Skip to main content

Advertisement

SpringerLink
Log in

Comparison of morphological changes of gluteus medius and abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Background

It is a general belief among orthopedists that the muscle damage of the hip abductors after total hip arthroplasty (THA) is theoretically minimal via posterior approach. However, there is little data scientifically supporting the purported advantage. The purpose of this study was to quantifiably assess the injury to the gluteus medius (GMED) after THA via the minimally invasive (MIS) posterior and the modified direct lateral (mDL) approaches.

Methods

Sixty-four consecutive patients enrolled prospectively were randomly assigned to the MIS posterior and the mDL approach groups. Three-dimensional MRI reconstruction of bilateral GMED, abductor strength measurement as well as post-operative pain assessment were included in the analysis. Data were collected pre-operatively, six, 12, and 52 weeks post-operatively.

Results

Interestingly, in terms of the morphological changes of GMED, the MIS posterior approach showed a more significant degeneration caused by the surgical trauma compared with the mDL approach in both muscle volume atrophy and fatty infiltration from six to 52 weeks post-operatively. However, the improvement of abductor muscle strength on surgical side and VAS pain score were comparable between the two groups during the entire follow-up.

Conclusion

The injury of hip abductors after THA via posterior approach cannot be neglected. And, the planned detachment of partial GMED tendon combined with the reconstruction in situ could also achieve the satisfactory muscle recovery. Moreover, the post-operative rehabilitation of abductor strength was the aggregated results of a battery of factors, especially the pain, not just determined by the muscular morphological changes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

All data is stored in the clinical trial registry. And the datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

THA:

Total hip arthroplasty

GMED:

Gluteus medius

MIS:

Minimally invasive

mDL:

Modified direct lateral

EMG:

Electromyography

SGN:

Superior gluteal nerve

References

  1. Bernard J, Razanabola F, Beldame J, Van Driessche S, Brunel H, Poirier T, Matsoukis J, Billuart F (2018) Electromyographic study of hip muscles involved in total hip arthroplasty: surprising results using the direct anterior minimally invasive approach. Orthop Traumatol Surg Res 104(8):1137–1142

    Article  Google Scholar 

  2. de Jong L, Klem TMAL, Kuijper TM, Roukema GR (2018) The minimally invasive anterolateral approach versus the traditional anterolateral approach (Watson-Jones) for hip hemiarthroplasty after a femoral neck fracture: an analysis of clinical outcomes. Int Orthop 42(8):1943–1948

    Article  Google Scholar 

  3. Mjaaland KE, Svenningsen S, Fenstad AM, Havelin LI, Furnes O, Nordsletten L (2017) Implant survival after minimally invasive anterior or anterolateral vs. conventional posterior or direct lateral approach: an analysis of 21,860 total hip arthroplasties from the Norwegian Arthroplasty Register (2008 to 2013). J Bone Joint Surg Am 99(10):840–847

    Article  Google Scholar 

  4. Pospischill M, Kranzl A, Attwenger B, Knahr K (2010) Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty—a comparative gait analysis. J Bone Joint Surg Am 92(2):328–337

    Article  CAS  Google Scholar 

  5. Müller M, Tohtz S, Dewey M, Springer I, Perka C (2011) Age-related appearance of muscle trauma in primary total hip arthroplasty and the benefit of a minimally invasive approach for patients older than 70 years. Int Orthop 35(2):165–171

    Article  Google Scholar 

  6. Repantis T, Bouras T, Korovessis P (2015) Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty: a randomized controlled trial. Eur J Orthop Surg Traumatol 25(1):111–116

    Article  CAS  Google Scholar 

  7. Agten CA, Sutter R, Dora C, Pfirrmann CWA (2017) MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol 27(3):1312–1321

    Article  Google Scholar 

  8. Abitbol JJ, Gendron D, Laurin CA, Beaulieu MA (1990) Gluteal nerve damage following total hip arthroplasty. J Arthroplast 5(4):319–322

    Article  CAS  Google Scholar 

  9. Miguel-Pérez M, Ortiz-Sagristà JC, López I, Pérez-Bellmunt A, Llusá M, Alex L, Combalia A (2010) How to avoid injuries of the superior gluteal nerve. Hip Int 20(S7):26–31

    Article  Google Scholar 

  10. Petis S, Howard JL, Lanting BL, Vasarhelyi EM (2014) Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg 58(2):128–139

    Article  Google Scholar 

  11. Kolk S, Minten MJ, van Bon GE, Rijnen WH, Geurts AC, Verdonschot N, Weerdesteyn V (2014) Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review. Clin Biomech (Bristol, Avon) 29(6):705–718

    Article  Google Scholar 

  12. Agostini V, Ganio D, Facchin K, Cane L, Moreira Carneiro S, Knaflitz M (2014) Gait parameters and muscle activation patterns at 3, 6 and 12 months after total hip arthroplasty. J Arthroplast 29(6):1265–1272

    Article  Google Scholar 

  13. Bahl JS, Nelson MJ, Taylor M, Solomon LB, Arnold JB, Thewlis D (2018) Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 26(7):847–863

