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Abstract
Background and purpose Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.
Methods 5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach. Postoperatively, the hips were dissected and muscle damage color-stained. We measured proportional muscle damage relative to the midsubstance cross-sectional surface area (MCSA) using computerized color detection. The integrity of external rotator muscles, nerves, and ligaments was assessed by direct observation.
Results None of the other MIS approaches resulted in less gluteus medius muscle damage than the lateral transgluteal approach. However, the MIS anterior approach completely preserved the gluteus medius muscle in 4 cases while partial damage occurred in 1 case. Furthermore, the superior gluteal nerve was transected in 4 cases after a MIS anterolateral approach and in 1 after the lateral transgluteal approach. The lateral femoral cutaneous nerve was transected once after both the MIS anterior approach and the MIS 2-incision approach.
Interpretation The MIS anterior approach may preserve the gluteus medius muscle during total hip arthroplasty, but with a risk of damaging the lateral femoral cutaneous nerve.
JvO: protocol design, logistics, funding, assistance at anatomical dissection, color segmentation, data analysis, editing of tables and figures, and writing and modification of final manuscript. PH: protocol design, logistics, anatomical dissection, and modification of final manuscript. GT: software programming and color segmentation, data analysis, and modification of final manuscript. RC: protocol design, surgical assistance, and logistics. TN: assistance at anatomical dissection and data analysis. MS: coordination of study, protocol design, funding, performance of the lateral transgluteal approach, and modification of final manuscript.
We thank the participating orthopedic surgeons: Dr HA Schuppers, SMT, Hengelo, the Netherlands; Dr I Udvarhelyi, Uzsoki Hospital, Budapest, Hungary; Dr R Hube, OCM, Munich, Germany; and Dr C Kukla, LKH, Feldbach, Austria. We also thank Iris Buscher and Mai Vo for their assistance.
No competing interests declared.