Soft tissue damage after minimally invasive THA.
OBJECTIVE
Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.


METHODS
5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach. Postoperatively, the hips were dissected and muscle damage color-stained. We measured proportional muscle damage relative to the midsubstance cross-sectional surface area (MCSA) using computerized color detection. The integrity of external rotator muscles, nerves, and ligaments was assessed by direct observation.


RESULTS
None of the other MIS approaches resulted in less gluteus medius muscle damage than the lateral transgluteal approach. However, the MIS anterior approach completely preserved the gluteus medius muscle in 4 cases while partial damage occurred in 1 case. Furthermore, the superior gluteal nerve was transected in 4 cases after a MIS anterolateral approach and in 1 after the lateral transgluteal approach. The lateral femoral cutaneous nerve was transected once after both the MIS anterior approach and the MIS 2-incision approach.


CONCLUSIONS
The MIS anterior approach may preserve the gluteus medius muscle during total hip arthroplasty, but with a risk of damaging the lateral femoral cutaneous nerve.
Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, the Netherlands. jakobvanoldenrijk@gmail.com
Jakob
J
van Oldenrijk
Piet V J M
PV
Hoogland
Gabriëlle J M
GJ
Tuijthof
Ruby
R
Corveleijn
Tom W H
TW
Noordenbos
Matthias U
MU
Schafroth
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D002102:Cadaver; D005260:Female; D006801:Humans; D008022:Ligaments / Q000293:injuries; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D018482:Muscle, Skeletal / Q000293:injuries; D009417:Nerve Tissue / Q000293:injuries; D017695:Soft Tissue Injuries / Q000209:etiology*