    Article  CAS  Google Scholar 

  14. Gibson A (1950) Posterior exposure of the hip joint. J Bone Joint Surg 32-B(2):183–186

    Article  CAS  Google Scholar 

  15. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg 64-B(1):17–19

    Article  Google Scholar 

  16. Daguet E, Jolivet E, Bousson V, Boutron C, Dahmen N, Bergot C, Vicaut E, Laredo J-D (2011) Fat content of hip muscles: an anteroposterior gradient. J Bone Joint Surg 93(20):1897–1905

    Article  Google Scholar 

  17. Gladstone JN, Bishop JY, Lo IK, Flatow EL (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35(5):719–728

    Article  Google Scholar 

  18. Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E, Harris TB (2002) Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc 50(5):897–904

    Article  Google Scholar 

  19. Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ (2006) Muscle damage during MIS total hip arthroplasty: Smith-Peterson versus posterior approach. Clin Orthop Relat Res 453:293–298

    Article  Google Scholar 

  20. Mardones R, Pagnano MW, Nemanich JP, Trousdale RT (2005) Muscle damage after total hip arthroplasty done with the two-incision and mini-posterior techniques. Clin Orthop Relat Res 441:63–67

    Article  Google Scholar 

  21. Rasch A, Byström AH, Dalén N, Martinez-Carranza N, Berg HE (2009) Persisting muscle atrophy two years after replacement of the hip. J Bone Joint Surg (Br) 91(5):583–588

    Article  CAS  Google Scholar 

  22. Apaydin N, Kendir S, Loukas M, Tubbs RS, Bozkurt M (2012) Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip. Clin Anat 26(5):614–620

    Article  Google Scholar 

  23. Odak S, Ivory J (2013) Management of abductor mechanism deficiency following total hip replacement. Bone Joint J 95-B(3):343–347

    Article  CAS  Google Scholar 

  24. Chomiak J, Huráček J, Dvořák J, Dungl P, Kubeš R, Schwarz O, Munzinger U (2015) Lesion of gluteal nerves and muscles in total hip arthroplasty through 3 surgical approaches. An electromyographically controlled study. Hip Int 25(2):176–183

    Article  Google Scholar 

  25. Güleç A, Büyükbebeci O (1996) Late superior gluteal nerve palsy following posterior fracture-dislocation of the hip. Acta Orthop Belg 62(4):218–221

    PubMed  Google Scholar 

  26. Grimaldi A (2011) Assessing lateral stability of the hip and pelvis. Man Ther 16(1):26–32

    Article  Google Scholar 

  27. Yamaguchi T, Naito M, Asayama I, Kambe T, Fujisawa M, Ishiko T (2003) The effect of posterolateral reconstruction on range of motion and muscle strength in total hip arthroplasty. J Arthroplast 18(3):347–351

    Article  Google Scholar 

  28. Kiyama T, Naito M, Shinoda T, Maeyama A (2010) Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplast 25(1):76–80

    Article  Google Scholar 

  29. Strasser EM, Draskovits T, Praschak M, Quittan M, Graf A (2013) Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly. Interface. 35(6):2377–2388

    Google Scholar 

  30. Mithal A, Bonjour J-P, Boonen S, Burckhardt P, Degens H, El Hajj Fuleihan G, Josse R, Lips P, Morales Torres J, Rizzoli R, Yoshimura N, Wahl DA, Cooper C, Dawson-Hughes B (2013) Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 24(4):1555–1566

    Article  CAS  Google Scholar 

  31. Rahemi H, Nigam N, Wakeling JM (2015) The effect of intramuscular fat on skeletal muscle mechanics: implications for the elderly and obese. Interface. 12(109):109–116

    Google Scholar 

  32. Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, Lieberman JR, Mears DC (2003) Minimally invasive total hip arthroplasty-development, early results, and a critical analysis. J Bone Joint Surg 85-A(11):2235–2246

    Article  Google Scholar 

Download references

Acknowledgments

Not applicable.

Author information

Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1, Yixueyuan Road, Yuanjiagang, Yuzhong District, Chongqing, China

    Ting Wang, Long Shao, Wei Xu, Hong Chen & Wei Huang

Authors
  1. Ting Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Long Shao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Wei Huang, Hong Chen, Ting Wang.

Data curation: Ting Wang, Long Shao.

Formal analysis: Ting Wang, Long Shao.

Investigation and measurement: Ting Wang, Long Shao.

Methodology: Ting Wang, Long Shao, Wei Xu.

Project administration: Ting Wang, Long Shao, Wei Xu.

Writing-original draft: Ting Wang, Long Shao.

Writing-review and editing: Hong Chen, Wei Huang.

Corresponding author

Correspondence to Wei Huang.

Ethics declarations

Competing interests

The authors declare no conflict of interest. No specific funding was received.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The paper is NOT based on a previous communication to a society or meeting.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, T., Shao, L., Xu, W. et al. Comparison of morphological changes of gluteus medius and abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches. International Orthopaedics (SICOT) 43, 2467–2475 (2019). https://doi.org/10.1007/s00264-019-04331-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04331-z

Keywords

Search

Navigation