Advances in study of surgical approaches and MRI evaluation of total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Xuemiao , LI Zhi , WAN Pu , ZHANG Weiguo ,  TIAN Kang

Department of Joint Surgery and Sports Medicine, the First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116000, P. R. China;

Corresponding author：

TIAN Kang, Email: dmu-tiankang@outlook.com

Keywords：

Total hip arthroplasty; MRI; surgical approach; muscle damage

DOI：

10.7507/1002-1892.202402033

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the research on different surgical approaches and MRI evaluation of total hip arthroplasty (THA), to clarify the possible muscle damage caused by different approaches, and to help clinicians avoid intraoperative muscle damage and identify the causes of certain muscle-related complications after operation. Methods The research literature on different surgical approaches and MRI evaluation of THA at home and abroad was extensively reviewed to summarize the MRI performance of the posterior approach, modified direct lateral approach, direct anterior approach, and minimally invasive anterolateral approach (also called Orthopadische Chirurgie Munchen approach). Results The traditional posterior approach mainly damages the short external rotator muscle group and increases the incidence of postoperative dislocation; the piriformis-keeping posterior approach significantly improves the quality of the pyriformis tendon in the postoperative period, but it may lead to damage to the intrapelvic portion of the piriformis muscle. The modified direct lateral approach mainly damages the gluteus medius muscle, which increases the risk of postoperative claudication. The direct anterior approach mainly damages the vastus tensoris muscle and may result in damage to the short external rotator muscle group and the muscles around the incision. The minimally invasive anterolateral approach primarily damages the superior gluteal nerve, which subsequently leads to denervation of the broad fascial tensor fasciae latae, and this approach may also result in injury to the gluteus medius and gluteus minimus muscles. The muscle damage status significantly affects prognosis, and the minimally invasive approach is more suitable for elderly patients. Conclusion MRI can clarify the different types of muscle damage caused by different surgical approaches. Minimally invasive approaches can reduce muscle damage and improve postoperative function compared with traditional approaches, and can benefit elderly patients more, but due to the small field, forcing to expand the surgical field will lead to unintended muscle damage and reduce postoperative function.

Citation： LIU Xuemiao, LI Zhi, WAN Pu, ZHANG Weiguo, TIAN Kang. Advances in study of surgical approaches and MRI evaluation of total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 618-625. doi: 10.7507/1002-1892.202402033 Copy

