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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Magnetic Resonance Imaging | Research article

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

Authors: Gongyin Zhao, Ruixia Zhu, Shijie Jiang, Nanwei Xu, Hongwei Bao, Yuji Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

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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.
Appendix
Available only for authorised users
Literature
1.
Post ZD, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014;22(9):595–603.CrossRef
2.
3.
Horne PH, Olson SA. Direct anterior approach for total hip arthroplasty using the fracture table. Curr Rev Musculoskelet Med. 2011;4(3):139–45.CrossRef
4.
Chen AF, et al. Higher Acetabular Anteversion in direct anterior Total hip Arthroplasty: a retrospective case-control study. HSS J. 2016;12(3):240–4.CrossRef
5.
Connolly KP. Direct anterior total hip arthroplasty: literature review of variations in surgical technique. World J Orthop. 2016;7(1):38.CrossRef
6.
Van Den Eeden YNT, De Turck BJG, Van Den Eeden FMC. 24 hours stay after hip replacement. Acta Orthop. 2016;88(1):24–8.CrossRef
7.
Siguier T, Siguier M, Brumpt B. Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements. Clin Orthop Relat Res. 2004;426:164–73.CrossRef
8.
Soderquist MC, Scully R, Unger AS. Acetabular placement accuracy with the direct anterior approach freehand technique. J Arthroplast. 2017;32(9):2748–54.CrossRef
9.
Thurig G, et al. Safety of total hip arthroplasty for femoral neck fractures using the direct anterior approach: a retrospective observational study in 86 elderly patients. Patient Saf Surg. 2016;10:12.CrossRef
10.
Petis S, et al. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg. 2015;58(2):128–39.CrossRef
11.
de Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res. 2015;473(12):3860–6.CrossRef
12.
Rivera F, et al. Risk of stem undersizing with direct anterior approach for total hip arthroplasty. Hip Int. 2016;26(3):249–53.CrossRef
13.
Nistor DV, et al. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon? Int Orthop. 2017;41(11):2245–52.CrossRef
14.
Kawasaki M, et al. Muscle damage after Total hip Arthroplasty through the direct anterior approach for developmental dysplasia of the hip. J Arthroplast. 2017;32(8):2466–73.CrossRef
15.
Barton C, Kim PR. Complications of the direct anterior approach for total hip arthroplasty. Orthop Clin North Am. 2009;40(3):371–5.CrossRef
16.
De Anta-Díaz B, et al. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int Orthop. 2016;40(10):2025–30.CrossRef
17.
Unis DB, et al. Postoperative changes in the tensor fascia Lata muscle after using the modified anterolateral approach for Total hip Arthroplasty. J Arthroplast. 2013;28(4):663–5.CrossRef
18.
Dewar DC, et al. The relative contribution of the medial and lateral femoral circumflex arteries to the vascularity of the head and neck of the femur: a quantitative MRI-based assessment. Bone joint Journal. 2016;98-B(12):1582–8.CrossRef
19.
Cooper HJ, Walters BL, Rodriguez JA. Anatomy of the hip capsule and pericapsular structures: a cadaveric study. Clin Anat. 2015;28(5):665–71.CrossRef
20.
Sasaki M, et al. Relationship between the hip joint capsule and piriformis tendon in a simulation of the modified Watson-Jones anterolateral approach in THA cadaver study. Clin Anat. 2013;26(5):610–3.CrossRef
21.
Kanda A, et al. Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty. Eur J Orthop Surg Traumatol. 2018;28(6):1111–6.CrossRef
22.
Benad K, et al. Technique to treat iliopsoas irritation after total hip replacement: thickening of articular hip capsule through an abridged direct anterior approach. Orthop Traumatol Surg Res. 2015;101(8):973–6.CrossRef
23.
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
24.
Babst D, et al. The Iliocapsularis Muscle: An Important Stabilizer in the Dysplastic Hip. Clin Orthop Relat Res. 2010;469(6):1728–34.CrossRef
25.
Engelken F, et al. Assessment of fatty degeneration of the gluteal muscles in patients with THA using MRI: reliability and accuracy of the Goutallier and quartile classification systems. J Arthroplast. 2014;29(1):149–53.CrossRef
26.
Goutallier D, et al. Fattu muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304(6):78–83.
27.
Lanting BA, et al. Bikini versus traditional incision direct anterior approach: is there any difference in soft tissue damage? Hip Int. 2017;27(4):397–400.CrossRef
28.
Retchford TH, et al. Can local muscles augment stability in the hip? A narrative literature review. J Musculoskelet Neuronal Interact. 2013;13(1):1–12.PubMed
29.
Haefeli PC, et al. An increased iliocapsularis-to-rectus-femoris ratio is suggestive for instability in borderline hips. Clin Orthop Relat Res. 2015;473(12):3725–34.CrossRef
30.
Ricci V, Özçakar L. Ultrasound imaging for anterior hip pain: hypertrophic bursitis between the direct tendon of the rectus Femoris and the Iliocapsularis muscle. Pm R. 2019.
31.
Cui T, Jiang MS. Myoglobin A79G polymorphism association with exercise-induced skeletal muscle damage. Genet Mol Res. 2016;15(2):gmr.15027506.
32.
Sorichter S, et al. Skeletal muscle injury induced by eccentric muscle action: muscle proteins as markers of muscle fiber injury. Exerc Immunol Rev. 1999;5:5–21.PubMed
33.
Muller M, et al. Evidence of reduced muscle trauma through a minimally invasive anterolateral approach by means of MRI. Clin Orthop Relat Res. 2010;468(12):3192–200.CrossRef
34.
Ricci V, Özçakar L. Ultrasound imaging for anterior hip pain: hypertrophic bursitis between the direct tendon of the rectus Femoris and the Iliocapsularis muscle. Pm R. 2019;11(9):1031–1033.CrossRef
35.
Tidball JG. Inflammatory processes in muscle injury and repair. Am J Physiol Regul Integr Comp Physiol. 2005;288(2):R345–53.CrossRef
36.
Baoge L, et al. Treatment of skeletal muscle injury: a review. ISRN Orthop. 2012;2012:689012.CrossRef
Metadata
Title
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
Authors
Gongyin Zhao
Ruixia Zhu
Shijie Jiang
Nanwei Xu
Hongwei Bao
Yuji Wang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-3035-9

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