Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement

Sendtner, Ernst; Borowiak, Katja; Schuster, Tibor; Woerner, Michael; Grifka, Joachim; Renkawitz, Tobias

doi:10.1007/s00402-010-1174-4

Cited by 55 publications

(47 citation statements)

References 32 publications

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“…Conversely, decreased weight loading is associated with muscle hypotrophy and fatty infiltration [20,11,21]. It is known that a different amount of traumatic injury occurs depending on the surgical approach that is chosen in patients with THA [10,22,23,7]. A recent report showed compensatory hypertrophy of the tensor fasciae latae muscle in patients with the lateral approach, when compared to the anterolateral approach in THA patients, due to increased muscle trauma to the gluteus medius [24].…”

Section: Discussionmentioning

confidence: 99%

Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle

et al. 2012

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OBJECTIVE: To evaluate the association between hypertrophy of the tensor fasciae latae muscle and abductor tendon tears. MATERIALS AND METHODS: Thirty-five patients who underwent MRI of the abductor tendons of the hip were included in this retrospective study. A subgroup of 18 patients was examined bilaterally. The area of the tensor fasciae latae muscle and the area of the sartorius muscle (size reference) were quantified at the level of the femoral head, and a ratio was calculated. Two radiologists assessed the integrity of the gluteus medius and minimus tendon in consensus. Data were analyzed with a Mann-Whitney U test. RESULTS: Sixteen out of 35 patients (46 %) had a tear of the gluteus medius or minimus tendon. The ratio of the area of the tensor fasciae latae to the sartorius muscle was significantly higher (p = .028) in the group with an abductor tendon tear (median 2.25; Interquartile Range [IQR] = 1.97-3.21) compared to the group without any tears (median 1.91; IQR = 1.52-2.26). The bilateral subanalysis showed that in patients without a tear, the ratio of the two areas did not differ between each side (p = .966), with a median of 1.54 (primary side) and 1.76 (contralateral side). In patients with an abductor tendon tear the ratio was significantly higher (p = .031) on the side with a tear (median 2.81) compared to the contralateral healthy side (1.67). CONCLUSION: Patients with abductor tendon tears showed hypertrophy of the tensor fasciae latae muscle when compared to the contralateral healthy side and to patients without a tear. AbstractObjective. To evaluate the association between hypertrophy of the tensor fasciae latae muscle and abductor tendon tears. Materials and Methods.Thirty-five patients with MRI of the abductor tendons of the hip were included in this retrospective study. A subgroup of 18 patients was examined bilaterally. The area of the tensor fasciae latae muscle and the area of the sartorius muscle (size reference) were quantified at the level of the femoral head, and a ratio was calculated. Two radiologists assessed the integrity of the gluteus medius and minimus tendon in consensus. Data were analyzed with a Mann-Whitney U test.Results. Sixteen out of 35 patients (46%) had a tear of the gluteus medius or minimus tendon. The ratio of the area of the tensor fasciae latae to the sartorius muscle was significantly higher (p=.028) in the group with an abductor tendon tear (median 2.25;Interquartile Range [IQR]= 1.97-3.21) compared to the group without tear (median 1.91; IQR= 1.52-2.26). The bilateral subanalysis showed that in patients without a tear, the ratio of the two areas did not differ between each side (p=.966), with a median of 1.54 (primary side) and 1.76 (contralateral side). In patients with an abductor tendon tear the ratio was significantly higher (p=.031) on the side with a tear (median 2.81) compared to the contralateral healthy side (1.67). Conclusion.Patients with abductor tendon tears showed hypertrophy of the tensor fasciae latae muscle when compared to the ...

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Section: Discussionmentioning

confidence: 99%

Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle

et al. 2012

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“…Recently some less invasive modifications have been described and compared to the standard approaches such as Kocher-Langenbeck (dorsal), Bauer or Hardinge (lateral), Watson-Jones (anterolateral) and Smith-Peterson (anterior). All of them seem to have several advantages and every modification leads to different new problems [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Biber

Brem

Singler³

et al. 2012

International Orthopaedics (SICOT)

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Purpose Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. Methods We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia® stem with selfcentring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test.Results After a dorsal approach 10.5 % [confidence interval (CI) 7.7-13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7-13.6 %), which was not significantly different (p00.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2-5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0-1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5-8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2-2.2 %). The frequency of the other types of complications did not significantly differ. Conclusions The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.

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“…Als Vorteile werden neben dem kosmetisch ansprechenden kleinen Hautschnitt besonders ein geringeres Gewebe-und Muskeltrauma mit geringerem Blutverlust und weniger postoperativen Schmerzen sowie zügigerer Rekonvaleszenz angegeben [4,11,24,25]. Befür-worter der Standardzugänge halten dem eine verlängerte Operationsdauer, erschwerte Wundheilung, zusätzliche Gefäß-und Nervenschäden und vorrangig eine schwierigere Implantatpositionierung mit erhöhtem Risiko der Implantatfehllage aufgrund verminderter Einsehbarkeit entgegen [1,13,32].…”

Section: Diskussionunclassified

MRT-basierte Messung des Muskelschadens nach minimal-invasiver Hüftprothesenimplantation

et al. 2012

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Muscle trauma in minimally invasive hip arthroplasty using a direct anterior approach was assessed by magnetic resonance imaging (MRI) in 25 patients preoperatively, as well as 6 months after total hip replacement. The MRI evaluation included the measurement of changes in muscle cross-sectional area (CSA = atrophy) and fatty infiltration of the muscles. Using MRI, preoperatively existing and operatively caused muscle tissue damage could be detected by assessing changes in muscle CSA and fatty infiltration. Even preoperatively, a muscular atrophy and fatty infiltration could be demonstrated in the diseased hip. Using the minimally invasive direct anterior approach, a postoperative significantly reduced CSA and significantly increased fatty degeneration was detected for the M. tensor fasciae latae and the M. glutaeus minimus. No increased damage of the M. glutaeus medius could be detected.

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Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement

Abstract: Consistent with recent meta-analysis we found reduced blood loss, similar clinical/radiographic outcome and similar complication rates compared to standard THA. Our study shows, that MI THR is a safe procedure during the learning curve of an experienced surgeon.

Cited by 55 publications

References 32 publications

Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle

Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

MRT-basierte Messung des Muskelschadens nach minimal-invasiver Hüftprothesenimplantation

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