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Yuan G, Xiao Y, Li Z, Chen Z, Liu X. Impact of surgical approaches on stem position and hidden blood loss in total hip arthroplasty: minimally invasive vs. posterolateral. BMC Musculoskelet Disord 2024; 25:681. [PMID: 39210297 PMCID: PMC11363634 DOI: 10.1186/s12891-024-07806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The surgical approach impacts the outcomes and recovery after total hip arthroplasty (THA), and approaches may affect the stem positioning. Contrary to the general concept of minimally invasive surgery, the direct anterior approach (DAA) results in more intraoperative blood loss. Therefore, the objective of this study was to compare stem positioning and hidden blood loss (HBL) among three surgical approaches: the minimally invasive DAA, Orthopadische Chirurgie Munchen (OCM), and the traditional posterolateral approach (PLA). METHODS A total of 201 patients undergoing their first non-cemented THA using the DAA, OCM, and PLA were included in the study. General demographic data, stem alignment, and blood loss were evaluated. Specific comparison measurements included femoral neck anteversion, femoral stem anteversion, alignment of the stem in coronal and sagittal planes, proximal and distal medullary ratios, and femoral offset. Blood loss was measured by calculating Intraoperative Blood Loss ( IBL), visible blood loss (VBL), and hidden blood loss (HBL). RESULTS There were no significant differences in age, gender, body mass index, preoperative diagnosis, or femoral Dorr classification among the three groups. The mean surgical time was longer for the DAA and OCM compared to the PLA (P < 0.01). IBL was highest in the DAA group and lowest in the PLA (P < 0.05). Postoperative stem anteversion were significantly different among the groups, with the DAA showing the greatest anteversion difference (P < 0.05). There was no difference in the stem coronal alignment. However, there were more valgus and varus implants in the sagittal plane for the DAA and OCM. The femoral offset reduction was less optimal in the DAA and OCM groups (P < 0.05). The proximal and distal medullary ratios were lower in the DAA and OCM (P < 0.05). HBL was significantly lower in the DAA and OCM compared to the PLA (P < 0.05). CONCLUSION Minimally invasive approaches such as DAA and OCM offer advantages in muscle and soft tissue preservation, leading to reduced HBL compared to the conventional PLA. However, these approaches present challenges in femoral stem positioning and longer surgical times.
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Affiliation(s)
- Gongwu Yuan
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, No. 11, Huangjiahu West Road, Hongshan District, Wuhan, 430065, Hubei Province, China
- Department of Orthopedic Surgery, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, No. 11, lingjiaohu Road, Jianghan District, Wuhan, 430015, Hubei Province, China
- Department of Orthopedic, Chinese PLA Central Theater General Hospital, Wuhan, 430070, Hubei Province, China
| | - Yaoguang Xiao
- Department of Orthopedic Surgery, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, No. 11, lingjiaohu Road, Jianghan District, Wuhan, 430015, Hubei Province, China
| | - Zhigang Li
- Department of Orthopedic Surgery, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, No. 11, lingjiaohu Road, Jianghan District, Wuhan, 430015, Hubei Province, China
| | - Zijian Chen
- Department of Orthopedic Surgery, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, No. 11, lingjiaohu Road, Jianghan District, Wuhan, 430015, Hubei Province, China
| | - Ximing Liu
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, No. 11, Huangjiahu West Road, Hongshan District, Wuhan, 430065, Hubei Province, China.
- Department of Orthopedic, Chinese PLA Central Theater General Hospital, Wuhan, 430070, Hubei Province, China.
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Lalevée M, Martinez L, Rey B, Beldame J, Matsoukis J, Poirier T, Brunel H, Van Driessche S, Noé N, Billuart F. Gait analysis after total hip arthroplasty by direct minimally invasive anterolateral approach: A controlled study. Orthop Traumatol Surg Res 2023; 109:103521. [PMID: 36539033 DOI: 10.1016/j.otsr.2022.103521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/13/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Clinical and functional improvement after minimally invasive total hip arthroplasty (THA) has become increasingly controversial. The minimally invasive anterolateral approach (MIALA) allows rapid recovery resulting in a reduced need for rehabilitation. Alterations in muscle and static balance have previously been demonstrated. Results in the context of quantified gait analysis (QGA) and MIALA compared to an asymptomatic population remain unknown beyond one year postoperatively. Thus, the main objective of this controlled study was to compare the spatiotemporal parameters of gait, obtained using a QGA, beyond one year postoperatively in subjects operated on for THA by MIALA, with a group of asymptomatic subjects of the same age. The secondary objectives of the study were to compare the other QGA and EMG data acquired in operated subjects with asymptomatic subjects. HYPOTHESIS We hypothesized that QGA and EMG parameters would not normalize beyond one year postoperatively. PATIENTS AND METHODS Thirty-one subjects were recruited, including 16 patients (68 years old; IQR: 65-70) who underwent MIALA, at 15.5 months postoperatively (IQR: 13-17) and 15 asymptomatic subjects (62 years old; IQR: 61-71). Subjects underwent QGA and maximal isometric muscle force tests on the gluteus medius, gluteus maximus, Tensor Fascia Lata (TFL) and Sartorius muscles. Spatiotemporal gait parameters were the primary endpoint. The other QGA parameters: kinetics (characteristic values of vertical ground reaction forces, peak hip moments) and kinematics (hip joint amplitudes and pelvic mobility in the frontal and sagittal plane) constituted the secondary criteria. RESULTS Five subjects were excluded for unrestored offset. Walking speed was lower in operated patients (1.03m/s versus 1.18m/s, p=0.005). Maximal isometric muscle force moments were lower in patients operated on for the gluteus maximus and medius as well as the TFL (p<0.005). The vertical ground reaction forces were lower for the operated patients for the loading phase (FzFCmax, p=0.001), the single stance phase (FzSPmin, p=5.05.10-2) and the swing phase (FzTOmax, p=0.0002). The moments were lower in the sagittal plane for the operated patients (0.6N.m for the operated versus 1.1N.m for the asymptomatic, p=0.02). The pelvic amplitudes in the sagittal plane were lower for operated patients (3.3° versus 7.2°, p=0.05). DISCUSSION Our hypothesis appears to be validated. Gait deficits persisted beyond one year postoperatively after THA with MIALA. A decrease in walking speed, maximal isometric muscle force of the gluteus medius and gluteus maximus and TFL was observed, as well as a decrease in propulsive force and peak hip moment. Functionally, these results could signify muscle damage following surgery, requiring rehabilitation for improved muscle function. LEVEL OF PROOF III: Non-randomized controlled trial.
