scholarly journals Medial Versus Conventional Approach for Prevention of Lateral Cutaneous Nerve Injury in Total hip Arthroplasty with Direct Anterior Approach: A Study for Dual-center, Single-blind, Randomized Controlled Trial

2020 ◽  
Author(s):  
Hiroki Tanabe ◽  
Tomonori Baba ◽  
Yu Ozaki ◽  
Naotake Yanagisawa ◽  
Sammy Bannno ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Skin Incision ◽  
Conventional Approach ◽  
Medial Approach ◽  
Randomized Controlled ◽  
Lateral Cutaneous Nerve ◽  
Tensor Fasciae Latae

Abstract Background; Lateral cutaneous nerve (LFCN) injury is one of the complication specific to total hip arthroplasty via the direct anterior approach. Recent anatomical studies have revealed that the LFCN not only courses between the sartorius and tensor fasciae latae muscles, but it also branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle. The latter is called the fan type, in which injury of the LFCN is almost unavoidable using the conventional site for incision of the fascia. In order to reduce LFCN injury in the fan type, we devised a new approach of incising the fascia at a side 2 cm medial from the conventional site of incision. The purpose of this study is to examine how the site of incision of the fascia influences LFCN injury.Methods; This is a prospective, randomized, controlled study. All patients are divided into the fan type and non-fan type using ultrasonography before surgery. Patients with the fan type LFCN will be performed by the conventional approach and the medial approach in the order specified in the allocation table created in advance by our clinical trial center. The conventional approach involves incision of the skin, followed by incision of the fascia just below the site of skin incision. The medial approach proceeds medially from the site of skin incision, and involves incision of the fascia at a site 2 cm medial from the conventional site of incision. The primary endpoint is the presence of LFCN injury. The secondary endpoints will be assessed based on PROs at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and the Forgotten-Joint Score-12 (FJS-12).Discussion; We hypothesize that the fan type LFCN can be protected from injury by incising the fascia at a more medial site than conventional site. If the usefulness of this surgical procedure is confirmed, the disadvantages of the DAA will be eliminated, potentially being highly beneficial to patients.Trial registration; UMIN Clinical Trials Registry, UMIN000035944.Registered on 20 Feburary 2019.

scholarly journals Lateral versus conventional fasciotomy for prevention of lateral femoral cutaneous nerve injury in total hip arthroplasty with direct anterior approach: a study protocol for dual-center, single-blind, randomized controlled trial

2021 ◽  
Author(s):  
Hiroki Tanabe ◽  
Tomonori Baba ◽  
Yu Ozaki ◽  
Naotake Yanagisawa ◽  
Sammy Banno ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Total Hip ◽  
Randomized Controlled ◽  
Femoral Cutaneous Nerve ◽  
Tensor Fasciae Latae

Abstract Background; An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between sartorius and tensor fasciae lataea muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Recent anatomical studies have revealed that the LFCN not only courses between the sartorius and tensor fasciae latae muscles, but it also branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle. The latter is called the fan type, and studies suggest that damage to the fan type LFCN is unavoidable by conventional fasciotomy. We previously demonstrated that injury to non-fan type LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury for non-fan type LFCN. LFCN injury is rarely reported in the anterolateral approach (ALA), which involves incision of fascia further away than DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury. Methods; This is a prospective, randomized, controlled study. All patients are divided into the fan type and non-fan type using ultrasonography before surgery. Patients with the non-fan type LFCN will be performed by the conventional fasciotomy and the lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint is the presence of LFCN injury. The secondary endpoints will be assessed based on patient-reported outcomes (PROs) at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and the Forgotten-Joint Score-12 (FJS-12). Discussion; We hypothesize that the incidence of LFCN injury due to DAA-THA can be reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA, improve patient satisfaction. Trial registration; UMIN Clinical Trials Registry, UMIN000035945.Registered on 20 Feburary 2019.

scholarly journals Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
Vol 10 (2) ◽  
pp. e575-e580
Author(s):  
David R. Maldonado ◽  
Samantha C. Diulus ◽  
Mitchell B. Meghpara ◽  
Rachel M. Glein ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Gluteus Medius ◽  
Direct Anterior Approach ◽  
Total Hip

scholarly journals Effects of body mass index and range of motion on intraoperative change in pelvic tilt during total hip arthroplasty using the direct anterior approach

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masanori Okamoto ◽  
Masashi Kawasaki ◽  
Toshiaki Okura ◽  
Taisuke Seki ◽  
Shiro Imagama
Keyword(s):  
Body Mass Index ◽  
Logistic Regression ◽  
Total Hip Arthroplasty ◽  
Internal Rotation ◽  
Hip Arthroplasty ◽  
Supine Position ◽  
Anterior Approach ◽  
Pelvic Tilt ◽  
Direct Anterior Approach ◽  
Axial Rotation

Abstract Background Intraoperative pelvic tilt changes that occurs during total hip arthroplasty (THA) in the supine position affects cup placement and sometimes causes malalignment. The relationship between body mass index (BMI) and pelvic movement has been reported for some procedures, but not the direct anterior approach (DAA). The purpose of this study was to investigate intraoperative pelvic tilt changes that occurs during DAA. Methods In this single-center, retrospective study, we reviewed 200 hips that underwent primary THA via DAA in the supine position using an accelerometer-based navigation system. Intraoperative changes in pelvic tilt and axial rotation from the start of surgery to cup placement were assessed using the navigation system. Preoperative clinical factors that increased pelvic tilt and axial rotation toward the surgical side by > 10° were analyzed via univariate and multiple logistic regression analyses. Results The mean pelvic tilt value increased by 7.6° ± 3.8° (95% confidence interval [CI], 7.1–8.2; range, − 5.0–19.0) intraoperatively, and the axial rotation increased by 3.2° ± 2.7° (95% CI, 2.7–3.7; range, − 13.0–12.0). Univariate analysis revealed that the group with increased pelvic tilt showed significantly greater range of abduction and internal rotation, and significantly lower BMI than the group with no increased tilt. Pre-incisional pelvic tilt was significantly greater in the group with increased axial rotation than in the group with no increased rotation. On logistic regression analysis, BMI (odds ratio [OR], 0.889; 95% CI, 0.809–0.977; p = 0.014) and the range of internal rotation (OR, 1.310; 95% CI, 1.002–1.061; p = 0.038) were predictors of large increases in pelvic tilt. No predictors of large increases in axial rotation were identified. Conclusion Significant forward pelvic tilt was observed in patients with a low BMI values and high ranges of internal rotation via THA using the DAA. Findings indicated that surgeons should pay attention to intraoperative pelvic movements, which may help identify patients with significant pelvic tilt changes.

Sign in / Sign up

Export Citation Format

Share Document