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Research article
Yuji Wang
Changzhou No.2 People's Hospital
Corresponding Author
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Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.
Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.
Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)
Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.
Keywords
direct anterior approach, total hip arthroplasty, tensor fasciae lata muscle, capsular, protect, trauma, muscle cross-sectional area, fatty atrophy
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CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
No community comments so far
Editorial decision: Accept
On 28 Dec, 2019
Editor assigned
On 27 Dec, 2019
Submission checks complete
On 26 Dec, 2019
Editor invited
On 26 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 23 Dec, 2019
Review #2 received
Received 21 Dec, 2019
Review #3 received
Received 18 Dec, 2019
Reviewer #3 agreed
On 08 Dec, 2019
Review #1 received
Received 08 Dec, 2019
Editor assigned
On 06 Dec, 2019
Reviewers invited
Invitations sent on 06 Dec, 2019
Reviewer #1 agreed
On 06 Dec, 2019
Reviewer #2 agreed
On 06 Dec, 2019
Submission checks complete
On 05 Dec, 2019
Editor invited
On 05 Dec, 2019
Version 1
Posted 25 Sep, 2019
No comments provided
Review #3 received
Received 06 Nov, 2019
Review #2 received
Received 06 Nov, 2019
Editorial decision: Major revision
On 06 Nov, 2019
Reviewer #4 agreed
On 04 Nov, 2019
Reviewer #3 agreed
On 29 Oct, 2019
Reviewer #2 agreed
On 25 Oct, 2019
Review #1 received
Received 14 Oct, 2019
Reviewer #1 agreed
On 13 Oct, 2019
Reviewers invited
Invitations sent on 03 Oct, 2019
Editor assigned
On 10 Sep, 2019
Submission checks complete
On 09 Sep, 2019
Editor invited
On 09 Sep, 2019
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Subject Areas
Orthopedics
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A new preprint design is coming!
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yuji Wang
Changzhou No.2 People's Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
No community comments so far
Editorial decision: Accept
On 28 Dec, 2019
Editor assigned
On 27 Dec, 2019
Submission checks complete
On 26 Dec, 2019
Editor invited
On 26 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 23 Dec, 2019
Review #2 received
Received 21 Dec, 2019
Review #3 received
Received 18 Dec, 2019
Reviewer #3 agreed
On 08 Dec, 2019
Review #1 received
Received 08 Dec, 2019
Editor assigned
On 06 Dec, 2019
Reviewers invited
Invitations sent on 06 Dec, 2019
Reviewer #1 agreed
On 06 Dec, 2019
Reviewer #2 agreed
On 06 Dec, 2019
Submission checks complete
On 05 Dec, 2019
Editor invited
On 05 Dec, 2019
Version 1
Posted 25 Sep, 2019
No comments provided
Review #3 received
Received 06 Nov, 2019
Review #2 received
Received 06 Nov, 2019
Editorial decision: Major revision
On 06 Nov, 2019
Reviewer #4 agreed
On 04 Nov, 2019
Reviewer #3 agreed
On 29 Oct, 2019
Reviewer #2 agreed
On 25 Oct, 2019
Review #1 received
Received 14 Oct, 2019
Reviewer #1 agreed
On 13 Oct, 2019
Reviewers invited
Invitations sent on 03 Oct, 2019
Editor assigned
On 10 Sep, 2019
Submission checks complete
On 09 Sep, 2019
Editor invited
On 09 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.
Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.
Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)
Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
This is a list of supplementary files associated with this preprint. Click to download.
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