Piriformis Muscle-Sparing Posterior Approach in Primary Total Hip Arthroplasty: A Comparative Study of Perioperative and Functional Outcomes
1Khurram Ali, 2Nouraiz Shakoor, 3Ahsan Ul haq, 4Ayesha Bano, 5Mobeen Ali
1PIMS
2Senior Registrar Orthopaedics, Madinah Teaching Hospital Faisalabad
3Associate Professor, Orthopaedic Surgery, Mohterma Benazir Bhutto Shaheed Medical College Mirpur Azad Kashmir
4PIMS
5PIMS
Vol: 14/02
Received: January 25, 2024 Accepted: March 02, 2024 Published: May 20, 2024
Abstract
Background: Total hip arthroplasty (THA) is a highly successful procedure for end-stage hip disease. However, the conventional posterior approach involves detachment of short external rotators, including the piriformis muscle, which may contribute to soft tissue trauma and delayed functional recovery. The piriformis muscle-sparing posterior approach has been proposed as a modification to enhance tissue preservation and improve early outcomes.
Objective: This study aimed to compare perioperative, functional, and radiographic outcomes between the piriformis muscle-sparing posterior approach and the conventional posterior approach in primary THA.
Methods: A comparative cohort study was conducted on patients undergoing primary THA using either a piriformis muscle-sparing posterior approach or a conventional posterior approach. Patients were evaluated for perioperative parameters, including operative time, blood loss, and hospital stay. Functional outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Harris Hip Score (HHS). Radiographic parameters and postoperative complications, including dislocation and infection, were also analyzed.
Results: Both groups were comparable in baseline demographic characteristics. The piriformis muscle-sparing group demonstrated favorable early postoperative recovery with lower pain scores and faster improvement in functional outcomes during the early follow-up period. Perioperative variables, including operative time and blood loss, were comparable between groups. Radiographic assessment showed no significant difference in implant positioning, including cup inclination and femoral stem alignment. Complication rates, including dislocation and infection, were similar in both groups.
Conclusion: The piriformis muscle-sparing posterior approach in primary THA is a safe and effective surgical modification that provides comparable perioperative and radiographic outcomes to the conventional posterior approach. It may offer advantages in early postoperative pain reduction and functional recovery without increasing complication risk. Further prospective randomized studies with long-term follow-up are required to confirm these findings.