1.	Scott CEH, Clement ND, Davis ET, et al. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J, 2022, 104-B(2): 189-192.
2.	Ackerman IN, Bohensky MA, Zomer E, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord, 2019, 20(1): 90. doi: 10.1186/s12891-019-2411-9.
3.	Kovalak E, Özdemir H, Ermutlu C, et al. Assessment of hip abductors by MRI after total hip arthroplasty and effect of fatty atrophy on functional outcome. Acta Orthop Traumatol Turc, 2018, 52(3): 196-200.
4.	Chang K, Albright JA, Testa EJ, et al. Sarcopenia is associated with an increased risk of postoperative complications following total hip arthroplasty for osteoarthritis. Biology (Basel), 2023, 12(2): 295. doi: 10.3390/biology12020295.
5.	Müller M, Tohtz S, Dewey M, et al. Muscle trauma in primary total hip arthroplasty depending on age, BMI, and surgical approach: minimally invasive anterolateral versus modified direct lateral approach. Orthopade, 2011, 40(3): 217-223.
6.	Vasilakis I, Solomou E, Vitsas V, et al. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA. Orthopedics, 2012, 35(12): e1684-e1691.
7.	Wang T, Shao L, Xu W, et al. Surgical injury and repair of hip external rotators in THA via posterior approach: a three-dimensional MRI-evident quantitative prospective study. BMC Musculoskelet Disord, 2019, 20(1): 22. doi: 10.1186/s12891-018-2367-1.
8.	Berkowitz JL, Potter HG. Advanced MRI techniques for the hip joint: Focus on the postoperative hip. AJR Am J Roentgenol, 2017, 209(3): 534-543.
9.	张聿达, 王昌耀, 王向宇. 微创全髋关节置换后的影像学评估. 中国组织工程研究, 2020, 24(33): 5379-5384.
10.	Busch A, Jäger M, Beck S, et al. Metal Artefact Reduction Sequences (MARS) in Magnetic Resonance Imaging (MRI) after Total Hip Arthroplasty (THA) : A non-invasive approach for preoperative differentiation between periprosthetic joint infection (PJI) and aseptic complications? BMC Musculoskelet Disord, 2022, 23(1): 620. doi: 10.1186/s12891-022-05560-x.
11.	丁超, 胡伟, 马成才, 等. 两种入路行全髋关节置换的早期疗效比较. 临床骨科杂志, 2023, 26(4): 500-504.
12.	Filippini M, Bortoli M, Montanari A, et al. Does surgical approach influence complication rate of hip hemiarthroplasty for femoral neck fractures? A literature review and meta-analysis. Medicina (Kaunas), 2023, 59(7): 1220. doi: 10.3390/medicina59071220.
13.	Haynes JA, Hopper RH, Ho H, et al. Direct anterior approach for primary total hip arthroplasty lowers the risk of dislocation compared to the posterior approach: A single institution experience. J Arthroplasty, 2022, 37(3): 495-500.
14.	Miranda L, Quaranta M, Oliva F, et al. Capsular repair vs capsulectomy in total hip arthroplasty. Br Med Bull, 2021, 139(1): 36-47.
15.	Elbuluk AM, Coxe FR, Schimizzi GV, et al. Abductor deficiency-induced recurrent instability after total hip arthroplasty. JBJS Rev, 2020, 8(1): e0164. doi: 10.2106/JBJS.RVW.18.00164.
16.	Kobayashi N, Kamono E, Kameda K, et al. Is there any clinical advantage of capsular repair over capsular resection for total hip arthroplasty? An updated systematic review and meta-analysis. Arch Orthop Trauma Surg, 2023, 143(3): 1689-1697.
17.	Khan RJ, Lam LO, Breidahl W, et al. Magnetic resonance imaging features of preserved vs divided and repaired piriformis during total hip arthroplasty: a randomized controlled trial. J Arthroplasty, 2012, 27(4): 551-558.
18.	McLawhorn AS, Potter HG, Cross MB, et al. Posterior soft tissue repair after primary THA is durable at mid-term followup: A prospective MRI study. Clin Orthop Relat Res, 2015, 473(10): 3183-3189.
19.	Moussallem CD, Hoyek FA, Lahoud JC. Incidence of piriformis tendon preservation on the dislocation rate of total hip replacement following the posterior approach: a series of 226 cases. J Med Liban, 2012, 60(1): 19-23.
20.	Minokawa S, Naito M, Shiramizu K, et al. Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging. Hip Int, 2018, 28(6): 599-605.
