Modified Mostardi approach with ultra-high-molecular-weight polyethylene tape for total hip arthroplasty provides a good rate of union of osteotomized fragments

doi:10.1007/s00776-015-0721-9

Journal of Orthopaedic Science

Volume 20, Issue 4, 2015, Pages 633-641

https://doi.org/10.1007/s00776-015-0721-9 Get rights and content

Abstract

Background

A lateral approach is common in total hip arthroplasty because of the good exposure it provides and its low complication rates. However, a drawback of the procedure is that the abductor mechanism is damaged when the tendinous insertion of the abductor muscle is split. Here, we describe a wafer technique using ultra-high-molecular-weight polyethylene tape for promising reattachment of the abductor mechanism.

Methods

We retrospectively evaluated 120 consecutive primary total hip arthroplasties performed using a modified Mostardi approach, which involved reattaching the trochanter using either a braided polyester suture (polyester suture group, n = 60) or ultra-high-molecular-weight polyethylene tape (UHMWPE tape group, n = 60). The osteotomized fragment was reattached by inducing bone-to-bone contact using 3-mm-wide tapes that were precisely tied with a double-loop sliding knot in conjunction with a cable gun tensioner. The abductor strength and radiographic union rate were postoperatively assessed at 4 weeks and 6 months, respectively.

Results

A statistically significant lower incidence of nonunion and cutout was observed in the UHMWPE group (0 and 5.0 %, respectively) compared to the polyester suture group (8.3 and 15 %, respectively). No differences in abductor strength either preoperatively or at 4 weeks postoperatively were observed between the groups. In radiographically healed patients, abductor strength at 4 weeks post-surgery exceeded preoperative strength. The recovery rate of hip abductor strength was 109.9 ± 34.3 % in union patients and 92.9 ± 23.3 % in nonunion patients, which was statistically significant. The mean Japanese Orthopedic Association hip scores improved from 48.6 to 86.8 in union patients and from 50.3 to 85.9 in nonunion patients at 1 year postoperatively; however, this difference was not significant.

Conclusions

The modified Mostardi approach using ultra-high molecular weight polyethylene tape can promote successful union of the osteotomized fragment.

References (23)

B.D. Mulliken et al.
A modified direct lateral approach in total hip arthroplasty: a comprehensive review
J Arthroplasty
(1998)
R.A. Mostardi et al.
Comparison of functional outcome of total hip arthroplasties involving four surgical approaches
J Arthroplasty
(1988)
M. Nankaku et al.
Prediction of ambulation ability following total hip arthroplasty
J Orthop Sci
(2011)
Y.H. Pua et al.
Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis
Arch Phys Med Rehabil
(2008)
M. Kuribayashi et al.
Reliability and validity of the Japanese Orthopaedic Association hip score
J Orthop Sci
(2010)
J. Charnley
Total hip replacement by low-friction arthroplasty
Clin Orthop Relat Res.
(1970)
J. Charnley
The long-term results of low-friction arthroplasty of the hip performed as a primary intervention
J Bone Joint Surg Br
(1972)
D. Dall
Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach
J Bone Joint Surg Br
(1986)
K. Hardinge
The direct lateral approach to the hip
J Bone Joint Surg Br
(1982)
R. Bauer et al.
The transgluteal approach to the hip joint
Arch Orthop Trauma Surg
(1979)

R.Y. Woo et al.

Dislocation after total hip arthroplasty

J Bone Joint Surg Am

(1982)

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Although introduction of minimally invasive techniques via anterolateral approaches considerably decreased prolonged limp after total hip arthroplasty (THA), potential damage to the abductor muscles is still a concern. This study aimed to evaluate the residual damage after primary THA with two types of anterolateral approach by assessing fatty infiltration and atrophy of the gluteus medius (GMed) and gluteus minimus (GMin) muscles.
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All 120 procedures were performed by one of the senior hip surgeons (K.G., Y.K., or K.S.). All surgeries were performed via the anterolateral approach [12]. A cemented stem was used in 89 hips, whereas an uncemented stem was used in 31 hips.
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A larger preoperative flexion ROM was associated with a higher score in the mHHS socks component (standardized coefficient [SC] = 0.26, P = .0041) at 12 months; the effect on the OHS socks component was not significant (P = .34). A larger flexion ROM at 12 months was associated with higher scores in the mHHS support (SC = 0.21, P = .026), stairs (SC = 0.35, P = .0002), and socks (SC = 0.32, P = .0007) components but had no significant effect on any OHS component. The effects of ROM on University of California Los Angeles activity score were limited.
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This prospective cohort study with a robust protocol enrolled 79 patients who received either 1 or 2 g of topical tranexamic acid in 30 mL normal saline solution or an equivalent volume of normal saline at the end of surgery. The primary outcomes were postoperative drain blood loss and hemoglobin decrease on postoperative day 7. The secondary outcomes were transfusion rate, d-dimer level on postoperative day 7, symptomatic deep vein thrombosis rate, and duration of hospital stay.
Both 1 and 2 g tranexamic acid significantly reduced postoperative drain blood loss (p < 0.001). These doses also reduced the hemoglobin concentration decrease on postoperative day 7, but not significantly. Furthermore, 1 and 2 g doses of tranexamic acid had similar effects on postoperative blood loss and hemoglobin concentration decrease. There was no difference in the transfusion rate, d-dimer level, symptomatic deep vein thrombosis rate, and length of hospital stay.
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ORIGINAL ARTICLEModified Mostardi approach with ultra-high-molecular-weight polyethylene tape for total hip arthroplasty provides a good rate of union of osteotomized fragments

Abstract

Background

Methods

Results

Conclusions

J Arthroplasty

J Arthroplasty

J Orthop Sci

Arch Phys Med Rehabil

J Orthop Sci

Total hip replacement by low-friction arthroplasty

Clin Orthop Relat Res.

The long-term results of low-friction arthroplasty of the hip performed as a primary intervention

J Bone Joint Surg Br

Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach

J Bone Joint Surg Br

The direct lateral approach to the hip

J Bone Joint Surg Br

The transgluteal approach to the hip joint

Arch Orthop Trauma Surg

Dislocation after total hip arthroplasty

J Bone Joint Surg Am

ORIGINAL ARTICLE
Modified Mostardi approach with ultra-high-molecular-weight polyethylene tape for total hip arthroplasty provides a good rate of union of osteotomized fragments