Minimal Influence on Muscle Strength and Patient Reported Outcome Measures by Conjoined Tendon Detachment in Anterolateral Muscle-Sparing Total Hip Arthroplasty

Hidetatsu Tanaka1,2, Norikazu Yamada2, Hiroaki Kurishima2, Yu Mori1, Toshimi Aizawa1
1Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
2Department of Orthopaedic Surgery, Japanese Recross Sendai Hospital, Sendai, Japan

Tóm tắt

The conjoined external rotator tendon (CERT), composed of the tendons of the gemellus superior, obturator internus (OI), and gemellus inferior muscles, stabilizes the hip joint. The study investigates the clinical and radiological effects of the CERT release during anterolateral-supine approach (ALSA) total hip arthroplasty (THA). A cohort of 60 patients who underwent ALSA THA was examined. Pre- and post-operative muscle width, muscle strength, and radiological data were compared between the CERT-detached and preserved groups. In addition, Clinical assessments were performed using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire and the short-form 36 questionnaires. 58.3% had CERT detached, resulting in radiological atrophy of the OI muscle. Despite this, hip flexion, extension, and abduction muscle strength significantly improved at 6 months post-surgery. The detached CERT did not substantially affect patient-reported outcome measures, including pain and daily activities, within the 6-month follow-up. The study suggests that while CERT detachment can lead to muscle atrophy, it has a limited impact on muscle strength and patient-reported outcome measures, indicating the muscle’s potential redundancy. Preserving the CERT might enhance stability and prevent atrophy but could increase the risk of complications. CERT release is recommended when femur exposure is inadequate.

