MRI assessment of minimally invasive anterolateral approaches in total hip arthroplasty - 27/09/22
, Helena Brunel a, Stéphane Van Driessche d, Julien Beldame e, f, Jean Matsoukis g
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Abstract |
Introduction |
Total hip arthroplasty (THA) on a minimally invasive anterolateral (MIAL) approach frequently leads to gluteus minimus and gluteus medius lesions, and sometimes to tensor fasciae latae (TFL) denervation. We therefore developed compensatory strategies, which we assessed on pre- and post-operative MRI: 1) to assess gluteus minimus and gluteus medius fatty infiltration (FI), 2) to assess TFL FI, and 3) to assess FI in the other periarticular muscles.
Hypothesis |
The modified MIAL approach reduces the rate of gluteus minimus and gluteus medius lesion.
Materials and methods |
A continuous prospective single-surgeon series of THA using a MIAL approach included 25 patients. Femoral implantation was performed with the hip in extension so as to distance the proximal femur from the gluteals, avoiding muscle trauma. The superior gluteal nerve branch in the space between the gluteus medius and TFL, running toward the TFL, was systematically released and protected. MRI was performed preoperatively and at 3 months and 1 year post-surgery. FI was analyzed according to the Goutallier classification in all periarticular muscles.
Results |
One patient lacked preoperative MRI and was excluded, leaving 24 patients, for 72 MRIs. In 10/24 patients (41.7%) the gluteus minimus and in 8/24 patients (33.3%) the anterior third of the gluteus medius showed ≥2 grade increase in FI between preoperative and 1-year MRI, with significant increases in both at 3 months (p<0.001) and 1 year (p<0.001). At least a 2 grade increase in FI at 1 year was seen in 1 patient (4.2%) in the TFL, in 2 (8.3%) in the piriformis, and in 1 (4.2%) in the obturator internus. There were no significant differences in FI between preoperative, 3-month or 1-year MRI in any other periarticular muscles.
Conclusion |
Femoral implantation in hip extension did not reduce the rate of gluteal lesions, which remained frequent. In contrast, release of the superior gluteal nerve branch could be effective in conserving TFL innervation. Some rare lesions of the proximal part of the pelvi-trochanteric muscles were also observed.
Level of evidence |
IV, Prospective case series.
Le texte complet de cet article est disponible en PDF.Keywords : Fatty degeneration, MRI, Hip replacement, Minimally invasive anterolateral approach, Modified Watson-Jones approach, Tensor Fasciae Latae, Gluteal muscles
Abbreviations : THA, MIAL, FI, TFL
Plan
Vol 108 - N° 6
Article 103356- octobre 2022 Retour au numéro
Article précédent
- Hip Arthroplasty, a mature surgical technique with room for improvement
- Pascal-André Vendittoli, Julien Girard, François Bonnomet
- Comparative MRI assessment of three minimally invasive approaches in total hip arthroplasty
- Matthieu Lalevée, Jonathan Curado, Jean Matsoukis, Julien Beldame, Helena Brunel, Stéphane Van Driessche, Fabien Billuart
Bienvenue sur EM-consulte, la référence des professionnels de santé.