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MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches

  • Musculoskeletal
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Abstract

Objectives

To compare soft-tissue changes after total hip arthroplasty with posterior, direct-lateral, anterolateral, or anterior surgical approaches.

Methods

MRI of 120 patients after primary total hip arthroplasty (30 per approach) were included. Each MRI was assessed by two readers regarding identification of surgical access, fatty muscle atrophy (Goutallier classification), tendon quality (0 = normal, 1 = tendinopathy, 2 = partial tear, 3 = avulsion), and fluid collections. Readers were blinded to the surgical approach.

Results

Surgical access was correctly identified in all cases. The direct lateral approach showed highest Goutallier grades and tendon damage for gluteus minimus muscle (2.07-2.67 and 2.00-2.77; p = 0.017 and p = 0.001 for readers 1 and 2, respectively) and tendon (2.30/1.67; p < 0.0005 for reader 1/2), and the lateral portion of the gluteus medius tendon (2.77/2.20; p < 0.0005 for reader 1/2). The posterior approach showed highest Goutallier grades and tendon damage for external rotator muscles (1.97-2.67 and 1.57-2.40; p < 0.0005-0.006 for reader 1/2) and tendons (1.41-2.45 and 1.93-2.76; p < 0.0005 for reader 1/2). The anterolateral and anterior approach showed less soft tissue damage. Fluid collections showed no differences between the approaches.

Conclusions

MRI is well suited to identify surgical approaches after THA. The anterior and anterolateral approach showed less soft tissue damage compared to the posterior and direct lateral approach.

Key Points

• Identification of the surgical approach is well possible with MR imaging.

• Anterolateral/anterior approaches show less soft-tissue damage compared to lateral/posterior approaches.

• Posterior approaches show marked damage to external rotator tendons and muscles.

• After direct lateral approaches the gluteus minimus tendon/muscle show severe damage.

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Abbreviations

THA:

Total hip arthroplasty

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Acknowledgments

An oral abstract of this manuscript was presented at the European Congress of Radiology 2015. The scientific guarantor of this publication is Christoph Agten. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland

    Christoph A. Agten, Reto Sutter & Christian W. A. Pfirrmann

  2. Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland

    Claudio Dora

  3. Faculty of Medicine, University of Zurich, Zurich, Switzerland

    Christoph A. Agten, Reto Sutter, Claudio Dora & Christian W. A. Pfirrmann

Authors
  1. Christoph A. Agten
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  2. Reto Sutter
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  3. Claudio Dora
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  4. Christian W. A. Pfirrmann
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Correspondence to Christoph A. Agten.

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Agten, C.A., Sutter, R., Dora, C. et al. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol 27, 1312–1321 (2017). https://doi.org/10.1007/s00330-016-4455-7

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  • DOI: https://doi.org/10.1007/s00330-016-4455-7

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