21.	Tan BKL, Khan RJK, Haebich SJ, et al. Piriformis-sparing minimally invasive versus the standard posterior approach for total hip arthroplasty: A 10-year follow-up of a randomized control trial. J Arthroplasty, 2019, 34(2): 319-326.
22.	Lalevée M, Matsoukis J, Beldame J, et al. MRI assessment of piriformis-sparing posterior approach in total hip arthroplasty. Orthop Traumatol Surg Res, 2021, 107(8): 103085. doi: 10.1016/j.otsr.2021.103085.
23.	Amanatullah DF, Shah HN, Barrett AA, et al. A small amount of retraction force results in inadvertent piriformis muscle damage during a piriformis-sparing approach to the hip. J Bone Joint Surg (Am), 2020, 102(19): 1687-1693.
24.	Graw BP, Woolson ST, Huddleston HG, et al. Minimal incision surgery as a risk factor for early failure of total hip arthroplasty. Clin Orthop Relat Res, 2010, 468(9): 2372-2376.
25.	Chechik O, Khashan M, Lador R, et al. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg, 2013, 133(11): 1595-1600.
26.	沈庆亮, 李少伟, 石耀权, 等. OCM入路与改良Hardinge入路行髋关节置换术的疗效比较. 实用中西医结合临床, 2021, 21(9): 124-125.
27.	孙建磊. 后外侧入路与改良Hardinge入路在全髋关节置换术中的应用比较. 老年医学研究, 2023, 4(4): 8-11.
28.	区钰强, 彭建, 郑仕强, 等. 改良Hardinge入路与后外侧入路全髋关节置换术治疗老年股骨颈骨折的临床对比研究. 岭南急诊医学杂志, 2022, 27(6): 542-544.
29.	薛博琼, 胡三保, 刘朋, 等. 改良Hardinge入路与后外侧入路半髋关节置换术治疗老年股骨颈骨折的围术期安全性对比研究. 北京医学, 2021, 43(6): 567-569.
30.	孙迎迎, 丁长青, 丁爱兰, 等. 臀中肌综合征的磁共振成像诊断价值. 实用医学影像杂志, 2020, 21(6): 601-603.
31.	Vadalà AP, Mazza D, Desideri D, et al. Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty? Int Orthop, 2020, 44(2): 275-282.
32.	Müller M, Tohtz S, Springer I, et al. Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg, 2011, 131(2): 179-189.
33.	von Roth P, Abdel MP, Wauer F, et al. Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint J, 2014, 96-B(12): 1618-1622.
34.	Manafi Rasi A, Zandi R, Qoreishi M, et al. Magnetic resonance imaging assessment of hip abductor after total hip arthroplasty using a direct lateral approach. Arch Bone Jt Surg, 2020, 8(1): 83-88.
35.	Wang T, Shao L, Xu W, et al. Comparison of morphological changes of gluteus medius and abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches. Int Orthop, 2019, 43(11): 2467-2475.
36.	Stolarczyk A, Stolarczyk M, Stępiński P, et al. The direct anterior approach to primary total hip replacement: radiological analysis in comparison to other approaches. J Clin Med, 2021, 10(11): 2246. doi: 10.3390/jcm10112246.
37.	Butler J, Singleton A, Miller R, et al. Bikini incision vs longitudinal incision for anterior total hip arthroplasty: A systematic review. Arthroplast Today, 2022, 17: 1-8.
38.	Corten K, Holzapfel BM. Direct anterior approach for total hip arthroplasty using the “bikini incision”. Oper Orthop Traumatol, 2021, 33(4): 318-330.
39.	李杰, 程治铭, 张瑗. 直接前方入路微创全髋关节置换术规范化方案. 局解手术学杂志, 2023, 32(9): 790-795.
40.	刘丁玮, 韦财, 曾进强, 等. 直接前侧入路微创全髋关节置换术研究进展. 中外医学研究, 2023, 21(15): 178-181.
41.	卞胡伟, 蒋涛, 薛峰. 直接前侧入路髋关节置换的研究进展. 中国矫形外科杂志, 2023, 31(13): 1194-1197.
42.	Flevas DA, Tsantes AG, Mavrogenis AF. Direct anterior approach total hip arthroplasty revisited. JBJS Rev, 2020, 8(4): e0144. doi: 10.2106/JBJS.RVW.19.00144.
43.	Nistor DV, Caterev S, Bolboacă SD, et al. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon? Int Orthop, 2017, 41(11): 2245-2252.
44.	Rykov K, Meys TWGM, Knobben BAS, et al. MRI assessment of muscle damage after the posterolateral versus direct anterior approach for THA (polada trial). A randomized controlled trial. J Arthroplasty, 2021, 36(9): 3248-3258.
45.	Zhao G, Zhu R, Jiang S, et al. Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial. BMC Musculoskelet Disord, 2020, 21(1): 21. doi: 10.1186/s12891-019-3035-9.
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1. Scott CEH, Clement ND, Davis ET, et al. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J, 2022, 104-B(2): 189-192.
