Soft tissue damage after minimally invasive THA.

Area of Science:

• Orthopedic Surgery
• Surgical Techniques
• Anatomy

Background:

• Minimally invasive surgery (MIS) aims to reduce soft tissue damage during hip replacement.
• Comparing muscle damage across different MIS approaches is crucial for surgical decision-making.

Purpose of the Study:

• To quantify and compare soft tissue damage resulting from four distinct MIS hip arthroplasty approaches against a conventional lateral transgluteal method.
• To assess the integrity of critical anatomical structures, including muscles, nerves, and ligaments, following each surgical approach.

Main Methods:

• Five surgeons performed total hip arthroplasty on five fresh frozen cadaver hips using one of five approaches: MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal.
• Postoperative dissection and computerized color-staining quantified proportional muscle damage.
• Direct observation evaluated the integrity of external rotator muscles, nerves, and ligaments.

Main Results:

• The MIS anterior approach demonstrated potential for complete gluteus medius muscle preservation in 4 out of 5 cases, unlike other MIS techniques.
• The lateral transgluteal approach did not show less gluteus medius damage compared to other MIS approaches.
• Nerve damage occurred with several approaches: superior gluteal nerve transection in 4 MIS anterolateral cases and 1 lateral transgluteal case; lateral femoral cutaneous nerve transection in 1 MIS anterior and 1 MIS 2-incision case.

Conclusions:

• The MIS anterior approach may offer superior gluteus medius muscle preservation during total hip arthroplasty.
• A potential risk of lateral femoral cutaneous nerve injury exists with the MIS anterior approach.
• Surgical technique selection requires careful consideration of potential muscle and nerve damage.