Ozawa Yuto, Osawa Yusuke, Seki Taisuke, Takegami Yasuhiko, Iida Hiroki, Funahashi Hiroto, Imagama Shiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Orthop Surg. 2025 Jan;17(1):53-61. doi: 10.1111/os.14194. Epub 2024 Nov 26.
The conjoined tendon-preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short-term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA.
This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow-up. Assessment tools included operative times, blood loss, preoperative and last follow-up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi-square tests and T-tests.
The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups.
Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.
保留联合肌腱的后方（CPP）入路是全髋关节置换术（THA）的一种改良后方入路，可保留短外旋肌和大部分坐骨股骨韧带。本研究的目的是比较THA中CPP入路和后方入路的短期临床结果、并发症及影像学评估。
这项回顾性研究纳入了2018年5月至2021年9月的83例患者：36例患者（42髋）采用CPP入路行THA（CPP组），47例患者（60髋）采用标准后方入路行THA（PA组），随访至少2年。评估工具包括手术时间、失血量、术前和末次随访时的Harris髋关节评分（HHS）、术后并发症以及两组间的假体植入角度。采用卡方检验和T检验进行统计学分析。
与PA组相比，CPP入路的手术时间明显更长，失血量更大。两组术前和术后的HHS无显著差异。考虑并发症方面，PA组有1例脱位和1例感染，CPP组有2例坐骨神经麻痹，但差异无统计学意义。两组间髋臼前倾角、倾斜度和股骨柄前倾角无显著差异。
功能结果、并发症发生率和假体植入角度与后方入路相当，CPP入路有可能降低术后脱位的发生率。然而，在早期开展CPP入路时应密切关注坐骨神经麻痹，且本研究未表明CPP入路明显优于后方入路。
