Hip fractures as well as coxarthrosis are conditions that are becoming more common in everyday orthopedic practice. With the aging of the world's population, there is an increasing need for partial (HA) or total hip arthroplasty (THA). No elective procedure is as important to quality of life as total hip arthroplasty, and partial hip arthroplasty is a method of treatment in elder population who suffered fracture of the femoral neck. There are several hip approaches that can be used for arthroplasty. Hip dislocation is a serious complication after hip arthroplasty and occurs somewhat more frequently when the posterior hip approach is used. The aim of this study is to show that the piriformis sparing technique gives better results in terms of reducing the frequency of dislocations in the early postoperative period (one year). We operated od 249 patients, and after follow-up that lasted from 13 to 22 months we had four dislocations, three in patient with THA(0.021) and one after HA(0.009). Preservation of the piriformis tendon is a minor modification in the operative technique that can lead to a great benefit in the quality of treatment and a reduced risk of complications.
References
1.
Pincus D, Jenkinson R, Paterson M, Leroux T, Ravi B. Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty. Vol. 323, JAMA. 2020. p. 1070.
2.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Vol. 393, The Lancet. 2019. p. 1745–59.
3.
Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of Total Hip and Knee Replacement in the United States. Vol. 97, The Journal of Bone and Joint Surgery-American Volume. 2015. p. 1386–97.
4.
Lespasio MJ, Sultan AA, Piuzzi NS, Khlopas A, Husni ME, Muschler GF, et al. Hip Osteoarthritis: A Primer. Vol. 22, The Permanente Journal. 2018.
5.
Kazley J, Fractures BKFN. 2021.
6.
Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, et al. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. Vols. 93-B, The Journal of Bone and Joint Surgery. British volume. 2011. p. 1045–8.
7.
Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, et al. Comparison of Bipolar Hemiarthroplasty with Total Hip Arthroplasty for Displaced Femoral Neck Fractures. Vol. 93, Journal of Bone and Joint Surgery. 2011. p. 445–50.
8.
Ju DG, Rajaee SS, Mirocha J, Lin CA, Moon CN. Nationwide Analysis of Femoral Neck Fractures in Elderly Patients. Vol. 99, Journal of Bone and Joint Surgery. 2017. p. 1932–40.
9.
Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Vols. 98-B, The Bone & Joint Journal. 2016. p. 291–7.
10.
Pine J, Binns M, Wright P, Soames R. Piriformis and obturator internus morphology: A cadaveric study. Vol. 24, Clinical Anatomy. 2011. p. 70–6.
11.
Siddappa VH, Meftah M. Piriformis-Sparing Technique in Total Hip Arthroplasty with Posterolateral Approach. 2020.
12.
Xu J, Zhuang WD, Li XW, Yu GY, Lin Y, Luo FQ, et al. Comparison of the effects of total hip arthroplasty via direct anterior approach and posterolateral piriformis-sparing approach. 2017.
13.
Gérard R, Savéan J, Lefèvre C. Minimally invasive posterolateral hip approach with SPARTAQUUS (Spare the Piriformis And Respect The Active QUadratus femoris and gluteus mediUS) technique. Vol. 106, Orthopaedics & Traumatology: Surgery & Research. 2020. p. 1523–6.
14.
Bono OJ, Damsgaard C, Robbins C, Aghazadeh M, Talmo CT, Bono JV. Influence of Soft Tissue Preservation in Total Hip Arthroplasty: A 16-Year Experience. 2018.
15.
Moussallem CD, Hoyek FA, Lahoud JC. Incidence of piriformis tendon preservation on the dislocation rate of total hip replacement following the posterior approach: a series of 226 cases. 2012.
16.
Zhou Y, Cao S, Li L, Narava M, Fu Q, Qian Q. Is soft tissue repair a right choice to avoid early dislocation after THA in posterior approach? Vol. 17, BMC Surgery. 2017.
17.
Aggarwal VK, Elbuluk A, Dundon J, Herrero C, Hernandez C, Vigdorchik JM, et al. Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Vols. 101-B, The Bone & Joint Journal. 2019. p. 646–51.
18.
Khan RJK, Lam LO, Breidahl W, Blakeney WG. Magnetic Resonance Imaging Features of Preserved vs Divided and Repaired Piriformis During Total Hip Arthroplasty. Vol. 27, The Journal of Arthroplasty. 2012. p. 551–8.
19.
Tan BKL, Khan RJK, 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. Vol. 34, The Journal of Arthroplasty. 2019. p. 319–26.
20.
Minokawa S, Naito M, Shiramizu K, Nakamura Y, Kinoshita K, Minamikawa T, et al. Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging. Vol. 28, HIP International. 2018. p. 599–605.
21.
Wang T, Shao L, Xu W, Li F, Huang W. Surgical injury and repair of hip external rotators in THA via posterior approach: a three-dimensional MRI-evident quantitative prospective study. Vol. 20, BMC Musculoskeletal Disorders. 2019.
22.
Amanatullah DF, Shah HN, Barrett AA, Storaci HW. A Small Amount of Retraction Force Results in Inadvertent Piriformis Muscle Damage During a Piriformis-Sparing Approach to the Hip. Vol. 102, Journal of Bone and Joint Surgery. 2020. p. 1687–93.
23.
Solomon LB, Naal FD, Howie DW. Piriformis muscle rupture during total hip arthroplasty using a muscle-preserving posterior approach. Vol. Dec;79(6):616-9. PMID. 2013. p. 24563964.
24.
Hanly RJ, Sokolowski S, Timperley AJ. The SPAIRE Technique Allows Sparing of the Piriformis and Obturator Internus in a Modified Posterior Approach to the Hip. Vol. 27, HIP International. 2017. p. 205–9.
25.
Price A, Ball S, Rhodes S, Wickins R, Gordon E, Aylward A, et al. Effects of a modified muscle sparing posterior technique in hip hemiarthroplasty for displaced intracapsular fractures on postoperative function compared to a standard lateral approach (HemiSPAIRE): protocol for a randomised controlled trial. Vol. 11, BMJ Open. 2021. p. e045652.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.