Hip Abductor Strengths After Total Hip Arthroplasty Via the Lateral and Posterolateral Approaches

doi:10.1016/j.arth.2008.11.001

The Journal of Arthroplasty

Volume 25, Issue 1, January 2010, Pages 76-80

https://doi.org/10.1016/j.arth.2008.11.001 Get rights and content

Abstract

A retrospective control study was carried out to compare the postoperative hip abductor strengths after primary total hip arthroplasties via the lateral (lateral group; 38 hips) and posterolateral (posterior group; 40 hips) approaches. At a minimum of 2 years after total hip arthroplasty, abductor muscle strength was evaluated qualitatively by the Trendelenburg test and quantitatively using a dynamometer. The ratio of normalized strength of the reconstructed side to that of the nonoperated side was calculated (strength ratio). The Trendelenburg test was positive in 10 of 38 patients in the lateral group and in 11 of 40 patients in the posterior group. The average strength ratios of the lateral and posterior groups were 86.1% and 87.3%, respectively (P = .67). Strength ratio was positively correlated to femoral offset within both groups.

Section snippets

Materials and Methods

A total of 722 patients underwent primary THA at our institution between 1997 and 2004. Hips with severe subluxation or dislocation of more than type 2, according to the criteria of Crowe et al [11], were excluded from the study. Patients with neurologic disorders or clear functional and morphological disorders of the knee or spine were excluded. Patients with radiographic abnormalities or functional disorders in their contralateral hips were also excluded. From the remaining 160 patients, 38

Clinical Assessment

The preoperative average Harris hip scores for pain, gait, and activity were 17.7 points (0-30), 21.3 points (0-30), and 10.4 points (5-14) in the lateral group and 17.0 points (0-30), 21.5 points (11-30), and 10.7 points (10-14) in the posterior group, respectively. No significant differences were seen in the preoperative pain, gait, and activity scores between the 2 groups (P = .79, P = .82, and P = .85, respectively). The postoperative average Harris hip scores were 94.2 (82-100) in the

Discussion

Many alternative surgical approaches have been used in THA, and 2 of the most popular are the posterior and lateral approaches. We studied these 2 approaches as they are the 2 most commonly performed procedures in our institution and both provide adequate exposure for THA. These 2 approaches each have advantages and disadvantages.

One of the disadvantages of the lateral approach is the delay in the recovery of hip abductor function. In a review of 770 THAs performed via the lateral approach,

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Cited by (63)

