Incidence of tensor fascia lata muscle atrophy after using the modified Watson-Jones anterolateral approach in total hip
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ORIGINAL ARTICLE
Incidence of tensor fascia lata muscle atrophy after using the modified Watson‑Jones anterolateral approach in total hip arthroplasty Ryohei Takada1 · Tetsuya Jinno1 · Kazumasa Miyatake1 · Masanobu Hirao1 · Toshitaka Yoshii1 · Atsushi Okawa1 Received: 10 June 2020 / Accepted: 3 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Post-operative tensor fascia lata (TFL) muscle atrophy due to superior gluteal nerve (SGN) injury during total hip arthroplasty (THA) can affect patients’ post-operative hip function. This study aimed to determine the incidence of TFL muscle atrophy in THA performed via the modified Watson-Jones anterolateral approach and the risk factors for TFL atrophy. Methods We reviewed pre- and post-operative magnetic resonance imaging (MRI) data of 164 patients who underwent cementless THA via the modified Watson-Jones approach at one institution. TFL atrophy was defined as worsening of ≥ 2 grades in the Goutallier classification or > 40% decrease in the cross-sectional area (CSA) of the TFL on post-operative MRI compared to that on preoperative MRI. Patients’ backgrounds were compared between those with or without TFL atrophy to determine the risk factors of TFL atrophy. Fatty atrophy grade and CSA of the gluteus minimus and medius were also evaluated. Results Thirteen (8.0%) cases of TFL atrophy were detected. The mean body mass index (BMI) in the cases with TFL atrophy was significantly higher than in those without TFL atrophy (p = 0.012). The fatty atrophy grade was worse post-operatively than preoperatively; moreover, the CSA of the gluteus minimus decreased. Conclusions We found a low incidence of TFL atrophy due to SGN injury after THA using the modified Watson-Jones approach. High BMI can be a risk factor for nerve injury. The gluteus minimus can be injured directly during surgery. We suggest that overexposure of the surgical site should be avoided, especially in patients with high BMI. Keywords Tensor fascia lata · Total hip arthroplasty · Atrophy · Magnetic resonance imaging Abbreviations THA Total hip arthroplasty TFL Tensor fascia lata SGN Superior gluteal nerve MRI Magnetic resonance imaging CSA Cross-sectional area BMI Body mass index
Introduction The modified Watson-Jones anterolateral approach has become one of the most popular minimally invasive surgeries for total hip arthroplasty (THA) [1–4]. Bertin and * Ryohei Takada [email protected] 1
Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1‑5‑45 Yushima, Bunkyo‑ku, Tokyo 113‑8519, Japan
Röttinger described this approach as a modification of the classic Watson-Jones approach, which utilizes the interval between the gluteus medius and tensor fascia lata (TFL) muscles without incising or detaching the muscles and tendons [2, 3]. Although excellent clinical results have been reported, this approach has a potential risk for injury to the intermuscular branch of the superior gluteal nerve (SGN) secondary to the retract
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