Tài liệu tham khảo

Learmonth, I. D., Young, C., & Rorabeck, C. (2007). The operation of the century: Total hip replacement. Lancet, 370(9597), 1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7 Anseth, S. D., Pulido, P. A., Adelson, W. S., Patil, S., Sandwell, J. C., & Colwell, C. W., Jr. (2007). Fifteen-year to twenty-year results of cementless Harris-Galante porous femoral and Harris-Galante porous I and II acetabular components. Journal of Arthroplasty, 25(5), 687–691. https://doi.org/10.1016/j.arth.2009.05.033. Epub 2009 Jul 29. Pfluger G, Junk-Jantsch S, Scholl V (2007) Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop 31 Suppl 1(Suppl 1): S7–11. https://doi.org/10.1007/s00264-007-0434-6. Civinini, R., Cozzi Lepri, A., Carulli, C., Matassi, F., Villano, M., & Innocenti, M. (2019). The anterior-based muscle-sparing approach to the hip: The “other” anterior approach to the hip. International Orthopaedics, 43(1), 47–53. https://doi.org/10.1007/s00264-018-4190-6 Tanaka, H., Yamada, N., Kurishima, H., Mori, Y., Sakamoto, T., Oyama, M., & Aizawa, T. (2021). Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty. Journal of Orthopaedic Surgery and Research, 16(1), 485. https://doi.org/10.1186/s13018-021-02644-7 Kawasaki, M., Hasegawa, Y., Okura, T., Ochiai, S., & Fujibayashi, T. (2017). Muscle damage after total hip arthroplasty through the direct anterior approach for developmental dysplasia of the hip. Journal of Arthroplasty, 32(8), 2466–2473. https://doi.org/10.1016/j.arth.2017.03.043. Epub 2017 Mar 27. Jewett, B. A., & Collis, D. K. (2011). High complication rate with anterior total hip arthroplasties on a fracture table. Clinical Orthopaedics and Related Research, 469(2), 503–507. https://doi.org/10.1007/s11999-010-1568-1 Meneghini, R. M., Pagnano, M. W., Trousdale, R. T., & Hozack, W. J. (2006). Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clinical Orthopaedics and Related Research, 453, 293–298. https://doi.org/10.1097/01.blo.0000238859.46615.34 T.H. Retchford KMC, A. Grimaldi, J.L. Kemp, S.M. Cowan, (2013) Can local muscles augment stability in the hip? A narrative literature review. J Musculoskelet Neuronal Interact 13 (1):1-12 Ito, Y., Matsushita, I., Watanabe, H., & Kimura, T. (2012). Anatomic mapping of short external rotators shows the limit of their preservation during total hip arthroplasty. Clinical Orthopaedics and Related Research, 470(6), 1690–1695. https://doi.org/10.1007/s11999-012-2266-y Kanda, A., Kaneko, K., Obayashi, O., Mogami, A., & Morohashi, I. (2018). Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty. European Journal of Orthopaedic Surgery & Traumatology, 28(6), 1111–1116. https://doi.org/10.1007/s00590-018-2166-2 Drouin, J. M., Valovich-mcLeod, T. C., Shultz, S. J., Gansneder, B. M., & Perrin, D. H. (2004). Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. European Journal of Applied Physiology, 91(1), 22–29. https://doi.org/10.1007/s00421-003-0933-0. Epub 2003 Sep 24. Matsumoto, T., Kaneuji, A., Hiejima, Y., Sugiyama, H., Akiyama, H., Atsumi, T., et al. (2012). Japanese orthopaedic association hip disease evaluation questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease the subcommittee on hip disease evaluation of the clinical outcome committee of the Japanese orthopaedic association. Journal of Orthopaedic Science, 17(1), 25–38. https://doi.org/10.1007/s00776-011-0166-8 Fukui, K., Kaneuji, A., Sugimori, T., Ichiseki, T., & Matsumoto, T. (2015). Clinical assessment after total hip arthroplasty using the Japanese orthopaedic association hip-disease evaluation questionnaire. Journal of Orthopaedics, 12(Suppl 1), S31–S36. https://doi.org/10.1016/j.jor.2015.01.021.eCollection Garratt, A., Schmidt, L., Mackintosh, A., & Fitzpatrick, R. (2002). Quality of life measurement: Bibliographic study of patient assessed health outcome measures. BMJ, 324(7351), 1417. https://doi.org/10.1136/bmj.324.7351.1417 Fukuhara, S., Ware, J. E., Jr., Kosinski, M., Wada, S., & Gandek, B. (1998). Psychometric and clinical tests of validity of the Japanese SF-36 Health survey. Journal of Clinical Epidemiology, 51(11), 146–153. https://doi.org/10.1016/s0895-4356(98)00096-1 Mahmood, S. S., Mukka, S. S., Crnalic, S., Wretenberg, P., & Sayed-Noor, A. S. (2016). Association between changes in global femoral offset after total hip arthroplasty and function quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthopaedica, 87(1), 36–41. https://doi.org/10.3109/17453674.2015.1091955 Fukushi, J., Kawano, I., Motomura, G., Hamai, S., Kawaguchi, K. I., & Nakashima, Y. (2018). Does hip center location affect the recovery of abductor moment after total hip arthroplasty? Orthopaedics & Traumatology, Surgery & Research, 104(8), 1149–1153. https://doi.org/10.1016/j.otsr.2018.06.022 Kanda, Y. (2013). Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplantation, 48(3), 452–458. https://doi.org/10.1038/bmt.2012.244. Epub 2012 Dec 3. Kelley, K. (2007). Constructing confidence intervals for standardized effect sizes: Theory, application, and implementation. Journal of Statistical Software, 20(8), 1–24. Dostal, W. F., Soderberg, D. G., & Andrews, J. G. (1986). Actions of hip muscles. Physical Therapy, 66(3), 351–361. https://doi.org/10.1093/ptj/66.3.351 Fujimaki, H., Inaba, Y., Kobayashi, N., Tezuka, T., Hirata, Y., & Saito, T. (2013). Leg length discrepancy and lower limb alignment after total hip arthroplasty in unilateral hip osteoarthritis patients. Journal of Orthopaedic Science, 18(6), 969–976. https://doi.org/10.1007/s00776-013-0457-3 Yao, R., Howard, J. L., & Lanting, B. A. (2017). Conjoint tendon release in direct anterior total hip arthroplasty: no impact on patient outcomes. Orthopedics, 40(6), e971–e974. https://doi.org/10.3928/01477447-20170918-05. Epub 2017 Sep 22. Walters, B. L., Cooper, J. H., & Rodriguez, J. A. (2014). New findings in hip capsular anatomy: dimensions of capsular thickness and pericapsular contributions. Arthroscopy, 30(10), 1235–1245. https://doi.org/10.1016/j.arthro.2014.05.012. Epub 2014 Jul 23. Tanaka H, Yamada N, Kurishima H, Mori Y, Aizawa T, (2022) Association between Hip Center Position and Isokinetic Hip Muscle Performance after Anterolateral Muscle-Sparing Total Hip Arthroplasty. Medicina 13, 58 (4). https://doi.org/10.3390/medicina58040538. Anton, R., Nils, D., & Hans, E. B. (2010). Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA. Acta Orthopaedica, 81(2), 183–188. https://doi.org/10.3109/17453671003793204 Frost, K. L., Bertocci, G. E., Wassinger, C. A., Munin, M. C., Burdett, R. G., & Fitzgerald, S. G. (2006). Isometric performance following total hip arthroplasty and rehabilitation. Journal of Rehabilitation Research and Development, 43(4), 435–444. https://doi.org/10.1682/jrrd.2005.06.0100 Dana, L. J., Douglas, A. D., Abbey, C. T., Pamela, W., Michael, R. D., & Jennifer, E. S. (2014). Muscle strength and functional recovery during the first year after THA. Clinical Orthopaedics and Related Research, 472(2), 654–664. https://doi.org/10.1007/s11999-013-3136-y