Aims. We wished to quantify the extent of soft-tissue damage sustained
during minimally invasive total hip arthroplasty through the direct
anterior (DA) and direct superior (DS) approaches. Materials and Methods. In eight cadavers, the DA approach was performed on one side,
and the DS approach on the other, a single brand of uncemented hip
prosthesis was implanted by two surgeons, considered expert in their
surgical approaches. Subsequent reflection of the gluteus maximus
allowed the extent of muscle and tendon damage to be measured and
the percentage damage to each anatomical structure to be calculated. Results. The DA approach caused substantially greater damage to the gluteus
minimus muscle and tendon when compared with the DS approach (t-test,
p = 0.049 and 0.003, respectively). The tensor fascia lata and rectus
femoris muscles were damaged only in the DA approach. There was
no difference in the amount of damage to the gluteus medius muscle
and tendon, piriformis tendon, obturator internus tendon, obturator
externus tendon or quadratus femoris muscle between approaches.
The posterior soft-tissue releases of the DA approach damaged the
gluteus minimus muscle and tendon, piriformis tendon and obturator
internus tendon. Conclusion. The DS approach caused less soft-tissue damage than the DA approach.
However the clinical relevance is unknown. Further clinical outcome
studies, radiographic evaluation of component position, gait analyses
and