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Affiliation(s)
- Matthieu Lalevée
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France
| | - Lucas Martinez
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de Recherche ERPHAN, UR 20201, UVSQ, France
| | - Benjamin Rey
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, Groupe Hospitalier du Havre, BP24, 76083, Le Havre cedex, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Stéphane Van Driessche
- Polyclinique Sainte-Marguerite, 5, avenue de la Font Sainte-Marguerite, 89000 Auxerre, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de Recherche ERPHAN, UR 20201, UVSQ, France; Université de Paris-Saclay, UFR Simone Veil-Santé, 2, avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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Zampogna B, Papalia GF, Parisi FR, Luciano C, Gregori P, Vorini F, Marinozzi A, Farsetti P, Papalia R. Early return to activity of daily living after total hip arthroplasty: a systematic review and meta-analysis. Hip Int 2023; 33:968-976. [PMID: 36571209 DOI: 10.1177/11207000221146116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Total hip arthroplasty (THA) is an orthopaedic procedure that improves the quality of life in patients suffering from hip pain related to osteoarthritis, fractures, and avascular osteonecrosis of the femoral head. Different surgical approaches can be used for THA leading to different recovery times. Because of the lowering medium age of people undergoing THA, it is important to focus on the earlier return of physiological activity after surgery. AIM To evaluate the best approach for THA in terms of earlier return to activity. METHOD Studies comparing the postoperative outcomes in patients who underwent THA through different approaches were analysed focusing on patients' self-reported outcomes, ADL score and UCLA activity score with a short follow-up. RESULTS A total of 1990 articles were identified in the search, and 14 met the inclusion criteria. The Review Manager software version 5.4 was used to conduct a meta-analysis to compare the direct anterior (DAA) and posterior (PA) approaches, which are the most adopted approaches. An earlier return to walk without aids and to independent ADLs were reported with DAA, but without statistical significance (respectively p = 0.06 and p = 0.10). The time to return to drive was similar among the 2 groups (p = 0.88). The return to work was faster with PA, but no statistical significance was reported (p = 0.47). CONCLUSIONS Further studies are needed with a larger number of patients, that present homogeneous outcomes, follow-ups and rehabilitation programmes, and that compare similar surgical approaches to assess the early return to activity of daily living after THA.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Rosario Parisi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Claudia Luciano
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Marinozzi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Martinez L, Noé N, Beldame J, Matsoukis J, Poirier T, Brunel H, Van Driessche S, Lalevée M, Billuart F. Quantitative gait analysis after total hip arthroplasty through a minimally invasive direct anterior approach: A case control study. Orthop Traumatol Surg Res 2022; 108:103214. [PMID: 35092851 DOI: 10.1016/j.otsr.2022.103214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) leads to excellent clinical and functional results. The Minimally Invasive Anterior Approach (MIAA) theoretically allows rapid recovery and a reduction in the need for rehabilitation, but alterations in muscle and static balance have previously been demonstrated. Kinetic, kinematic and muscular alterations have been shown to persist up to 1year postoperatively but data beyond 1year postoperatively is lacking. Thus, the objective of this study was to compare the data from Quantitative Gait Analysis (QGA) coupled with electromyography (EMG), of patients one year postoperatively with THA through MIAA, compared to an asymptomatic control group. HYPOTHESIS We hypothesized that QGA and EMG parameters would not normalize beyond one year postoperatively. PATIENTS AND METHODS Twenty-seven patients were recruited, including 15 subjects (64.6±6.6years) operated on by MIAA, who at 15.9±3.1months postoperatively, along with 12 asymptomatic control subjects (68.9±9.7years), who underwent QGA and maximal isometric muscle strength tests, coupled with EMG on the gluteus medius and maximus, Tensor Fascia Lata (TFL) and Sartorius muscles. The spatiotemporal parameters of walking (step length, walking speed, cadence, single leg support time), kinetics (vertical ground reaction forces, hip moments in the 3 planes) and kinematics (coxofemoral and pelvic amplitudes) were analyzed. RESULTS The walking speed was lower on the non-operated side of the experimental subjects (0.96ms-1 compared to 1.13ms-1 for asymptomatic [p=0.018]), as was the step length on the operated side (0.53m compared to 0.60m for asymptomatic [p=0.042]). Maximal isometric muscle strength was lower in subjects operated on for the gluteus maximus and medius (p=0.004), compared to asymptomatic subjects. Moments were lower in the subjects operated on in extension (0.72Nm on the operated side, 0.75Nm on the non-operated side compared to 1.06Nm for asymptomatic [p=0.007 and p=0.024]) and lateral rotation (0.09Nm on the operated side, 0.05Nm on the non-operated side compared to 0.16Nm for asymptomatic subjects [p=0.009 and p=0.0005]). Hip adduction amplitudes were lower on the operated side compared to asymptomatic subjects (3.93° versus 9.14° for asymptomatic [p=0.005]). Pelvic amplitudes in the frontal plane were lower amongst operated subjects (0.44° against 1.97° for asymptomatic [p=0.041]). Pelvic amplitudes in the sagittal plane were higher in the operated subjects (15.74° on the operated side, 15.43° on the non-operated side compared to 9.65° for asymptomatic [p=0.041 and p=0.032]). DISCUSSION Our initial hypothesis was validated, since walking deficits persisted beyond one year postoperatively after THA through MIAA. A decrease in maximal isometric muscle strength of the gluteus medius and gluteus maximus was observed, as well as an alteration of kinetic and kinematic parameters in the sagittal and frontal planes. The results were in agreement with the literature and reflected the establishment of compensatory mechanisms to overcome alterations in joint strength and range more than one year postoperatively. These results would allow rehabilitation programs to be more specific and would justify a study on the other approaches for THA. LEVEL OF EVIDENCE III; non-randomized control trial.
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Affiliation(s)
- Lucas Martinez
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, Versailles, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, Groupe hospitalier du Havre, BP24, 76083, Le Havre cedex, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | | | - Matthieu Lalevée
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, Versailles, France.