The Influence of Lateral and Posterior Total Hip Arthroplasty Approaches on Muscle Activation and Joint Mechanics During Gait
2020, Journal of Arthroplasty
Lateral and posterior total hip arthroplasty (THA) approaches disrupt muscle function, which could impact gait. The objectives of this study were to compare muscle activation and joint mechanics during gait, and isometric strength between participants after lateral and posterior THA approaches and healthy adults.
Participants 1 year post-THA from either lateral (n = 21) or posterior (n = 21) approaches, and healthy adults (n = 21) ambulated at self-selected speeds. Surface electromyography, optical motion capture, and force plates measured muscle activation and joint mechanics during gait. A dynamometer measured isometric torque. Gait characteristics and isometric torque were compared using analysis of variance and effect sizes (d).
Lateral THA group had higher gluteus medius amplitudes during gait compared to the healthy group (P < .01, d = −0.97). Posterior THA group had higher gluteus maximus amplitudes during loading response (P = .02, d = −0.94) and higher hamstring amplitudes during midstance (P = .02, d = 0.45-1.31) than the healthy group. Both THA groups had decreased hip flexion and adduction angle excursions during gait (d = 0.89-1.14), but increased medial rotation angle excursions (d = −1.06 to −0.91), compared to the healthy group. Lateral THA group had lower isometric hip abduction torque than the healthy group (P = .03, d = 0.74). There was no pelvic drop in the THA groups.
There were few differences in gait and isometric torque between lateral and posterior THA groups. The elevated muscle activation amplitudes in the lateral and posterior THA groups compared to healthy adults were likely due to muscle weakness. Despite these findings, there was no evidence of pelvic drop.
Influence of Hip Geometry Reconstruction on Frontal Plane Hip and Knee Joint Moments During Walking Following Primary Total Hip Replacement
2019, Journal of Arthroplasty
Citation Excerpt :
All gait variables were normalized to 100% stance duration, which is the time between the instant of heel-strike (first ground contact) and toe-off (last ground contact). According to many other studies [17–24,32–36], radiographic parameters were determined on routine standardized anteroposterior pelvis and lateral radiographs obtained preoperatively and postoperatively at the same time as the gait analysis with a commercially available templating program, TraumaCad (version 2.3.4.1; Voyant Health, Petach-Tikva, Israel). The FO was defined as the distance between the center of rotation of the femoral head and the central long axis of the femur (Fig. 1) [19].
Following total hip replacement (THR), hip geometry reconstruction parameters such as the femoral offset (FO) correlate with hip stability and wear. The purpose of this study is to determine the relationship between hip geometry parameters and knee and hip joint loading during walking.
Forty-one patients were examined before and a minimum of 1 year after primary THR. Pearson correlation coefficient (r) was performed to identify relationships between radiographic parameters and gait data. In addition, we divided patients into 2 groups according to the restoration of the FO (within ±5 mm vs more than 5 mm increment).
The FO and global offset (GO) showed a positive correlation with the first (r = 0.469, P = .002; r = 0.542, P < .001) and second (r = 0.365, P = .019; r = 0.484, P = .001) knee adduction moment (KAM). The neck-shaft angle revealed a negative correlation with the first hip adduction moment (r = −0.375, P = .047). The reconstruction of FO with an increment of more than 5 mm was associated with a significant higher first KAM (+16%, P = .045) compared to the restored group.
Our findings suggest that abnormal hip and knee joint loading during walking after THR have a biomechanical background originating from hip geometry reconstruction. Patients with a high FO/GO were more likely to have an increased KAM during walking or vice versa. Surgeons need to be aware that an accurate control of FO, GO, and neck-shaft angle restoration in THR has an impact on hip and knee joint loading that may influence degenerative changes of the knee and higher wear of the artificial hip joint, respectively.
Patient satisfaction in different approaches for total hip arthroplasty
2019, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
The posterolateral approach on the other hand is still the most frequently used approach, even though this approach violates the posterior hip capsule and muscular structures, which may be associated with increased risk of dislocation. [10],[11] Lastly, the direct lateral approach is accompanied by the risk of abductor weakness caused by damage to the gluteus medius muscle [12]. The patient reported outcome measures (PROMs) gained more popularity by clinicians and investigators in the field of total joint arthroplasty [13].
At present, the posterolateral, the direct lateral and direct anterior approach (DAA) are the most frequently used techniques for total hip arthroplasty (THA), however there is no clear superiority of one of the approaches based on clinical outcome measures. The goal of this study is to lead the patient and the surgeon to an optimal treatment by providing them with relevant information based on patient reported outcome measures (PROMs).
Patient satisfaction and hip function one year postoperatively were investigated retrospectively in a cohort of patients who underwent hip replacement surgery by DAA on one hip and by posterolateral or direct lateral approach on the contralateral hip. Additionally, a control group who underwent the DAA bilaterally was used for comparison.
