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Soft tissue damage after minimally invasive THA
Jakob van Oldenrijk1, Piet V J M Hoogland, Gabriëlle J M Tuijthof
1Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, the Netherlands. jakobvanoldenrijk@gmail.com
Background And Purpose:
Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.
Methods:
5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach. Postoperatively, the hips were dissected and muscle damage color-stained. We measured proportional muscle damage relative to the midsubstance cross-sectional surface area (MCSA) using computerized color detection. The integrity of external rotator muscles, nerves, and ligaments was assessed by direct observation.
Results:
None of the other MIS approaches resulted in less gluteus medius muscle damage than the lateral transgluteal approach. However, the MIS anterior approach completely preserved the gluteus medius muscle in 4 cases while partial damage occurred in 1 case. Furthermore, the superior gluteal nerve was transected in 4 cases after a MIS anterolateral approach and in 1 after the lateral transgluteal approach. The lateral femoral cutaneous nerve was transected once after both the MIS anterior approach and the MIS 2-incision approach.
Interpretation:
The MIS anterior approach may preserve the gluteus medius muscle during total hip arthroplasty, but with a risk of damaging the lateral femoral cutaneous nerve.
Insights
Minimally invasive surgery (MIS) for hip replacement shows varied muscle damage. The MIS anterior approach may preserve gluteus medius muscle but risks lateral femoral cutaneous nerve injury.
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.