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Billuart F, Lalevée M, Brunel H, Van Driessche S, Beldame J, Matsoukis J. MRI assessment of minimally invasive anterolateral approaches in total hip arthroplasty. Orthop Traumatol Surg Res 2022; 108:103356. [PMID: 35724839 DOI: 10.1016/j.otsr.2022.103356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
| | - Matthieu Lalevée
- Centre hospitalier universitaire de Rouen, service de chirurgie orthopédique et traumatologique, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | | | - Julien Beldame
- Institut clinique du Pied-Paris, Ramsay santé, clinique blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
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Lalevée M, Curado J, Matsoukis J, Beldame J, Brunel H, Van Driessche S, Billuart F. Comparative MRI assessment of three minimally invasive approaches in total hip arthroplasty. Orthop Traumatol Surg Res 2022; 108:103354. [PMID: 35716987 DOI: 10.1016/j.otsr.2022.103354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/10/2022] [Accepted: 04/22/2022] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Matthieu Lalevée
- Centre Hospitalier Universitaire de Rouen, Service de Chirurgie Orthopédique et Traumatologique, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Jonathan Curado
- Centre Hospitalier Universitaire de Rouen, Service de Chirurgie Orthopédique et Traumatologique, 37, boulevard Gambetta, 76000 Rouen, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Julien Beldame
- Institut Clinique du Pied-Paris, Ramsay Santé, Clinique Blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Helena Brunel
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | | | - Fabien Billuart
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
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Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach-a University clinic case control study of 120 cases. Arch Orthop Trauma Surg 2022; 142:747-754. [PMID: 33386978 DOI: 10.1007/s00402-020-03719-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The surgical approach used in total hip arthroplasty (THA) has been identified as a factor affecting the outcome. In our University Hospital, the posterior surgical approach is the gold standard. The Rottinger approach is an anterolateral approach which is truly minimally invasive, as it does not vertically cut any muscle fibers. The objective of this study was to determine the difference in surgical outcomes between the posterior hip approach and the Rottinger approach which was newly adopted at our Hospital. METHODS In a retrospective study, a total of 120 patients underwent THA; 60 patients using the Rottinger approach by the young consultant surgeon and another 60 patients using the standard posterior approach by the senior orthopaedic surgeon. Patients have been controlled for age, gender, and ASA grades. All preoperative demographic data showed no significant difference between the control and study groups. The following parameters were analyzed: incision length, duration of the surgery, intraoperative blood loss, WOMAC index, Harris Hip Score, range of motion at 3 and 12 months after surgery, time of quitting the crutches, and willingness for the contralateral hip arthroplasty. RESULTS WOMAC index, surgical time, and incision lengths have been without significant difference in both approaches. Intraoperative blood loss was significantly lower in the Rottinger group (CI: - 10.903, - 0.064). Harris Hip score was significantly higher (CI: 4.564, 12.973) in the Rottinger group at 3 months, but similar (CI: - 3.484, 2.134) at 12 months follow-up. At 3 months, active flexion and extension were significantly higher in the Rottinger group (CI: 0.595, 8.239; 2.487, 4.480, respectively), and active abduction and passive adduction (CI: - 5.662, - 0.338; - 6.290, - 1.410, respectively) in the posterior approach group. Patients in the Rottinger approach group on average quit crutches 3 weeks earlier and had no postoperative dislocations compared to 2 dislocations in the control group. CONCLUSION The Rottinger approach offered faster rehabilitation with less need for crutches and with lower complication rates.
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Martinez L, Noé N, Simon H, Beldame J, Matsoukis J, Brunel H, Van Driessche S, Billuart F. Stabilometric assessments of two rehabilitation protocols on postural parameters after posterior total hip arthroplasty: A prospective randomized comparative study. Orthop Traumatol Surg Res 2022; 108:103174. [PMID: 34896580 DOI: 10.1016/j.otsr.2021.103174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION After total hip arthroplasty (THA), patients continue to have muscular, functional and postural deficits. The literature seems to support the use of postoperative rehabilitation, especially self-directed programs. However, there is no set protocol for the management of postural disorders. Therefore, the purpose of this study was to compare postural parameters of a group of patients who underwent posterior THA followed by 2 different types of rehabilitation (stabilometric platform (SP) and home-based self-directed protocols) with a control group of operated patients who did not undergo rehabilitation and a control group of age-matched asymptomatic subjects. HYPOTHESIS We hypothesized that rehabilitation would normalize the stabilometric parameters. PATIENTS AND METHODS A total of 67 subjects were enrolled in this study (mean age 67.85±1.22years) and divided into 4 groups. Forty-one of these subjects had undergone a posterior THA were randomly assigned between D10 and D21 to one of the following 3 groups: no rehabilitation control group (THACG=14), supervised rehabilitation with a stabilometric platform group (RSPG=16), and a self-directed home-based rehabilitation group (SDHRG=11). The 4th group was a control group made up of 26 age-matched asymptomatic nonoperated subjects (CG55-80). These rehabilitation protocols lasted 3weeks. At the end of the 3weeks, the groups performed the same stabilometric single leg and double leg stance tests (considering lower limb dominance) on an SP. RESULTS No significant differences were observed between groups in the bipedal stance, except between the CG55-80 and the THACG, where a higher energy expenditure was observed in the THACG during the static stance with eyes open (EO) and eyes closed (EC): increase in the path length (Plength) covered by the center of pressure (COP) (EO: p=01; EC: p=03) and the average velocity (Vavg) of the COP (EO: p=01; EC: p=03). These differences were not observed in the SDHRG and RSPG whether they were compared with one another or with both control groups. In the unipedal stance, subjects in the RSPG and SDHRG showed greater muscle activity in the anterior and posterior chains and hip abductors, and used less energy to maintain the stance than those in the CG55-80, regardless of lower limb dominance: decrease in the mediolateral range of COP displacement (Xrange) (hip abductor muscles) (p=02) and anteroposterior range of COP displacement (Yrange) (anterior and posterior chains) (p=3.49.10-3), 95% confidence ellipse area (Earea) of COP data (p=1.47.10-3), Plength (p=04) and Vavg (p=04). The RSPG had a smaller Earea than the SDHRG (p=04), demonstrating a better postural stability during the unipedal stance performed on the dominant operated leg. DISCUSSION Our results were consistent with the literature on the benefits of rehabilitation after THA, thus confirming our hypothesis that rehabilitation normalized stabilometric parameters between D31-D45, depending on the subjects. These results provide new information regarding rehabilitation techniques to be implemented postoperatively after a THA. A home-based self-directed rehabilitation program is just as effective as an SP program in managing postural disorders. LEVEL OF EVIDENCE II; randomized controlled trial with low statistical power.
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Affiliation(s)
- Lucas Martinez
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Hermann Simon
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP24, 76083 Le Havre cedex, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | | | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, France.
