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, ?zdemir 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.	張聿達, 王昌耀, 王向宇. 微創全髖關節置換后的影像學評估. 中國組織工程研究, 2020, 24(33): 5379-5384.
10.	Busch A, J?ger 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, 胡偉, 馬成才, 等. 兩種入路行全髖關節置換的早期療效比較. 臨床骨科雜志, 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.	沈慶亮, 李少偉, 石耀權, 等. OCM入路與改良Hardinge入路行髖關節置換術的療效比較. 實用中西醫結合臨床, 2021, 21(9): 124-125.
27.	孫建磊. 后外側入路與改良Hardinge入路在全髖關節置換術中的應用比較. 老年醫學研究, 2023, 4(4): 8-11.
28.	區鈺強, 彭建, 鄭仕強, 等. 改良Hardinge入路與后外側入路全髖關節置換術治療老年股骨頸骨折的臨床對比研究. 嶺南急診醫學雜志, 2022, 27(6): 542-544.
29.	薛博瓊, 胡三保, 劉朋, 等. 改良Hardinge入路與后外側入路半髖關節置換術治療老年股骨頸骨折的圍術期安全性對比研究. 北京醫學, 2021, 43(6): 567-569.
30.	孫迎迎, 丁長青, 丁愛蘭, 等. 臀中肌綜合征的磁共振成像診斷價值. 實用醫學影像雜志, 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, St?piński 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.
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38.	Corten K, Holzapfel BM. Direct anterior approach for total hip arthroplasty using the “bikini incision”. Oper Orthop Traumatol, 2021, 33(4): 318-330.
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40.	劉丁瑋, 韋財, 曾進強, 等. 直接前側入路微創全髖關節置換術研究進展. 中外醫學研究, 2023, 21(15): 178-181.
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43.	Nistor DV, Caterev S, Bolboac? 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.
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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, ?zdemir 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. 張聿達, 王昌耀, 王向宇. 微創全髖關節置換后的影像學評估. 中國組織工程研究, 2020, 24(33): 5379-5384.
10. Busch A, J?ger 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, 胡偉, 馬成才, 等. 兩種入路行全髖關節置換的早期療效比較. 臨床骨科雜志, 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. 沈慶亮, 李少偉, 石耀權, 等. OCM入路與改良Hardinge入路行髖關節置換術的療效比較. 實用中西醫結合臨床, 2021, 21(9): 124-125.
27. 孫建磊. 后外側入路與改良Hardinge入路在全髖關節置換術中的應用比較. 老年醫學研究, 2023, 4(4): 8-11.
28. 區鈺強, 彭建, 鄭仕強, 等. 改良Hardinge入路與后外側入路全髖關節置換術治療老年股骨頸骨折的臨床對比研究. 嶺南急診醫學雜志, 2022, 27(6): 542-544.
29. 薛博瓊, 胡三保, 劉朋, 等. 改良Hardinge入路與后外側入路半髖關節置換術治療老年股骨頸骨折的圍術期安全性對比研究. 北京醫學, 2021, 43(6): 567-569.
30. 孫迎迎, 丁長青, 丁愛蘭, 等. 臀中肌綜合征的磁共振成像診斷價值. 實用醫學影像雜志, 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, St?piński 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, 程治銘, 張瑗. 直接前方入路微創全髖關節置換術規范化方案. 局解手術學雜志, 2023, 32(9): 790-795.
40. 劉丁瑋, 韋財, 曾進強, 等. 直接前側入路微創全髖關節置換術研究進展. 中外醫學研究, 2023, 21(15): 178-181.
41. 卞胡偉, 蔣濤, 薛峰. 直接前側入路髖關節置換的研究進展. 中國矯形外科雜志, 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, Bolboac? 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.
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Advances in study of surgical approaches and MRI evaluation of total hip arthroplasty

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