Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2021 | Hip-TEP | Research article

Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty

Authors: Hidetatsu Tanaka, Norikazu Yamada, Hiroaki Kurishima, Yu Mori, Takashi Sakamoto, Masamizu Oyama, Toshimi Aizawa

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2021

Abstract

Background

The 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.

Methods

The 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.

Results

Among 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.

Conclusion

The 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.

Anseth SD, Pulido PA, Adelson WS, Patil S, Sandwell JC, Colwell CW Jr. Fifteen-year to twenty-year results of cementless Harris-Galante porous femoral and Harris-Galante porous I and II acetabular components. J Arthroplasty. 2010;25(5):687–91.CrossRef

Capuano N, Grillo G, Carbone F, Del Buono A. Total hip arthroplasty performed with a tissue-preserving technique using superior capsulotomy. Int Orthop. 2018;42(2):281–7.CrossRef

Leunig M, Faas M, von Knoch F, Naal FD. Skin crease 'bikini' incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res. 2013;471(7):2245–52.CrossRef

Homma Y, Baba T, Kobayashi H, Desroches A, Ozaki Y, Ochi H, et al. Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series. Int Orthop. 2016;40(12):2487–94.CrossRef

George NE, Gwam CU, Etcheson JI, Smith SS, Semenistyy AA, Delanois RE. Short-term outcomes of the supine muscle-sparing anterolateral versus direct lateral approach to primary total hip arthroplasty. Hip Int. 2019;29(5):504–10.CrossRef

Civinini R, Cozzi Lepri A, Carulli C, Matassi F, Villano M, Innocenti M. The anterior-based muscle-sparing approach to the hip: the “other” anterior approach to the hip. Int Orthop. 2019;43(1):47–53.CrossRef

Pfluger G, Junk-Jantsch S, Scholl V. Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop. 2007;31(Suppl 1):S7–11.CrossRef

KMC THR, Grimaldi A, Kemp JL, Cowan SM. Can local muscles augment stability in the hip? A narrative literature review. J Musculoskelet Neuronal Interact. 2013;13(1):1–12.

Xu D, Koyama H, Furuhashi H, Nishikino S, Hoshino H, Matsuyama Y. Comparison of hip muscle volume between fit-and-fill stem and tapered-wedge stem after total hip arthroplasty using the anterolateral approach. J Orthop Sci. 2017;22(6):1102–6.CrossRef

10.

Iorio R, Specht LM, Healy WL, Tilzey JF, Presutti AH. The effect of EPSTR and minimal incision surgery on dislocation after THA. Clin Orthop Relat Res. 2006;447:39–42.CrossRef

11.

Goldstein WM, Gleason TF, Kopplin M, Branson JJ. Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy. J Bone Joint Surg Am. 2001;83-A Suppl 2(Pt 1):2-7.

12.

Yao R, Howard JL, Lanting BA. Conjoint Tendon Release in Direct Anterior Total Hip Arthroplasty: No Impact on Patient Outcomes. Orthopedics. 2017;40(6):e971–e4.PubMed

13.

Ito Y, Matsushita I, Watanabe H, Kimura T. Anatomic mapping of short external rotators shows the limit of their preservation during total hip arthroplasty. Clin Orthop Relat Res. 2012;470(6):1690–5.CrossRef

14.

Takeda H, Kamogawa J, Sakayama K, Kamada K, Tanaka S, Yamamoto H. Evaluation of clinical prognosis and activities of daily living using functional independence measure in patients with hip fractures. J Orthop Sci. 2006;11(6):584–91.CrossRef

15.

Matsumoto T, Kaneuji A, Hiejima Y, Sugiyama H, Akiyama H, Atsumi T, et al. Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci. 2012;17(1):25–38.CrossRef

16.

Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Matsumoto T, Hiejima Y. Clinical assessment after total hip arthroplasty using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire. J Orthop. 2015;12(Suppl 1):S31–6.CrossRef

17.

Behrend H, Giesinger K, Giesinger JM, Kuster MS. The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty. 2012;27(3):430–6 e1.CrossRef

18.

Matsumoto M, Baba T, Homma Y, Kobayashi H, Ochi H, Yuasa T, et al. Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure. Eur J Orthop Surg Traumatol. 2015;25(7):1141–5.CrossRef

19.

Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ. 2002;324(7351):1417.CrossRef

20.

Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol. 1998;51:1037-44.

21.

Fukuhara S, Ware JE, Kosinski M, Wada S, Gandek B. Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol. 1998;51:1045-53.

22.

Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.CrossRef

23.

Zomar BO, Bryant D, Hunter S, Howard JL, Lanting BA. The effect of conjoint tendon release on gait after direct anterior total hip arthroplasty. Hip Int. 2019;29(6):578–83.CrossRef

24.

White RE Jr, Forness TJ, Allman JK, Junick DW. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res. 2001;393:163–7.CrossRef

25.

Walters BL, Cooper JH, Rodriguez JA. New findings in hip capsular anatomy: dimensions of capsular thickness and pericapsular contributions. Arthroscopy. 2014;30(10):1235–45.CrossRef

26.

Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006;453:293–8.CrossRef

27.

Yoshitani J, Kabata T, Kajino Y, Takagi T, Ohmori T, Ueno T, et al. The effect of flexion alignment in total hip arthroplasty with a cementless tapered-wedge femoral stem. Eur J Orthop Surg Traumatol. 2018;28(8):1625–32.CrossRef

Title: Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty
Authors: Hidetatsu Tanaka
Norikazu Yamada
Hiroaki Kurishima
Yu Mori
Takashi Sakamoto
Masamizu Oyama
Toshimi Aizawa
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Hip-TEP
Hip-TEP
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2021
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-021-02644-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Preoperative characteristics and intraoperative factors do not correlate with accomplishments of active straight-leg raising, standing up, and walking after primary total knee arthroplasty

The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients

Efficacy and safety of a self-developed home-based enhanced knee flexion exercise program compared with standard supervised physiotherapy to improve mobility and quality of life after total knee arthroplasty: a randomized control study

Comparison of SDSG and CARDS classifications for L5/S1 lumbar degenerative spondylolisthesis: an independent inter- and intra-observer agreement study

Investigation of the role of the miR17-92 cluster in BMP9-induced osteoblast lineage commitment

Genipin and insulin combined treatment improves implant osseointegration in type 2 diabetic rats