Sato Ryuichi, Sugiyama Hajime, Matsushita Yohei, Kanno Tatsuya, Kashihara Yasunori, Tonotsuka Hisahiro, Hayama Tetsuo, Saito Mitsuru
Department of Orthopaedic Surgery, Kanagawa Rehabilitation Hospital, Kanagawa, 243-0121, Japan.
Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, 105-8461, Japan.
J Orthop. 2025 May 21;66:225-231. doi: 10.1016/j.jor.2025.05.029. eCollection 2025 Aug.
For total hip arthroplasty (THA), minimally invasive surgery (MIS) has been reported to enhance early functional recovery. The conjoined tendon-preserving posterior (CPP) approach is a posterior MIS-THA technique designed to minimise muscle-tendon dissection while preserving the piriformis muscle, conjoined tendon, and the joint capsule covered by the conjoined tendon. This approach is expected to facilitate early postoperative functional recovery; however, clinical outcomes remain unreported. This study aimed to evaluate the impact of muscle preservation on walking ability by comparing THA performed using the CPP and posterolateral (PL) approaches through gait analysis and patient-reported outcome measures (PROMs).
Seventy-two patients who underwent THA with preoperative and postoperative gait analyses were included. To minimise physical bias, sex, age, height, and weight were matched between groups using propensity score matching, resulting in 14 participants per approach. Walking velocity, cadence, step length, and hip motion angle were assessed preoperatively, as well as at 3, 6, and 12 months postoperatively. Additionally, PROMs were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) at each time point.
At 3 months postoperatively, the CPP group exhibited significantly higher walking velocity (CPP: 120.4 ± 17.1 cm/s; PL: 103.2 ± 22.5 cm/s, = 0.041) and cadence (CPP: 118.0 ± 6.1 steps/min; PL: 110.3 ± 9.4 steps/min, = 0.012) compared to the PL group. However, no significant differences were observed after 6 months. Among the JHEQ scores, only the 'movement' domain was significantly higher in the CPP group at 3 months, mirroring the gait analysis results, with no significant differences thereafter.
Compared to the PL approach, the CPP approach enhanced walking velocity, cadence, and movement-related PROMs during the early postoperative period of up to 3 months.
对于全髋关节置换术（THA），据报道微创手术（MIS）可促进早期功能恢复。保留联合肌腱的后方入路（CPP）是一种后方MIS-THA技术，旨在尽量减少肌腱肌肉的分离，同时保留梨状肌、联合肌腱以及联合肌腱覆盖的关节囊。预计该入路将有助于术后早期功能恢复；然而，尚无临床结果报告。本研究旨在通过步态分析和患者报告结局指标（PROMs），比较采用CPP和后外侧（PL）入路进行的THA，评估保留肌肉对步行能力的影响。
纳入72例行THA且术前行术后步态分析的患者。为尽量减少身体偏差，采用倾向得分匹配法使两组间的性别、年龄、身高和体重相匹配，每种入路各有14名参与者。术前以及术后3、6和12个月评估步行速度、步频、步长和髋关节运动角度。此外，在每个时间点使用日本骨科协会髋关节疾病评估问卷（JHEQ）评估PROMs。
术后三个月，与PL组相比，CPP组的步行速度（CPP：120.4±17.1cm/s；PL：103.2±22.5cm/s，P=0.041）和步频（CPP：118.0±6.1步/分钟；PL：110.3±9.4步/分钟，P=0.012）显著更高。然而六个月后未观察到显著差异。在JHEQ评分中，仅“活动”领域在术后三个月时CPP组显著更高，与步态分析结果一致，此后无显著差异。
与PL入路相比，CPP入路在术后长达三个月的早期阶段提高了步行速度、步频和与活动相关的PROMs。
