[Muscle trauma in primary total hip arthroplasty depending on age, BMI, and surgical approach: minimally invasive anterolateral versus modified direct lateral approach].
BACKGROUND
Maximum preservation of periarticular musculature is essential for the success of total hip arthroplasty. A poorer functional outcome often occurs following total hip arthroplasty, especially in older and overweight patients and is presumed to have a muscular basis. Minimally invasive hip endoprosthetics for muscle-preserving implantation have now become established in orthopedic surgery.


METHODS
A primary hip endoprosthesis was implanted in a total of 39 patients using a transgluteal (modified direct-lateral, mDL, n=19) or anterolateral minimally invasive approach (ALMI, n=20). Magnetic resonance imaging was performed preoperatively as well as 3 and 12 months after the operation. Fatty atrophy (FA) of the gluteus medius muscle was evaluated as a function of body mass index (BMI), patient age and the influence of the access route.


RESULTS
In the overweight group a significantly higher FA of the gluteus medius muscle was found 3 and 12 months after the operation and a significantly higher grade FA using the standard access in contrast to the normal weight group. A significantly higher FA of the gluteus medius muscle was found in the older patient group 3 and 12 months postoperation as well as a significantly higher atrophy using the mDL access.


CONCLUSIONS
Muscle trauma is demonstrably reduced using a minimally invasive access, especially in older and overweight patients. In these patients there is also a substantially higher postoperative muscular atrophy after implantation of a prosthesis than in corresponding normal weight and younger patients. The higher vulnerability and poorer capacity for regeneration of periarticular musculature means that this patient group particularly profits from a minimally invasive access route.
Klinik für Orthopädie, Klinik für Unfall- und Wiederherstellungschirurgie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland. michael.mueller@charite.de
M
M
Müller
S
S
Tohtz
M
M
Dewey
I
I
Springer
C
C
Perka
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015992:Body Mass Index; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D018482:Muscle, Skeletal / Q000293:injuries*; D009133:Muscular Atrophy / Q000175:diagnosis / Q000209:etiology*; D009765:Obesity / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome
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