Maldonado David R, Glein Rachel M, Annin Shawn, Owens Jade S, Jimenez Andrew E, Saks Benjamin R, Lall Ajay C, Domb Benjamin G
Orthopedics. 2023 Jan-Feb;46(1):39-46. doi: 10.3928/01477447-20221003-09. Epub 2022 Oct 6.
Outcomes following total hip arthroplasty (THA) with concomitant gluteus medius (GM) repair using the direct anterior approach (DAA) are scarce. The primary purpose of this study was to report patient-reported outcome measures (PROMs) with 2-year follow-up of patients with osteoarthritis and GM tear who underwent primary THA and GM repair through the DAA. The secondary purpose was to compare these outcomes with a benchmark propensity-matched control group who underwent a DAA THA without GM tear. Patients were eligible if they received a primary THA and GM repair via the DAA between January 2015 and October 2018 and had baseline PROMs with 2-year follow-up. Patients were excluded if they had workers' compensation or were unwilling to participate. PROM subanalysis was performed between patients and a propensity-matched control group with DAA THA without GM tear. Fourteen patients were included in the study, all of whom were female. Significant improvement for all PROMs and high rate of achieving the minimal clinically important difference (MCID) at 2-year follow-up were reported. All patients were propensity-matched to 28 patients for sex, age, and body mass index. Preoperative PROMs between groups were similar, and both groups reported comparable improvement, satisfaction, and MCID achievement at 2-year follow-up. Primary THA with concomitant GM repair using the DAA yielded good functional outcomes and a high rate of MCID achievement at 2-year follow-up. Based on these results, the DAA can be used safely to address symptomatic GM tears during THA. Furthermore, these outcomes were comparable to a propensity-matched control group without GM tear. [. 2023;46(1):39-46.].
采用直接前路（DAA）行全髋关节置换术（THA）并同时修复臀中肌（GM）的相关研究结果较少。本研究的主要目的是报告骨关节炎合并GM撕裂且通过DAA进行初次THA和GM修复患者的2年随访患者报告结局指标（PROMs）。次要目的是将这些结果与未发生GM撕裂而行DAA THA的倾向评分匹配对照组进行比较。如果患者在2015年1月至2018年10月期间通过DAA接受初次THA和GM修复且有基线PROMs并进行了2年随访，则符合纳入标准。如果患者有工伤赔偿或不愿意参与，则被排除。对患者与未发生GM撕裂而行DAA THA的倾向评分匹配对照组进行了PROM亚分析。本研究共纳入14例患者，均为女性。报告了所有PROMs在2年随访时均有显著改善且达到最小临床重要差异（MCID）的比例较高。所有患者在性别、年龄和体重指数方面与28例患者进行了倾向评分匹配。两组术前PROMs相似，且两组在2年随访时报告的改善程度、满意度和MCID达成情况相当。采用DAA同时修复GM的初次THA在2年随访时产生了良好的功能结局且MCID达成率较高。基于这些结果，在THA期间使用DAA可安全地处理有症状的GM撕裂。此外，这些结果与无GM撕裂的倾向评分匹配对照组相当。[. 2023;46(1):39 - 46.]