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Labanca L, Ciardulli F, Bonsanto F, Sommella N, Di Martino A, Benedetti MG. Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2021; 22:1055. [PMID: 34930190 PMCID: PMC8690357 DOI: 10.1186/s12891-021-04919-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA. METHODS A systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study. RESULTS Thirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception. CONCLUSION Balance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Francesca Ciardulli
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Bonsanto
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Nadia Sommella
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Di Martino
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- I Orthopaedic Clinic, IRCSS- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Dahm F, Aichmair A, Dominkus M, Hofstaetter JG. Incidence of lateral femoral cutaneous nerve lesions after direct anterior approach primary total hip arthroplasty - a literature review. Orthop Traumatol Surg Res 2021; 107:102956. [PMID: 33962046 DOI: 10.1016/j.otsr.2021.102956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Lesions of the lateral cutaneous femoral nerve are a reported complication of the direct anterior approach (DAA) for total hip arthroplasty (THA). Little is known about the incidence rates of this lesion. The goal of this study was to answer the following questions: (1) Is the true incidence rate of LFCN lesions after DAA THA known? (2) What are the reasons for the wide range of reported incidence rates in the literature? (3) Are surgeons increasingly aware of the significance of LFCN lesions? METHODS A US Medical Library of Medicine database search was performed for DAA THA. In total, 1261 search results were screened for reported LFCN lesions. RESULTS Forty-five studies were included reporting LFCN lesions rates of 0-83%. Subgroup analysis for studies with (group A, 6 studies, n=1113 cases) and without (group B, 39 studies n=16,741) primary focus on the LFCN lesions was performed. Incidence in group A ranged from 14.8-81% (mean 31%) and 0-83% (mean 3.8%) in group B. The difference between the groups was significant (p=0.005). No uniform and time sensitive definition of postoperative LFCN lesions was found in the literature. An analysis of the publication year and the discovered incidence rate showed an increase of incidence rates [rs=0.521 (p<0.001, two-tailed)] over time. CONCLUSION Despite the absence of a uniform definition: LFCN lesions after DAA THA are a frequent and, in the past, often underestimated complication. LEVEL OF EVIDENCE IV; systematic review of level II to level IV studies.
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Affiliation(s)
- Falko Dahm
- II. Orthopedic Department, Orthopedic Hospital Speising, Speisinger Str. 109, 1130 Vienna, Austria; Division of Orthopedic Surgery, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - Alexander Aichmair
- II. Orthopedic Department, Orthopedic Hospital Speising, Speisinger Str. 109, 1130 Vienna, Austria; Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Speising, Speisinger Str. 109, 1130 Vienna, Austria
| | - Martin Dominkus
- II. Orthopedic Department, Orthopedic Hospital Speising, Speisinger Str. 109, 1130 Vienna, Austria; Sigmund Freud Medical University, Freudplatz 1, 1020 Vienna, Austria
| | - Jochen G Hofstaetter
- II. Orthopedic Department, Orthopedic Hospital Speising, Speisinger Str. 109, 1130 Vienna, Austria; Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Speising, Speisinger Str. 109, 1130 Vienna, Austria
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Lalevée M, Matsoukis J, Beldame J, Brunel H, Billuart F, Van Driessche S. MRI assessment of piriformis-sparing posterior approach in total hip arthroplasty. Orthop Traumatol Surg Res 2021; 107:103085. [PMID: 34583011 DOI: 10.1016/j.otsr.2021.103085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), the posterior approach is the most common throughout the world. Dislocation is one of the main complications incurred, but the risk may be reduced by sparing posterior structures. Thus, piriformis-sparing posterior approaches (PSPA) were described, and satisfactory conservation of the muscle was reported. On the other hand, a recent cadaver study reported occult intrapelvic piriformis lesions in 91% of cases. In the light of this discordance, we performed pre- and postoperative MRI in THA by PSPA: 1) to assess the fatty infiltration of the piriformis induced by the approach, with particular attention to intrapelvic lesions; and 2) to assess fatty infiltration of the other periarticular muscles. HYPOTHESIS The piriformis muscle will show little fatty infiltration following PSPA. MATERIALS AND METHODS A continuous prospective single-surgeon series of THA by PSPA included 25 patients. MRI was performed preoperatively and at 3 months and 1 year postoperatively. Fatty infiltration was assessed on the Goutallier classification in all periarticular muscles. RESULTS Preoperative MRI was lacking in 4 patients, who were excluded from analysis; 21 patients with MRI were thus analyzed. In the piriformis muscle, there was no significant change in fatty infiltration between preoperative and 3-month (p=0.29) or 1-year (p=0.41) MRI. Two of the 21 patients (9.5%) showed grade 3 or 4 fatty infiltration at 1 year, compared to 0/21 (0%) preoperatively; both showed sacral avulsion of the piriformis. Significant differences between preoperative and 1-year MRI were found for the obturator internus and externus, with grade 3 or 4 infiltration at 1 year in 14 cases for the obturator internus (14/21: 66.7%), in 3/21 for the obturator externus (14.3%) and in 6/21 for the quadratus femoris (28.6%), compared to respectively 0/21 (0%), 0/21 (0%) and 3/21 (14.3%) preoperatively. There were no significant differences for any of the other periarticular muscles. CONCLUSION PSPA in THA ensured good conservation of the piriformis. There may, however, be rare and irreversible sacral lesions invisible intraoperatively. LEVEL OF EVIDENCE IV; prospective case series.
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Affiliation(s)
- Matthieu Lalevée
- Service de chirurgie orthopédique et traumatologique, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Julien Beldame
- Institut clinique du Pied-Paris, Ramsay Santé, Clinique Blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France; UVSQ, Erphan, Université Paris-Saclay, 78000 Versailles, France
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Cailleaud M, Lalevée M, Matsoukis J, Beldame J, Masse M, Billuart F, Van Driessche S. Fatty muscle infiltration of the hip lateral rotator muscles following direct anterior minimally invasive total hip arthroplasty. Orthop Traumatol Surg Res 2020; 106:1515-1521. [PMID: 33097452 DOI: 10.1016/j.otsr.2020.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is no consensus as to the best surgical approach to use when doing total hip arthroplasty (THA). There has been renewed interest in recent years in so-called anatomic minimally invasive direct anterior approaches (DAA). However, their reduced impact has not been confirmed with imaging data. This led us to carry out a prospective study to 1) evaluate fatty infiltration (FI) of muscles around the hip joint and 2) analyze how this FI changes over time. HYPOTHESIS THA done by the DAA induces FI of the anterolateral muscles around the hip adjacent to the approach. MATERIAL AND METHODS A continuous case series of THA by DAA using a traction table was done by a single experienced surgeon. MRI images (GE Optima* MR360 1.5T) were taken preoperatively, then at 3 months and 1 year after the THA surgery. Muscle FI was classified as described by Goutallier by an independent radiologist on all the muscles around the hip joint. A Wilcoxon test was used to compare the preoperative MRI data to the data at 3 months and 1 year postoperative. RESULTS Sixty-nine MRI examinations were done in 23 patients. Two were not interpretable because the patient moved during the preoperative acquisition. No intraoperative or postoperative complications were reported. None of the patients had hip pain or limped at 1 year postoperative. The FI was significantly worse from the preoperative MRI to the 3-month postoperative MRI (p=0.02) and 1-year MRI (p=0.0007) in the internal obturator muscle and at 1 year in the piriformis muscle (p=0.04). There was no significant difference for the other muscles. The rectus femoris, superior and inferior gemellus muscles and the quadratus femoris could not be analyzed. DISCUSSION Our hypothesis was not confirmed, although we had a paradoxical finding of muscle FI in the posterior lateral rotator muscles not the anterolateral muscles after THA by DAA. These lesions may be secondary to detachment or denervation of these muscles when elevating the femur to prepare the femoral canal or insert the stem. LEVEL OF EVIDENCE IV; Prospective case series.
