Piriformis Muscle Sparing Posterior Approach in Total Hip Replacement: Our Experience
Keywords:
Total Hip Arthroplasty (THA), Piriformis Muscle, Oxford hip Ratio (OHS)Abstract
Background: The total hip arthroplasty (THA) procedure is effective surgical procedures of twentieth century. THA has been considered using a variety of techniques. The objective of current study was to determine outcome of Piriformis muscle sparing (PSM) posterior approach in total hip replacement.
Materials and Methods: This cohort study was carried out in Institute Of Orthopaedics & Surgery and South City Hospital Karachi. The study includes total 60 patients that underwent THA. Piriformis-sparing posterior approach procedure was performed. Outcome was assessed before procedure and at 2 weeks and 6 weeks, 3 months and 1 year postoperatively. Pain was assessed visual analogue scale (VAS).The Oxford Hip Score (OHS) and 12-item Short Form Survey (SF-12) were applied to evaluate pain and hip function, respectively.
Results: Mean BMI of the patients was 27.5±4.7, Mean pain score on VAS was 6.2±1.5 and OHS score was 20±8.After 1 year of procedure. Mean pain score on VAS was decreased to 1.2±0.5 and mean OHS score was 44±4.9 out of total score of 48, mean SF-12 PCS was 40.2±12.2, mean SF-12 MCS was 56.6±11.3.
Conclusion: Piriformis muscle sparing posterior approach in Total Hip Replacement has better functional outcome in terms of postoperative pain and hip function. Piriformis muscle is very important for the hip function, so it should be saved whenever possible to get the best results after Total hip replacement with posterior approach
References
Barry JJ, Masonis JL, Mason JB. Recovery and outcomes of direct anterior approach total hip arthroplasty. Annals of joint. 2018;3(6):1-8.
Aggarwal VK, Iorio R, Zuckerman JD, Long WJ. Surgical approaches for primary total hip arthroplasty from Charnley to now: the quest for the best approach. JBJS reviews. 2020;8(1):e0058.
Wang T, Zhou Y, Li X, Gao S, Yang Q. Comparison of postoperative effectiveness of less invasive short external rotator sparing approach versus standard posterior approach for total hip arthroplasty. Journal of Orthopaedic Surgery and Research. 2021;16(1):1-8.
Peters RM, van Beers LW, van Steenbergen LN, Wolkenfelt J, Ettema HB, Ten Have BL, et al. Similar superior patient-reported outcome measures for anterior and posterolateral approaches after total hip arthroplasty: postoperative patient-reported outcome measure improvement after 3 months in 12,774 primary total hip arthroplasties using the anterior, anterolateral, straight lateral, or posterolateral approach. The Journal of arthroplasty. 2018;33(6):1786-93.
Khan R, Maor D, Hofmann M, Haebich S. A comparison of a less invasive piriformis-sparing approach versus the standard posterior approach to the hip: a randomised controlled trial. The Journal of bone and joint surgery British volume. 2012;94(1):43-50.
Solomon LB, Naal FD, Howie DW. Piriformis muscle rupture during total hip arthroplasty using a muscle-preserving posterior approach. Acta Orthop Belg. 2013;79(6):616-9.
Tan BK, Khan RJ, Haebich SJ, Maor D, Blake EL, Breidahl WH. Piriformis-sparing minimally invasive versus the standard posterior approach for total hip arthroplasty: a 10-year follow-up of a randomized control trial. The Journal of arthroplasty. 2019;34(2):319-26.
Solomon L, Lee Y, Callary S, Beck M, Howie D. Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip. The Journal of Bone and Joint Surgery British volume. 2010;92(9):1317-24.
Prigent F. Incidence of capsular closure and piriformis preservation on the prevention of dislocation after total hip arthroplasty through the minimal posterior approach: comparative series of 196 patients. European Journal of Orthopaedic Surgery & Traumatology. 2008;18(5):333-7.
Ostendorf M, Van Stel H, Buskens E, Schrijvers A, Marting L, Verbout A, et al. Patient-reported outcome in total hip replacement: a comparison of five instruments of health status. The Journal of Bone and Joint Surgery British volume. 2004;86(6):801-8.
Murray D, Fitzpatrick R, Rogers K, Pandit H, Beard D, Carr A, et al. The use of the Oxford hip and knee scores. The Journal of bone and joint surgery British volume. 2007;89(8):1010-4.
Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC. Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial. Clinical Orthopaedics and Related Research®. 2011;469(1):200-8.
Shitama T, Kiyama T, Naito M, Shiramizu K, Huang G. Which is more invasive—mini versus standard incisions in total hip arthroplasty? International orthopaedics. 2009;33(6):1543-7.
Procyk S. Initial results with a mini-posterior approach for total hip arthroplasty. International orthopaedics. 2007;31(1):17-20.
Stevenson C, Ogonda L, Blaney J, Dennison J, O’Brien S, Beverland D. Minimal incision total hip arthroplasty: a concise follow-up report on functional and radiographic outcomes at 10 years. JBJS. 2017;99(20):1715-20.
Müller M, Tohtz S, Springer I, Dewey M, Perka C. Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Archives of orthopaedic and trauma surgery. 2011;131(2):179-89.