Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging

Minokawa, So; Naito, Masatoshi; Shiramizu, Kei; Nakamura, Yoshinari; Kinoshita, Koichi; Minamikawa, Tomohiko; Seo, Hajime; Yamamoto, Takuya

doi:10.1177/1120700017752565

Cited by 8 publications

(4 citation statements)

References 12 publications

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“…However, once the capsule and short external rotator muscles are resected, the re-rupture rate is high (75–92%), even if being repaired [ 23 , 24 ]. Previous reports have described modifications to surgical procedures performed to reduce the incidence of postoperative dislocations after hemiarthroplasty or THA with a posterior approach [ 13 , 14 , 25 , 26 ]. The CPP approach in BHA for femoral neck fractures preserves the attachment of short external rotator muscles; the dislocation rate was reported as 0% [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Preserving soft tissue is important to reduce the risk of postoperative dislocation. Regarding contiguity, muscle atrophy, and dislocation, the piriformis tendon preservation strategy used during the posterior approach in total hip arthroplasty (THA) is said to be superior to the reattachment technique [ 13 ]. An external rotator preservation (ERP) procedure for THA described by Kim et al preserves muscles from the piriformis to the internal obturator muscle and has good outcomes with no cases of postoperative dislocation [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures

Tanaka,

Mori,

Noro

et al. 2024

Medicina

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Background and Objectives: The conventional posterior approach in the lateral decubitus position is widely used for femoral neck fractures in femoral hemiarthroplasty. Postoperative dislocation is the major problem with this approach. The conjoined tendon-preserving posterior (CPP) approach is a less invasive surgical approach than the conventional posterior approach to the hip, maintains posterior stability, and preserves short external rotators and joint capsules. However, the mention was required to avoid muscle damage and whether muscle damage affects postoperative dislocation or not. The current study aimed to evaluate the clinical results of the CPP approach in hemiarthroplasty for femoral neck fractures and identify muscle damage risk factors. Materials and Methods: This study was a retrospective cohort study and included 170 hips in 168 patients. The mean age at the operation was 81.2 years. The preservation rate of the internal obturator muscle and gemellus inferior muscle and factors related to intraoperative short rotator muscle injury were investigated retrospectively. The postoperative complications and the relation between muscle damage and postoperative dislocation were investigated. Results: In the four hips (2.3%) with the obturator internus muscle damage, thirty-eight hips (22.4%) with gemellus inferior muscle damage were detected; in the muscle-damaged cases, the high body mass index (BMI) was significantly higher. The complication occurred in four hips (2.3%), including postoperative posterior dislocation in one hip without muscle damage (0.6%). Postoperative infection occurred in one hip (0.6%), and peroneal or sciatic nerve paralysis was suspected in two hips (1.1%). Conclusions: Compared to the conventional posterior approach in previous reports, the CPP approach reduces postoperative dislocation. A higher BMI is a risk factor for muscle damage, and the gemellus inferior muscle damage has no effect on postoperative dislocation. The CPP approach for BHA appeared to be an effective treatment method.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures

Tanaka,

Mori,

Noro

et al. 2024

Medicina

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“…The iliotibial band and quadratus femoris preservation, the smaller incision, the SERs and capsule repair [ 2 , 8 , 9 ], the surgeon’s seniority, physiotherapy and postoperative pain management protocols may have contributed to the early functional recovery of both groups; however, these parameters were similar between groups and cannot be considered responsible for their different outcomes. A recent posterior approaches’ comparative study found that the PF muscle demonstrated significantly less contiguity, atrophy and better function in patients where the PF was preserved than in those where PF was reattached [ 10 ]. Another RCT comparing PF preservation or re-attachment after standard posterior approach THA demonstrated significantly less muscle grade and bulk deterioration in the PF-preserving group at three postoperative months but no functional differences at two postoperative years [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Superior Transverse Atraumatic Reconstruction (STAR) approach provides a better-compared outcome to standard Direct Superior Approach (DSA): a matched, prospective comparative single-surgeon study

Kenanidis

Milonakis

Georgios

et al. 2023

SICOT-J

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Introduction: The Direct Superior Approach (DSA) is a muscle-sparing hip approach that does not protect the piriformis and the other short external rotators. We present a DSA modification we named STAR (Superior Transverse Atraumatic Reconstruction), which has DSA advantages but always preserves piriformis. Our study compared the early postoperative, radiological, and functional results of patients undergoing primary total hip arthroplasty (THA) through the STAR approach with a matched DSA group performed by a senior surgeon. Methods: Each group, DSA, and STAR included 200 elective primary unilateral THAs performed by the surgeon between 2016–2017 and 2020–2021, respectively. Patients were included in both groups using the same inclusion criteria. Both groups were matched for age and sex. The same postoperative pain management, chemoprophylaxis, and physiotherapy protocols were followed in both groups. Two independent orthopaedic surgeons performed the clinical and radiological follow-up. Results: The STAR group had significantly lower mean incision length (p = 0.042) and hospital stay (p = 0.002) than the DSA group. The mean intraoperative blood loss (p = 0.085) and the need for blood transfusion (p = 0.228) were less for the STAR than the DSA group. The mean postoperative functional scores improvement was significantly higher for the STAR than the DSA group at the end of the first and third postoperative months. Conclusions: The STAR approach offers earlier functional improvement, shorter hospital stay and less transfusion need than DSA for patients undergoing primary THA. Both approaches showed a limited complication risk and an outstanding acetabular and femoral access enabling the procedure.

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“…Preserving soft tissue in BHA is important for reducing the risk of postoperative dislocation, and a variety of surgical approaches have been reported recently considering this complication [4]. The preservation technique of the piriformis tendon during the posterolateral approach in total hip arthroplasty (THA) is reportedly superior to the reattachment technique in terms of contiguity, muscle atrophy, and dislocation [5]. Kim et al reported a method of THA that preserves muscles from the piriformis muscle to the internal obturator muscle (external rotator preservation procedure [ERP]) and had good outcomes with no cases of postoperative dislocation [6].…”

Section: Introductionmentioning

confidence: 99%

Bipolar hip arthroplasty in geriatric patients using a conjoined tendon-preserving posterior approach

Tetsunaga

Yamada

Furumatsu

et al. 2019

Preprint

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Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging

Abstract: In our study, we suggest that the preservation technique of the piriformis tendon is superior to the reattachment technique in terms of contiguity and muscle atrophy.

Cited by 8 publications

References 12 publications

Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures

Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures

Superior Transverse Atraumatic Reconstruction (STAR) approach provides a better-compared outcome to standard Direct Superior Approach (DSA): a matched, prospective comparative single-surgeon study

Bipolar hip arthroplasty in geriatric patients using a conjoined tendon-preserving posterior approach

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