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Affiliation(s)
- Martin Cailleaud
- Service d'imagerie médicale Charles Nicolle, centre hospitalier universitaire de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - Matthieu Lalevée
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Rouen, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Julien Beldame
- Clinique mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Marion Masse
- Clinique mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
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Common H, Rousseau R, Putman S, Migaud H, Girard J. High-level judo practice after hip resurfacing. Orthop Traumatol Surg Res 2020; 106:1511-1514. [PMID: 33189662 DOI: 10.1016/j.otsr.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND HYPOTHESIS The ability to participate in sports after hip arthroplasty is increasingly being requested by patients. The possibilities of participating in sports such as judo after hip arthroplasty have not been explored sufficiently even though these sports are associated with a high risk of loosening, dislocation or revision. The aim of this study was to evaluate the return to judo after hip resurfacing arthroplasty (HRA) in terms of time and level of practice in an expert population and to determine the surgical complication rate. MATERIALS AND METHODS This was a retrospective observational study of all licensed judo practitioners at an expert level (≥black belt 3rd Dan) who underwent HRA. Patients filled out a sport-specific questionnaire that captured their level of judo practice (international, national, regional, recreational), type of practice (teaching, technical recreational, competitive recreational), dan grade, weekly volume of practice and time elapsed after surgery before resuming judo. The features of the return to judo were analyzed (technical, ground, combat). RESULTS Sixty-seven HRA were implanted in 60 patients: 11 were international judokas, 3 were national, 8 were regional and 38 were recreational. The case series consisted of 18 patients who were 3rd Dan, 18 were 4th Dan, 7 were 5th Dan, 5 were 6th Dan and 12 were 7th Dan. The average follow-up was 65.3 months (range 9.9-11.9). All the clinical scores pointed to clinically and statistically significant improvement. Of the 60 patients, 53 had resumed judo at the final assessment (90%) after a mean of 4 months (2-7) for technical judo, 6 months (3-10) for ground judo and 7 months (3-12) for combat judo. Of those who did not resume their judo practice, 3 patients voluntarily changed sports, 2 had psychological apprehension and 2 had residual groin pain. The weekly volume of practice preoperatively was 0.9hours (0-5) and postoperatively it reached 5hours (2-18) (P<0.001). CONCLUSION HRA in a population of high-level judokas allows for return to sport practice without short-term complications such as fracture, dislocation or loosening. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Harold Common
- Faculté de médecine de Rennes, université de Rennes 1, Rennes, France; Service de chirurgie orthopédique réparatrice et traumatologique, hôpital Pontchaillou, CHU de Rennes, Rennes, France; Service dorthopédie C, hôpital Salengro, CHRU de Lille, Lille, France
| | - Romain Rousseau
- Institut Nollet, 23, rue Brochant, 75017 Paris, France; Groupe d'étude en médecine du judo, fédération française de judo et disciplines associées, Paris, France
| | - Sophie Putman
- Service dorthopédie C, hôpital Salengro, CHRU de Lille, Lille, France
| | - Henri Migaud
- Service dorthopédie C, hôpital Salengro, CHRU de Lille, Lille, France
| | - Julien Girard
- Service dorthopédie C, hôpital Salengro, CHRU de Lille, Lille, France; University Lille, University Artois, University Littoral Côte d'Opale, EA 7369-URePSS-unité de recherche pluridisciplinaire sport santé société, 59000 Lille, France.
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Herndon CL, Drummond N, Sarpong NO, Cooper HJ, Shah RP, Geller JA. Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications. Arthroplast Today 2020; 6:257-261. [PMID: 32577474 PMCID: PMC7303493 DOI: 10.1016/j.artd.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/21/2020] [Accepted: 02/16/2020] [Indexed: 01/16/2023] Open
Abstract
Background Anterior-based approaches to primary total hip arthroplasty (THA) are being used more frequently, and several variations have been described. The supine direct anterior (DA) approach has been widely studied, but few studies have compared it with the mini-anterolateral (mini-AL) approach (abductor-sparing, Watson-Jones approach) in the lateral decubitus position. This study aims to compare early perioperative complications and outcomes between these 2 approaches. Methods This study retrospectively reviewed 340 consecutive THAs (n = 170 DA, n = 170 mini-AL) performed by 3 arthroplasty surgeons at a single institution between January 2017 and May 2018. The primary outcome was reoperation for any reason within 1 year. Secondary outcomes included wound-healing complications and several perioperative factors. A Student's t-test was used for continuous variables, and a chi-squared test was used for categorical variables. Results In this cohort, 6 patients (4%) from the mini-AL group required reoperation within 1 year, compared with 2 patients (1%) from the DA group (P = .024). However, the DA group had 13 patients (8%) with wound-healing complications compared with 6 patients (4%) in the mini-AL group 4% (P = .036). Perioperative outcomes were similar for operative time, distance walked with physical therapy, morphine milligram equivalent consumed, length of stay, and discharge disposition. Pain scores during index hospitalization were also similar. Conclusions Patients who underwent THA using the supine DA approach had fewer reoperations within 1 year, but more wound-healing complications compared with the mini-AL approach in the lateral decubitus position. For surgeons performing primary THA using an anterior-based approach, relative risks and benefits of these approaches must be understood. Level of Evidence Level III.
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Affiliation(s)
- Carl L Herndon
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathan Drummond
- Baylor Scott and White Health, Austin/Round Rock Department of Orthopedic Surgery, Lakeway, TX, USA
| | - Nana O Sarpong
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - H John Cooper
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P Shah
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Increased Muscle Strength Limits Postural Sway During Daily Living Activities in Total Hip Arthroplasty Patients. Am J Phys Med Rehabil 2020; 99:608-612. [PMID: 31977324 PMCID: PMC7292493 DOI: 10.1097/phm.0000000000001382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Objective The aim of the study was to investigate the effect of maximal strength training on postural sway after total hip arthroplasty, performed before and after a battery of physical performance tests that resemble daily living activities. Design This study is an exploratory study based on data from a 3-mo randomized controlled trial involving 54 total hip arthroplasty patients performing maximal strength training or conventional rehabilitation. At 3, 6, and 12 mos postoperatively, postural sway was evaluated in two gait tests; ie, one test before and one test after conducting a battery of physical performance tests. Results At 3 mos postoperatively, postural sway in the test after was significantly higher for the conventional rehabilitation group than the maximal strength training group (P = 0.045); however, there was no between-group difference at the test before (P = 0.670). Postural sway was also significantly higher in the test after compared with the test before in the conventional rehabilitation group (P < 0.001). No difference was found between the test before and test after in the maximal strength training group (P = 0.713). At 6 and 12 mos postoperatively, there were no statistically significant within- or between-group differences in postural sway. Conclusions Increased muscular strength limits postural sway 3 mos postoperatively in total hip arthroplasty patients after a demanding battery of physical performance tests simulating daily living activities.
