstructive Review ◽

10.15438/rr.7.1.153 ◽

2017 ◽

Vol 7 (1) ◽

Author(s):

Stephen J Nelson ◽

Murillo Adrados ◽

Raj J Gala ◽

Erik J Geiger ◽

Matthew L Webb ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Operating Table ◽

Leg Length ◽

Neck Length ◽

Anterior Capsule ◽

Total Hip

BackgroundAchieving correct leg and femoral neck lengths remains a challenge during total hip arthroplasty (THA). Several methods for intraoperative evaluation and restoration of leg length have been proposed, and each has inaccuracies and shortcomings. Both the supine positioning of a patient on the operating table during the direct anterior approach (DAA) THA and the preservation of the anterior capsule tissue are simple, readily available, and cost-effective strategies that can lend themselves well as potential solutions to this problem.TechniqueThe joint replacement is performed through a longitudinal incision (capsulotomy) of the anterior hip joint capsule, and release of the capsular insertion from the femoral intertrochanteric line. As trial components of the prosthesis are placed, the position of the released distal capsule in relationship to its original insertion line is an excellent guide to leg length gained, lost, or left unchanged.MethodsThe radiographs of 80 consecutive primary THAs were reviewed which utilized anterior capsule preservation and direct capsular measurement as a means of assessing change in leg/femoral neck length. Preoperatively, the operative legs were 2.81 +/- 8.5 mm (SD) shorter than the nonoperative leg (range: 17.7 mm longer to 34.1 mm shorter). Postoperatively, the operative legs were 1.05 +/- 5.64 mm (SD) longer than the nonoperative leg (range: 14.9 mm longer to 13.7 mm shorter).ConclusionThe preservation and re-assessment of the native anterior hip capsule in relationship to its point of release on the femur is a simple and effective means of determining leg/femoral neck length during DAA THA.

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Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial

The Bone & Joint Journal ◽

10.1302/0301-620x.103b2.bjj-2020-0529.r2 ◽

2021 ◽

Vol 103-B (2) ◽

pp. 321-328

Author(s):

Frans-Jozef Vandeputte ◽

Jens Vanbiervliet ◽

Cigdem Sarac ◽

Ronald Driesen ◽

Kristoff Corten

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Harris Hip Score ◽

Anterior Capsule ◽

Total Hip ◽

Implant Positioning ◽

Sf 36 ◽

One Year

Aims Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). Methods In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. Results At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). Conclusion No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321–328.

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