The effect of conjoint tendon release on gait after direct anterior total hip arthroplasty

Abstract

Introduction: There has been considerable interest in the direct anterior (DA) approach to total hip arthroplasty (THA) recently. To facilitate exposure of the proximal femur it is sometimes necessary to release the conjoint tendon. Aim: To prospectively investigate whether release of the conjoint tendon has an impact on gait in the early postoperative period. Methods: We measured gait velocity, stride length, single-limb support and single-limb support symmetry preoperatively, at discharge from the hospital, and 2, 6 and 12 weeks and postoperatively. Participants also completed the Timed Up and Go and a series of questionnaires (WOMAC, SF-12, Harris Hip Score, and pain VAS) at each visit. Results: 36 participants undergoing a DA THA with a single surgeon were enrolled in this study. 22 participants had a release of the conjoint tendon during their surgery. We found no differences between the groups for any gait, patient-reported or surgical outcomes ( p < 0.05). There was a total of 3 complications reported in the release group, and 1 complication in the group that did not have a release. Conclusion: Although the conjoint tendon has an important role in the biomechanics of the hip, we found release of the conjoint tendon during the DA approach for THA to have no impact on gait or patient reported outcomes within 12 weeks post-surgery. Therefore, if the exposure of the proximal femur is limited, a low threshold for release of the conjoint tendon is recommended to improve visualisation.

Letter to the Editor on “Prospective Evaluation of the Posterior Tissue Envelope and Anterior Capsule after Anterior Total Hip Arthroplasty”

“…Second, the authors criticize our lack of information on electrocautery denervation of the unresurfaced patella, and reference both their personal experience and the 2011 randomized trial by van Jonbergen et al [1] as evidence of this procedure's efficacy. However, van Jonbergen's later report on the same cohort found no difference in the incidence of anterior knee pain, as did 2 other randomized controlled trials [2,3] and a recent meta-analysis [4]. We believe the efficacy of this procedure is controversial at best.…”

“…First, they suggest our length of follow-up was inadequate. In fact, for the 31,956 total knee arthroplasty (TKA) procedures included in our study, the mean follow-up was 7.3 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Given the mean time to secondary patella resurfacing (SPR) was 3.8 years, a longer follow-up would not alter our findings.…”

Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty

“…Although the deep external rotators have been proposed as key active stabilizers of the hip described as the ‘rotator cuff’ of the hip [ 8 ], the CERT release during the DAA in THA has no impact on gait or patient-reported outcomes within the 12-week period post-surgery [ 23 ]. Yao et al investigated the outcome of DAA for THA and showed that the CERT release was not predictive of the length of stay, one year inpatient pain medication requirements, or outcome scores [ 12 ].…”

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

“…For exposure of the proximal femur, many scholars have reported different methods to prevent femoral fracture [ 29 , 30 ]. After 3 years of practice, the authors have gained their own experience in releasing the proximal femur.…”