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Hartog C, Metzler C, Meier C, Kalberer F, Wahl P. Anatomy of the lateral circumflex femoral artery: Does the direct anterior approach to the hip jeopardize vascularization of the proximal femur? Orthop Traumatol Surg Res 2019; 105:1257-1264. [PMID: 31537495 DOI: 10.1016/j.otsr.2019.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Blood supply of the proximal metaphysis of the femur comes mainly from the lateral circumflex femoral artery (LCFA). Essentially, the anterior approach has gained popularity in hip surgery but routinely requires the ligation of the ascending branch of the LCFA. Until now, there is no study analysing the effect of previous hip surgery on the vascularization of the proximal femur. Notably, it might, however, have consequences on osteointegration of uncemented prosthesis as well as in the management of early complications. Therefore we conducted a retrospective study to address the following questions: (1) Is the blood supply of the trochanteric region impaired by previous hip surgery, (2) does the anterior approach alter it more than other ones? HYPOTHESIS We hypothesised that the surgical approach to the hip influences blood supply of the proximal femur, as visualised by retrospective analysis of femoral digital subtraction arteriograms (FDSA). PATIENTS AND METHODS A retrospective review of 1280 FDSA, performed for vascular indications with a standard frame rate, between 07/2014 and 06/2016 in a single institution. Qualitatively sufficient FDSA were divided into 4 groups according to the history of previous hip surgery: hip replacement through an anterior approach (n=10) or through a lateral approach (n=31), cephalomedullary nailing for fractures of the proximal femur (n=5), and a control group of 50 continuous patients without previous hip surgery. The number of frames was counted between contrast injection into the femoral bifurcation and filling of the ipsilateral vessels of the greater trochanter to measure a potential delay/impairment of its arterial perfusion. Anatomic variations of the LCFA were also recorded. RESULTS The number of frames between contrast injection and visualisation of the blood supply of the greater trochanter was 3.6±0.9 (mean±SD) in the control group (p<0.001 vs. all other groups). In patients with a hip replacement, the delay was 7.0±1.9 frames for the anterior approach and 5.2±1.1 frames for the lateral approach, respectively. In patients after cephalomedullary nailing, a delay of 4.8±1.5 frames was measured. The delay in the anterior approach group was significantly longer (p<0.001) compared to all other investigated groups. The ascending branch of the LCFA could not be detected after the anterior approach. As after lateral approach or as in the control group, the transverse branch was detectable in approximately 2/3 of the patients. DISCUSSION Arterial perfusion of the greater trochanter is impaired after hip surgery, particularly after an anterior approach. The clinical relevance of these findings still needs to be investigated. It might, however, explain some early aseptic failures of uncemented stems. Moreover, it should be considered in early revision surgery, because combining different approaches might critically impair femoral blood supply. LEVEL OF EVIDENCE III, retrospective case control study.
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Affiliation(s)
- Christoph Hartog
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, P.O. Box 834, 8401 Winterthur, Switzerland
| | - Christoph Metzler
- Institute of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Christoph Meier
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, P.O. Box 834, 8401 Winterthur, Switzerland
| | - Fabian Kalberer
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, P.O. Box 834, 8401 Winterthur, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, P.O. Box 834, 8401 Winterthur, Switzerland.
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ALDI (Anterior Lateral Decubitus Intermuscular) approach to the hip: Comprehensive description of the surgical technique with operative video. Orthop Traumatol Surg Res 2019; 105:923-930. [PMID: 31178409 DOI: 10.1016/j.otsr.2019.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
The direct anterior approach to the hip is judged to be difficult and even after many solutions, such as special operating tables, have been proposed to perform it, in some reports the complication rate remains high. The complications reported are nerve lesions, dislocation, muscles damages, intraoperative fractures. We describe a modification of the anterior approach, undertaken keeping the patient in lateral decubitus, in order to gain a better range of leg movement and a significant reduction of the force applied to the retractors, the technique was named ALDI (anterior lateral decubitus intermuscular) approach. The surgeon starts behind the patient as in all the other traditional approaches, to maintain unchanged the acetabular view and the dexterity in cup implantation. For the femoral preparation, he moves in front of the patient to have a better visualization. In a series of 150 patients, with a mean operative time of 51.38minutes (range, 40-112), we had no intraoperative fractures, one (0.6%) lateral femoral cutaneous nerve temporary neurapraxia, one (0.8%) posttraumatic dislocation four years after the operation and, no revisions for aseptic loosening or infection. At the 5 years follow-up, the mean Oxford Hip score was 45.2 (range, 38-48; SD 2.6), the mean Harris Hip Score was 96,7 (range, 76-100; SD 2.8), and the mean UCLA score was 7 (range, 5-10; SD 1.4). The possibility to always obtain the optimal position of the surgical window with reduced tension on the muscles, and the unchanged initial surgeon position, could make the ALDI approach the ideal technique for the surgeons that decide to perform an anterior approach.
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Bon G, Kacem EB, Lepretre PM, Weissland T, Mertl P, Dehl M, Gabrion A. Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry. Orthop Traumatol Surg Res 2019; 105:445-452. [PMID: 30853454 DOI: 10.1016/j.otsr.2019.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/21/2019] [Accepted: 02/01/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), the anterior approach is attractive, being intermuscular, with theoretic functional benefit. Such benefit has been frequently claimed, but there are few data from randomized comparative studies using more precise metrics than patient satisfaction. We therefore conducted a randomized trial comparing early functional results between anterior and posterior approaches on gait analysis and functional scores. HYPOTHESIS The study hypothesis was that there is no difference between the two approaches in terms of early recovery of walking. MATERIALS AND METHOD A single-center single-surgeon prospective randomized study was conducted between February 2017 and April 2018. Inclusion criteria comprised: age<85 years, body-mass index (BMI)<32, and hip osteoarthritis with indication for THA. Preoperatively, the 2 groups were comparable for age, gender, BMI, Charnley, Harris, Postel-Merle-d'Aubigné and Oxford-12 scores and locomotor parameters (triaxial acceleration, step regularity and walking power). Preoperative and 3-, 6- and 12-week assessment comprised triaxial acceleration in walking and Postel-Merle-d'Aubigné, Harris and Oxford SF-12 scores. RESULTS One hundred patients were randomized to the anterior approach (AA: n=50) and posterior approach (PA: n=50) groups. Hospital stay was comparable between groups: PA, 2.8±1.78 days [range, 2.29-3.31 days]; AA, 2.84±1.25 days [range, 2.48-3.2 days] (p=0.8). Operative time was significantly longer in AA: 70.1±11 minutes vs. 56.7±11.79 (p<0.0001). There were no significant differences in locomotor parameters (p 0.122 to 0.987) or functional scores (p 0.052 to 0.968) over the 3-month follow-up. There was no difference in cup inclination: PA, 39.6±6.87° [range, 37.65-41.55°] vs. AA, 37.74±4.2° [range, 36.55-38.93°] (p=0.09). There were 8/50 cases (16%) of neurapraxia of the lateral cutaneous nerve of the thigh in the AA group; rates for other complications did not differ between groups. CONCLUSION Early functional results and especially objective locomotor parameters following THA were comparable between anterior and posterior approaches at 3 to 12 weeks. The approach should be chosen according to the surgeon's experience. LEVEL OF EVIDENCE II, low-power prospective randomized study.
