Evaluating the Clinical Outcomes and Biomechanical Advantages of the Piriformis Muscle-Sparing Posterior Approach in Total Hip Replacement: A Comparative Study
Submission: 20 July 2025 | Acceptance: 25 September 2025 | Publication: 11 November 2025
1Dr Muhammad Arshad Ghani, 2Dr.Abdul Basit, 3Dr Yasir Mustafa, 4Dr. Mohammed Akhtar Khan
1Consultant Orthopedic and spine Surgeon Jinnah hospital Lahore
2Consultant Orthopedic Surgeon Govt.Aziz Bibi THQ hospital Roshan Bheela Kasur
3Consultant Orthopedic surgeon, Social security hospital manga-raiwind road
4Consultant Surgeon/ Head of the Department of Orthopedics, NSHS SZABIST
ABSTRACT:
Background: The posterior approach in total hip replacement (THR) is widely used; however, concerns about postoperative stability and muscle damage remain. The piriformis muscle-sparing technique has been proposed to preserve biomechanical function and reduce complications.
Aim: This study aimed to evaluate the clinical outcomes and biomechanical advantages of the piriformis muscle-sparing posterior approach in THR compared to the conventional posterior approach. Methods: A comparative study was conducted at Services Hospital, Lahore, from October 2023 to September 2024. A total of 50 patients undergoing THR were included and divided into two groups: the piriformis-sparing approach (n=25) and the conventional posterior approach (n=25). Clinical outcomes were assessed using the Harris Hip Score (HHS) and postoperative pain levels. Biomechanical advantages, including gait analysis and hip stability, were also evaluated.
Results: Patients in the piriformis-sparing group demonstrated significantly higher HHS scores at three and six months postoperatively (p<0.05). Pain levels were lower in this group compared to the conventional approach. Gait analysis revealed improved hip stability, with a lower incidence of postoperative limp and dislocations. The preservation of the piriformis muscle contributed to enhanced early mobility and faster recovery.
Conclusion: The piriformis muscle-sparing posterior approach in THR resulted in superior clinical outcomes and biomechanical advantages compared to the conventional approach. This technique enhanced early functional recovery, reduced postoperative complications, and improved overall hip stability. Further research with larger sample sizes is recommended to validate these findings. Keywords: Total hip replacement, piriformis muscle-sparing, posterior approach, hip stability, clinical outcomes, biomechanics, functional recovery.