Comparative MRI assessment of three minimally invasive approaches in total hip arthroplasty - 27/09/22
, Jonathan Curado a, Jean Matsoukis b, Julien Beldame c, d, Helena Brunel e, Stéphane Van Driessche f, Fabien Billuart e, g
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Abstract |
Introduction |
Minimally invasive approaches (direct anterior approach: DAA; minimally invasive anterolateral: MIAL; piriformis-sparing posterior approach: PSPA) are widely used for total hip arthroplasty (THA), with a muscle-sparing objective. There are no published comparative studies of muscle damage secondary to these approaches. The aim of the present study was to compare fatty infiltration (FI) on MRI induced by DAA, MIAL and PSPA in THA 1) in the tensor fasciae latae (TFL) and sartorius muscles, 2) in the gluteal muscles, and 3) in the pelvitrochanteric muscles.
Hypothesis |
Greater FI is induced by DAA in anterior muscles, by MIAL in gluteal muscles and by PSPA in pelvitrochanteric muscles.
Materials and methods |
Three continuous prospective series of THA by DAA, MIAL and PSPA included 25 patients each. MRI was performed preoperatively and at 1 year postoperatively. FI was graded on the Goutallier classification in all periarticular hip muscles. Muscles showing ≥2 grade aggravation at 1 year were considered damaged.
Results |
Nine patients whose preoperative MRI was uninterpretable were excluded. In all, 66 patients (21 DAA, 24 MIAL and 21 PSPA) with 132 MRI scans were analyzed. TFL was damaged in 2/21 DAA patients (9.5%), 1/24 MIAL patients (4.2%) and 0/21 PSPA patients (0%). There were no sartorius lesions. The anterior third of the gluteus medius was damaged in 8/24 MIAL patients (33.3%) and the gluteus minimus in 10/24 (41.7%), compared to 1/21 DAA patients (4.8%) and 0/21 PSPA patients (0%). The mid and posterior thirds of the gluteus medius and the gluteus maximus were never damaged. The piriformis muscle was damaged in 3/21 DAA patients (14.3%), 2/24 MIAL patients (8.3%) and 2/21 PSPA patients (9.5%). The obturator internus was damaged in 4/21 DAA patients (19%), 1/24 MIAL patients (4.2%) and 16/21 PSPA patients (76.2%). The obturator externus and quadratus femoris were mainly damaged in PSPA patients: respectively, 5/21 (23.8%) and 4/21 patients (19%)).
Conclusion |
The muscle-sparing properties of minimally invasive hip approaches are only theoretical. In the present series, there were rare TFL lesions with DAA and MIAL. Gluteus medius and minimus lesions were frequent in MIAL. Pelvitrochanteric muscles lesions were more frequent in PSPA, but found in all 3 approaches. These findings should help guide surgeons in their choice of approach and in informing patients about the damage these minimally invasive approaches can cause.
Level of evidence |
III, prospective comparative study.
Le texte complet de cet article est disponible en PDF.Keywords : Fatty infilitration, MRI, Hip arthroplasty, Minimally invasive, Anterior approach, Anterolateral approach, Röttinger, Modified Watson-Jones, Posterior approach, Gluteal muscles, Tensor fasciae latae, Pelvitrochanteric muscles, Piriformis
Plan
Vol 108 - N° 6
Article 103354- octobre 2022 Retour au numéro
Article précédent
- MRI assessment of minimally invasive anterolateral approaches in total hip arthroplasty
- Fabien Billuart, Matthieu Lalevée, Helena Brunel, Stéphane Van Driessche, Julien Beldame, Jean Matsoukis
- Quantitative gait analysis after total hip arthroplasty through a minimally invasive direct anterior approach: A case control study
- Lucas Martinez, Nathalie Noé, Julien Beldame, Jean Matsoukis, Thomas Poirier, Helena Brunel, Stéphane Van Driessche, Matthieu Lalevée, Fabien Billuart
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