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Affiliation(s)
- Gautier Bon
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France.
| | - Elias Ben Kacem
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France
| | - Pierre Marie Lepretre
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France
| | - Thierry Weissland
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France
| | - Massinissa Dehl
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d'Amiens Picardie, Amiens, France
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Lustig S, Mertl P, Fessy MH, Massin P. Is direct anterior approach plus dual-mobility cup a good match? Orthop Traumatol Surg Res 2018; 104:1135-1136. [PMID: 30385198 DOI: 10.1016/j.otsr.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Sébastien Lustig
- Groupement hospitalier Nord, hospices civils de Lyon, université Claude-Bernard Lyon I, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69004 Lyon, France
| | - Patrice Mertl
- Service orthopédie, CHU d'Amiens - hôpital Nord, place Victor-Pauchet, 80054 Amiens, France
| | - Michel-Henri Fessy
- Service de chirurgie orthopédique, centre hospitalier Lyon Sud, bâtiment 3A, 69495 Pierre-Bénite, France
| | - Philippe Massin
- 3, rue de l'Hôtel-de-Ville, 92200 Neuilly-sur-Seine, France.
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Bernard J, Razanabola F, Beldame J, Van Driessche S, Brunel H, Poirier T, Matsoukis J, Billuart F. Electromyographic study of hip muscles involved in total hip arthroplasty: Surprising results using the direct anterior minimally invasive approach. Orthop Traumatol Surg Res 2018; 104:1137-1142. [PMID: 29753876 DOI: 10.1016/j.otsr.2018.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The functional and clinical benefit of minimally invasive total hip arthroplasty (THA) is well-known, but the literature reports impaired gait and posture parameters as compared to the general population, especially following use of the anterior minimally invasive approach, which has more severe impact on posture than the posterior approach. The reasons for this impairment, however, remain unexplained. We therefore conducted a surface electromyography (sEMG) study of the hip muscles liable to be affected by arthroplasty surgery: gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S). The study addressed the following questions: (1) Is bipodal and unipodal GMed activity greater following anterior THA than in asymptomatic subjects? (2) Is a single manual test sufficient to assess maximal voluntary contraction (MVC) in hip abductors (GMax, GMed, TFL) and flexors (TFL, S)? HYPOTHESIS Bipodal and unipodal GMed activity is greater following anterior THA than in asymptomatic subjects. METHOD Eleven patients with anterior THA and 11 asymptomatic subjects, matched for age, gender and body-mass index, were included. Subjects underwent 3 postural tests: bipodal, eyes closed (BEC), unipodal on the operated side (UOP), and unipodal on the non-operated side (UnOP), with unipodal results averaged between both sides in the asymptomatic subjects. Data were recorded from 4-channel EMG and a force plate. EMG test activity was normalized as a ratio of MVC activity. RESULTS Postural parameters (mean center of pressure displacement speed) were poorer and sEMG activity higher in anterior THA than asymptomatic subjects (p<0.005). On the BEC test, GMax and GMed activity was higher on both operated and non-operated sides than in asymptomatic controls (respectively, 0.15±0.12 and 0.12±0.6 versus 0.07±0.06 for GMax, and 0.13±0.08 and 0.13±0.08 versus 0.08±0.05 for GMed; p<0.05). On unipodal tests, both UOP and UnOP GMed activities were higher than in controls (respectively, 0.51±0.3 and 0.48±0.27 versus 0.28±0.13; p<0.04); GMax and TFL activities were higher than in controls only on the UOP tests (respectively, 0.49±0.43 versus 0.24±0.18, and 0.23±0.17 versus 0.12±0.16; p<0.05). DISCUSSION sEMG activity in the hip abductors, which are the main stabilizing muscles for the pelvis, is increased following anterior THA, in parallel with impaired postural parameters. This finding may be due to intraoperative TFL and S neuromuscular spindle lesion. The present preliminary study is to be followed up by a comparison of all 3 common minimally invasive approaches (anterior, anterolateral and posterior) using the same study protocol. LEVEL OF EVIDENCE III, prospective case-control study.
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Affiliation(s)
- Jules Bernard
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - Fredson Razanabola
- Département de chirurgie orthopédique, centre hospitalier régional d'Orléans La Source, 45100 Orléans, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | | | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France.
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Lecoanet P, Vargas M, Pallaro J, Thelen T, Ribes C, Fabre T. Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D. Orthop Traumatol Surg Res 2018; 104:1143-1148. [PMID: 30314938 DOI: 10.1016/j.otsr.2018.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 06/09/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Leg length discrepancy (LLD) occurs in about 25% of cases after total hip arthroplasty (THA) and adversely affects function if greater than 10mm. When using the direct anterior approach (DAA), limb length control is considered easier with a standard operating table than with a traction table. However, this assumption has not been confirmed. More specifically, no studies have used EOS imaging, which is currently the reference for assessing limb length. The objectives of this retrospective study were: (1) to use EOS imaging to determine whether THA via the DAA on a standard table allowed satisfactory limb length control; (2) whether LLD was associated with other parameters such as age, gender, body mass index (BMI), or side; and (3) to compare clinical score values between patients with and without LLD. HYPOTHESIS The DAA without a traction table allows satisfactory limb length control as assessed using 3D EOS imaging. MATERIAL AND METHODS This retrospective descriptive study included 56 patients who underwent primary THA via the DAA between March 2013 and June 2014. LLD was measured on pre- and post-operative EOS images, using sterEOS™ 3D software. Age, gender, BMI, and side of THA were collected. The 12-item Short Form score, Harris Hip Score, and Postel-Merle d'Aubigné score were determined to look for radio-clinical correlations. RESULTS Of the 56 patients, 15 (26.8%) had an LLD >10mm before THA and 12 (21.4%) after THA. Limb length equality was restored in 7 patients with 1 with a shorter and 1 with a longer limb before THA. In 5 patients with equal limb length before THA, the operated limb was lengthened after THA, by a mean of 8.92mm (range, 5.8-10.8mm). Thus, in all, 5/56 (8.9%) patients experienced a detrimental change in limb length due to the surgery. No statistically significant differences were found between patients with and without LLD regarding age, gender, BMI, side, or clinical scores. DISCUSSION Although the frequency of LLD after THA in our study was consistent with earlier reports, our results show that good limb length control can be obtained via the DAA with a standard operating table. Thus, 7 of the 11 patients with a shorter limb and 1 of 4 with a longer limb before THA had equal limb lengths after THA, and only 8.9% of patients experienced a detrimental increase in limb length after THA. The DAA without a traction table allows satisfactory intra-operative limb length control based on visualisation of anatomical landmarks (antero-superior iliac spines and medial malleoli). This technique is therefore valuable for limiting the risk of LLD. When combined with 3D EOS planning, it may increase the accuracy of limb length adjustment. LEVEL OF EVIDENCE IV, retrospective study with no control group.