2. Ackerman IN, Bohensky MA, Zomer E, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord, 2019, 20(1): 90. doi: 10.1186/s12891-019-2411-9.
3. Kovalak E, Özdemir H, Ermutlu C, et al. Assessment of hip abductors by MRI after total hip arthroplasty and effect of fatty atrophy on functional outcome. Acta Orthop Traumatol Turc, 2018, 52(3): 196-200.
4. Chang K, Albright JA, Testa EJ, et al. Sarcopenia is associated with an increased risk of postoperative complications following total hip arthroplasty for osteoarthritis. Biology (Basel), 2023, 12(2): 295. doi: 10.3390/biology12020295.
5. Müller M, Tohtz S, Dewey M, et al. Muscle trauma in primary total hip arthroplasty depending on age, BMI, and surgical approach: minimally invasive anterolateral versus modified direct lateral approach. Orthopade, 2011, 40(3): 217-223.
6. Vasilakis I, Solomou E, Vitsas V, et al. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA. Orthopedics, 2012, 35(12): e1684-e1691.
7. Wang T, Shao L, Xu W, et al. Surgical injury and repair of hip external rotators in THA via posterior approach: a three-dimensional MRI-evident quantitative prospective study. BMC Musculoskelet Disord, 2019, 20(1): 22. doi: 10.1186/s12891-018-2367-1.
8. Berkowitz JL, Potter HG. Advanced MRI techniques for the hip joint: Focus on the postoperative hip. AJR Am J Roentgenol, 2017, 209(3): 534-543.
9. 张聿达, 王昌耀, 王向宇. 微创全髋关节置换后的影像学评估. 中国组织工程研究, 2020, 24(33): 5379-5384.
10. Busch A, Jäger M, Beck S, et al. Metal Artefact Reduction Sequences (MARS) in Magnetic Resonance Imaging (MRI) after Total Hip Arthroplasty (THA) : A non-invasive approach for preoperative differentiation between periprosthetic joint infection (PJI) and aseptic complications? BMC Musculoskelet Disord, 2022, 23(1): 620. doi: 10.1186/s12891-022-05560-x.
11. 丁超, 胡伟, 马成才, 等. 两种入路行全髋关节置换的早期疗效比较. 临床骨科杂志, 2023, 26(4): 500-504.
12. Filippini M, Bortoli M, Montanari A, et al. Does surgical approach influence complication rate of hip hemiarthroplasty for femoral neck fractures? A literature review and meta-analysis. Medicina (Kaunas), 2023, 59(7): 1220. doi: 10.3390/medicina59071220.
13. Haynes JA, Hopper RH, Ho H, et al. Direct anterior approach for primary total hip arthroplasty lowers the risk of dislocation compared to the posterior approach: A single institution experience. J Arthroplasty, 2022, 37(3): 495-500.
14. Miranda L, Quaranta M, Oliva F, et al. Capsular repair vs capsulectomy in total hip arthroplasty. Br Med Bull, 2021, 139(1): 36-47.
15. Elbuluk AM, Coxe FR, Schimizzi GV, et al. Abductor deficiency-induced recurrent instability after total hip arthroplasty. JBJS Rev, 2020, 8(1): e0164. doi: 10.2106/JBJS.RVW.18.00164.
16. Kobayashi N, Kamono E, Kameda K, et al. Is there any clinical advantage of capsular repair over capsular resection for total hip arthroplasty? An updated systematic review and meta-analysis. Arch Orthop Trauma Surg, 2023, 143(3): 1689-1697.
17. Khan RJ, Lam LO, Breidahl W, et al. Magnetic resonance imaging features of preserved vs divided and repaired piriformis during total hip arthroplasty: a randomized controlled trial. J Arthroplasty, 2012, 27(4): 551-558.
18. McLawhorn AS, Potter HG, Cross MB, et al. Posterior soft tissue repair after primary THA is durable at mid-term followup: A prospective MRI study. Clin Orthop Relat Res, 2015, 473(10): 3183-3189.
19. Moussallem CD, Hoyek FA, Lahoud JC. Incidence of piriformis tendon preservation on the dislocation rate of total hip replacement following the posterior approach: a series of 226 cases. J Med Liban, 2012, 60(1): 19-23.
20. Minokawa S, Naito M, Shiramizu K, et al. Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging. Hip Int, 2018, 28(6): 599-605.