No difference in hip function was found between the DAA and the posterolateral or direct lateral approach, measured with the Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaire at least one year postoperatively to the last THA in the study group. Also in the control group no difference was found between the hips. However, the overall scores of the control group were higher, although not statistically significant, than those of the study group (p = 0.055). And a majority of the study group preferred the DAA (68%), with the reasons reported being faster recovery, less sleeping disturbance and earlier mobilization.
As expected, the postoperative hip function is similar, but patients’ preference is not. The latter result might be true or possibly influenced by preoperative psychological factors and mental health. The DAA and the posterolateral or direct lateral approaches have shown to lead to a similar hip function, but a majority of patients subjectively prefer the DAA.
III.
O 089 - Influence of the femoral offset on hip and knee joint loading following primary total hip replacement for unilateral osteoarthritis
2018, Gait and Posture
Posterior or anterolateral approach in hip joint arthroplasty - Impact on frontal plane moment
2018, Clinical Biomechanics
Citation Excerpt :
Since the abductor muscles of the hip are divided when utilizing a lateral approach, it is natural to question whether a decreased postoperative function could be partly explained by dysfunction of these muscles. The static strength of the hip abductor complex has been examined in several studies using the Trendelenburg test, in which the patient is asked to keep the pelvis horizontally stabile while performing a one-leg stance (Baker and Bitounis, 1989; Barber et al., 1996; Downing et al., 2001; Edmunds and Boscainos, 2011; Kiyama et al., 2010). Rather than to focus on static strength of a single muscle complex and pelvic stability during one-leg stance, as in the Trendelenburg test, it may be more relevant to examine dynamic frontal plane kinematics and kinetics during gait, by use of 3D motion capture.
Anterolateral surgical approach in hip joint arthroplasty necessitates division of the hip abductor muscle complex, which may compromise postoperative gait observed in the frontal plane. The aim of the study was to compare frontal plane moment after hip joint arthroplasty by anterolateral or posterior approach and to explore which compensatory strategies patients use to decrease frontal plane moment.
Twenty-eight patients were randomized by sealed envelopes to hip resurfacing arthroplasty surgery by anterolateral (ad modum Watson) or posterior (ad modum Moore) approach, performed by two senior surgeons. Gait analyses were performed using 3D motion capture before surgery, 3, and 12 months after surgery. Peak ground reaction force was extracted for early and late stance and the corresponding frontal plane moment was defined. Measures of lateral trunk inclination, pelvic drop and hip abduction were obtained for the stance phase of the affected leg.
An effect of surgical approach on frontal plane moment for the affected leg was found during early stance phase (p = 0.006) where average frontal plane moment in the anterolateral groups was 202.42 N mm/kg in less compared to the posterior group after one year. A similar effect from baseline to 12 months for trunk inclination (p = 0.03) and an overall negative correlation between frontal plane moment and trunk inclination was found (r = −0.66, p = 0.03).
Frontal plane moment during early stance was less one year after hip joint arthroplasty through anterolateral compared to posterior approach. Patients' primary strategy to reduce frontal plane moment seems to be increased lateral trunk inclination.
Surgical approaches for primary total hip replacement
2018, Orthopaedics and Trauma
Excellent exposure is an essential requirement for successful hip surgery. The surgical approach selected should provide appropriate exposure of the acetabulum together with safe mobilization and exposure of the proximal femur. The approach should be versatile, allowing adequate release and exposure in the various circumstances in which primary hip arthroplasty is indicated. It should be extensile, allowing intraoperative flexibility, safe, avoiding significant risk to adjacent neurovascular structures and limit soft tissue damage and blood loss. This review article describes the common surgical approaches used for primary total hip replacement, reviewing those in common use and discussing reduced access variations on those approaches. Newer trends, such as the direct anterior approach and the direct superior approaches will be described. The strengths, limitations and clinical evidence related to each option will be discussed.

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Hip Abductor Strengths After Total Hip Arthroplasty Via the Lateral and Posterolateral Approaches

Abstract

Section snippets

Materials and Methods

Clinical Assessment

Discussion

J Arthroplasty

J Arthroplasty

J Arthroplasty

A prospective randomized comparison of two surgical approaches to total hip arthroplasty

Clin Orthop

A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty

Clin Orthop

Anterolateral compared to posterior approach in total hip arthroplasty: difference in component positioning, hip strength, and hip motion

Clin Orthop

The direct lateral approach to the hip arthroplasty: advantages and complications

Orthopedics

The direct lateral approach to the hip

J Bone Joint Surg Br

Approach to the hip: a suggested improvement on Kocher's method

J Bone Joint Surg Br