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Affiliation(s)
- Paul Lecoanet
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Morgane Vargas
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Julien Pallaro
- Service de chirurgie orthopédique, hôpital privé Saint-Martin, allée des Tulipes, 33600 Pessac, France
| | - Thomas Thelen
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Clément Ribes
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Thierry Fabre
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Bernard J, Beldame J, Van Driessche S, Brunel H, Poirier T, Guiffault P, Matsoukis J, Billuart F. Does hip joint positioning affect maximal voluntary contraction in the gluteus maximus, gluteus medius, tensor fasciae latae and sartorius muscles? Orthop Traumatol Surg Res 2017; 103:999-1004. [PMID: 28789998 DOI: 10.1016/j.otsr.2017.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimally invasive total hip arthroplasty (THA) is presumed to provide functional and clinical benefits, whereas in fact the literature reveals that gait and posturographic parameters following THA do not recover values found in the general population. There is a significant disturbance of postural sway in THA patients, regardless of the surgical approach, although with some differences between approaches compared to controls: the anterior and anterolateral minimally invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S)] could shed light, the relevant literature involves discordant methodologies. We developed a methodology to assess EMG activity during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius muscles as a reference for normalization. A prospective study aimed to assess whether hip joint positioning and the learning curve on an MVC test affect the EMG signal during a maximal voluntary contraction. HYPOTHESIS Hip positioning and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed, TFL and S. METHODS Thirty young asymptomatic subjects participated in the study. Each performed 8 hip muscle MVCs in various joint positions recorded with surface EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule every day, controlling for activity levels in the preceding 24h. EMG activity during MVC was expressed as a ratio of EMG activity during unipedal stance. Non-parametric tests were applied. RESULTS Statistical analysis showed no difference according to hip position for abductors or flexors in assessing EMG signal during MVC over the 3 sessions. Hip abductors showed no difference between abduction in lateral decubitus with hip straight versus hip flexed: GMax (19.8±13.7 vs. 14.5±7.8, P=0.78), GMed (13.4±9.0 vs. 9.9±6.6, P=0.21) and TFL (69.5±61.7 vs. 65.9±51.3, P=0.50). Flexors showed no difference between hip flexion/abduction/lateral rotation performed in supine or sitting position: TFL (70.6±45.9 vs. 61.6±45.8, P=0.22) and S (101.1±67.9 vs. 72.6±44.6, P=0.21). The most effective tests to assess EMG signal during MVC were for the hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax, 76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation performed in supine decubitus (50% for TFL, 76.7% for S). DISCUSSION The study hypothesis was not confirmed, since hip joint positioning and the learning curve on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S muscles. Therefore, a single session and one specific test is enough to assess MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position). This method could be applied to assess muscle function after THA, and particularly to compare different approaches. LEVEL OF EVIDENCE III, case-matched study.
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Affiliation(s)
- J Bernard
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - J Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - S Van Driessche
- Clinique de Montargis, 46, rue de la Quintaine, 45200 Montargis, France
| | - H Brunel
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - T Poirier
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - P Guiffault
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - J Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - F Billuart
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France.
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Girard J, Lons A, Pommepuy T, Isida R, Benad K, Putman S. High-impact sport after hip resurfacing: The Ironman triathlon. Orthop Traumatol Surg Res 2017; 103:675-678. [PMID: 28552834 DOI: 10.1016/j.otsr.2017.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Returning to high-impact sport is an increasingly frequent functional demand following hip replacement. The literature, however, is sparse on the subject and nonexistent regarding triathlon. We therefore conducted a retrospective study of hip resurfacing in triathlon players, to determine: (1) whether it is possible to return to this kind of sport; (2) if so, whether it is possible to return to the same level; and (3) how a resurfaced hip behaves under these conditions. HYPOTHESIS Hip resurfacing allows return to competition level in long-distance triathlon. MATERIAL AND METHODS A single-center single-operator retrospective study included patients undergoing hip resurfacing with the Conserve Plus implant inserted through a posterolateral approach, who had ceased long-distance triathlon practice due to osteoarthritis of the hip. Fifty-one of the 1688 patients undergoing resurfacing during the inclusion period were long-distance triathlon players. RESULTS The series comprised 48 patients: 51 implants; 43 male, 5 female; mean age, 44.8 years (range, 28.2-58.9 years). At a mean 4.7 years' follow-up (range, 2.2-7.6 years), all clinical scores showed significant improvement; Merle d'Aubigné and Harris scores rose respectively from 12.3 (5-16) and 42 (37-56) preoperatively to 17.5 (13-18) and 93.2 (73-100) (P<0.001). There were no cases of dislocation or implant revision. Forty-five patients returned to sport (94%). Rates of return to swimming, cycling and running were respectively 38/48 (79%), 41/48 (85%) and 33/48 (69%). Preoperatively, all patients had taken part in at least 1 competition: 29 with distance=70.3km and 19 with distance=140.6km. At follow-up, 28 patients had taken part in an Ironman competition: 21 with distance=70.3km and 7 with distance=140.6km. Mean competition performance did not differ between pre and postoperative periods. DISCUSSION Return-to-sport rates were good following hip resurfacing. Non-impact sports (swimming, cycling) predominated postoperatively, whereas the rate of impact sport (running) diminished. Return to competition-level sport (extreme triathlon) was possible for 28/48 patients (58%). Implant survival seemed unaffected by this high-impact sports activity at a mean 4.7 years' follow-up. LEVEL OF EVIDENCE IV, retrospective, non-controlled.
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Affiliation(s)
- J Girard
- Université de Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
| | - A Lons
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - T Pommepuy
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - R Isida
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - K Benad
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie D, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - S Putman
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie D, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
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