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Effect of percutaneous assisted approach on functional rehabilitation for total hip replacement compared to anterolateral approach: study protocol for a randomized controlled trial.

Hendrickx C, De Hertogh W, Van Daele U, Mertens P, Stassijns G - Trials (2014)

Bottom Line: The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome.The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach.Therefore, we assume that functional outcome and gluteus medius function of patients after the percutaneous assisted approach will be better than after the anterolateral approach.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. willem.dehertogh@uantwerpen.be.

ABSTRACT

Background: The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome.

Methods/design: This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (surface-electromyography, strength measurements of abductors and quadriceps and the Trendelenburg test), questionnaires (Oxford Hip Score and 36-item Short Form Health Survey) and functional measures (the Timed Get-Up-and-Go test, Five times Sit-to-Stand test and Six-Minute Walk test). These measurements will be repeated four and 12 weeks after surgery. After surgery both groups will receive usual care.

Discussion: The gluteus medius is the main stabilizer of the hip joint. Therefore, we assume that functional outcome and gluteus medius function of patients after the percutaneous assisted approach will be better than after the anterolateral approach.

Trial registration: This trial was registered with ClinicalTrials.gov on 8 January 2014, registration number: NCT02032017.

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Percutaneous assisted approach, side view.
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Fig1: Percutaneous assisted approach, side view.

Mentions: Muscles are major contributors to hip contact force, with gravitational and centrifugal forces combined contributing less than 5%. One of the most important muscles for this is the gluteus medius [10]. It is responsible for stabilizing the femoral neck in the acetabulum during the different stages of gait [11, 12]. This makes it a very important muscle for normal functioning and gait. The gluteus medius is often already weakened before surgery in patients with osteoarthritis of the hip [13]. Since the AA detaches approximately two thirds of the gluteus medius, it affects normal function. Consequently, it can be assumed that interventions sparing the gluteus medius are probably beneficial for patients’ postoperative functional outcome.Damage to the gluteus muscle can be limited using the percutaneous assisted approach (PAA). In this technique, a second small incision (1 cm) at the anterior border of the femur is made. A canula is placed underneath the muscle and used to pass the reamers in the direction of the acetabulum (Figures 1 and 2). There is no need to enlarge the skin incision or to release more muscle insertion to achieve good working access to the acetabulum. There are two advantages of this procedure: sparing of the gluteus medius muscle and safe access to the acetabulum to obtain perfect positioning of the implants.Figure 1


Effect of percutaneous assisted approach on functional rehabilitation for total hip replacement compared to anterolateral approach: study protocol for a randomized controlled trial.

Hendrickx C, De Hertogh W, Van Daele U, Mertens P, Stassijns G - Trials (2014)

Percutaneous assisted approach, side view.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197322&req=5

Fig1: Percutaneous assisted approach, side view.
Mentions: Muscles are major contributors to hip contact force, with gravitational and centrifugal forces combined contributing less than 5%. One of the most important muscles for this is the gluteus medius [10]. It is responsible for stabilizing the femoral neck in the acetabulum during the different stages of gait [11, 12]. This makes it a very important muscle for normal functioning and gait. The gluteus medius is often already weakened before surgery in patients with osteoarthritis of the hip [13]. Since the AA detaches approximately two thirds of the gluteus medius, it affects normal function. Consequently, it can be assumed that interventions sparing the gluteus medius are probably beneficial for patients’ postoperative functional outcome.Damage to the gluteus muscle can be limited using the percutaneous assisted approach (PAA). In this technique, a second small incision (1 cm) at the anterior border of the femur is made. A canula is placed underneath the muscle and used to pass the reamers in the direction of the acetabulum (Figures 1 and 2). There is no need to enlarge the skin incision or to release more muscle insertion to achieve good working access to the acetabulum. There are two advantages of this procedure: sparing of the gluteus medius muscle and safe access to the acetabulum to obtain perfect positioning of the implants.Figure 1

Bottom Line: The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome.The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach.Therefore, we assume that functional outcome and gluteus medius function of patients after the percutaneous assisted approach will be better than after the anterolateral approach.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. willem.dehertogh@uantwerpen.be.

ABSTRACT

Background: The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome.

Methods/design: This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (surface-electromyography, strength measurements of abductors and quadriceps and the Trendelenburg test), questionnaires (Oxford Hip Score and 36-item Short Form Health Survey) and functional measures (the Timed Get-Up-and-Go test, Five times Sit-to-Stand test and Six-Minute Walk test). These measurements will be repeated four and 12 weeks after surgery. After surgery both groups will receive usual care.

Discussion: The gluteus medius is the main stabilizer of the hip joint. Therefore, we assume that functional outcome and gluteus medius function of patients after the percutaneous assisted approach will be better than after the anterolateral approach.

Trial registration: This trial was registered with ClinicalTrials.gov on 8 January 2014, registration number: NCT02032017.

Show MeSH
Related in: MedlinePlus