21. Tan BKL, Khan RJK, Haebich SJ, et al. Piriformis-sparing minimally invasive versus the standard posterior approach for total hip arthroplasty: A 10-year follow-up of a randomized control trial. J Arthroplasty, 2019, 34(2): 319-326.
22. Lalevée M, Matsoukis J, Beldame J, et al. MRI assessment of piriformis-sparing posterior approach in total hip arthroplasty. Orthop Traumatol Surg Res, 2021, 107(8): 103085. doi: 10.1016/j.otsr.2021.103085.
23. Amanatullah DF, Shah HN, Barrett AA, et al. A small amount of retraction force results in inadvertent piriformis muscle damage during a piriformis-sparing approach to the hip. J Bone Joint Surg (Am), 2020, 102(19): 1687-1693.
24. Graw BP, Woolson ST, Huddleston HG, et al. Minimal incision surgery as a risk factor for early failure of total hip arthroplasty. Clin Orthop Relat Res, 2010, 468(9): 2372-2376.
25. Chechik O, Khashan M, Lador R, et al. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg, 2013, 133(11): 1595-1600.
26. 沈庆亮, 李少伟, 石耀权, 等. OCM入路与改良Hardinge入路行髋关节置换术的疗效比较. 实用中西医结合临床, 2021, 21(9): 124-125.
27. 孙建磊. 后外侧入路与改良Hardinge入路在全髋关节置换术中的应用比较. 老年医学研究, 2023, 4(4): 8-11.
28. 区钰强, 彭建, 郑仕强, 等. 改良Hardinge入路与后外侧入路全髋关节置换术治疗老年股骨颈骨折的临床对比研究. 岭南急诊医学杂志, 2022, 27(6): 542-544.
29. 薛博琼, 胡三保, 刘朋, 等. 改良Hardinge入路与后外侧入路半髋关节置换术治疗老年股骨颈骨折的围术期安全性对比研究. 北京医学, 2021, 43(6): 567-569.
30. 孙迎迎, 丁长青, 丁爱兰, 等. 臀中肌综合征的磁共振成像诊断价值. 实用医学影像杂志, 2020, 21(6): 601-603.
31. Vadalà AP, Mazza D, Desideri D, et al. Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty? Int Orthop, 2020, 44(2): 275-282.
32. Müller M, Tohtz S, Springer I, et al. Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg, 2011, 131(2): 179-189.
33. von Roth P, Abdel MP, Wauer F, et al. Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint J, 2014, 96-B(12): 1618-1622.
34. Manafi Rasi A, Zandi R, Qoreishi M, et al. Magnetic resonance imaging assessment of hip abductor after total hip arthroplasty using a direct lateral approach. Arch Bone Jt Surg, 2020, 8(1): 83-88.
35. Wang T, Shao L, Xu W, et al. Comparison of morphological changes of gluteus medius and abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches. Int Orthop, 2019, 43(11): 2467-2475.
36. Stolarczyk A, Stolarczyk M, Stępiński P, et al. The direct anterior approach to primary total hip replacement: radiological analysis in comparison to other approaches. J Clin Med, 2021, 10(11): 2246. doi: 10.3390/jcm10112246.
37. Butler J, Singleton A, Miller R, et al. Bikini incision vs longitudinal incision for anterior total hip arthroplasty: A systematic review. Arthroplast Today, 2022, 17: 1-8.
38. Corten K, Holzapfel BM. Direct anterior approach for total hip arthroplasty using the “bikini incision”. Oper Orthop Traumatol, 2021, 33(4): 318-330.
39. 李杰, 程治铭, 张瑗. 直接前方入路微创全髋关节置换术规范化方案. 局解手术学杂志, 2023, 32(9): 790-795.
40. 刘丁玮, 韦财, 曾进强, 等. 直接前侧入路微创全髋关节置换术研究进展. 中外医学研究, 2023, 21(15): 178-181.
41. 卞胡伟, 蒋涛, 薛峰. 直接前侧入路髋关节置换的研究进展. 中国矫形外科杂志, 2023, 31(13): 1194-1197.
42. Flevas DA, Tsantes AG, Mavrogenis AF. Direct anterior approach total hip arthroplasty revisited. JBJS Rev, 2020, 8(4): e0144. doi: 10.2106/JBJS.RVW.19.00144.
43. Nistor DV, Caterev S, Bolboacă SD, et al. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon? Int Orthop, 2017, 41(11): 2245-2252.
44. Rykov K, Meys TWGM, Knobben BAS, et al. MRI assessment of muscle damage after the posterolateral versus direct anterior approach for THA (polada trial). A randomized controlled trial. J Arthroplasty, 2021, 36(9): 3248-3258.
45. Zhao G, Zhu R, Jiang S, et al. Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial. BMC Musculoskelet Disord, 2020, 21(1): 21. doi: 10.1186/s12891-019-3035-9.
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Advances in study of surgical approaches and MRI evaluation of total hip arthroplasty

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