Effect of the surgical approach on the incidence of nerve injury in patients with Crowe IV hip dysplasia undergoing total hip arthroplasty: a comparison between the direct anterior and the posterior approaches.

IF 1.3 4区医学 Q3 ORTHOPEDICS

HIP International Pub Date : 2025-06-27 DOI:10.1177/11207000251349739

Yanbo Zhang, Junying He, Bo Liu, Hui Bu

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引用次数: 0

Abstract

Background: Nerve injury is a major complication of total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH), and its incidence is influenced by the type of surgical approach used. The aim of this study was to compare the recently developed direct anterior approach (DAA) and the classic posterior approach (PA) regarding the characteristics of nerve injuries in Crowe IV DDH patients.

Methods: A total of 149 Crowe IV DDH patients who underwent THA were retrospectively included and divided into 2 groups based on surgical approach (DAA: 68 patients and PA: 81 patients). Postoperatively, the nerve injury was evaluated both clinically and electrophysiologically. The incidence, severity and prognosis of nerve injuries and involved nerves were compared and analysed.

Results: The overall incidence of nerve injury was 30.88% (21/68) for the DAA and 29.63% (24/81) for the PA (p = 0.868). The incidence of motor nerve injury (12.35%, 10/81) was higher with the PA than with the DAA (2.94%, 2/68, p = 0.036). The sciatic nerve was more commonly injured when the PA was performed (overall incidence: 27.16% vs. 8.82%, p = 0.004). In contrast, nerve injuries with the DAA mainly affected the femoral nerve (overall incidence: 25.00% vs. 11.11%, p = 0.026). The independent risk factors for symptomatic nerve injury were previous surgical history (OR 7.075) and body mass index (OR 1.598) for the DAA and previous surgical history (OR 9.143), surgical time (OR 1.029) and amount of limb lengthening (OR 1.104) for the PA.

Conclusions: Patients undergoing THA due to osteoarthritis secondary to Crowe IV DDH can be operated on with a DAA. However, there is an increased incidence of femoral nerve injury when compared to the posterior approach. To prevent symptomatic nerve injury, the DAA should not be used in obese patients and might require more extensive intraoperative soft-tissue release.

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手术入路对Crowe IV型髋关节发育不良患者行全髋关节置换术后神经损伤发生率的影响：直接前路与后路的比较

背景：神经损伤是Crowe IV型发育不良髋关节（DDH）患者全髋关节置换术（THA）的主要并发症，其发生率受手术入路类型的影响。本研究的目的是比较最近发展的直接前路入路（DAA）和经典后路入路（PA）关于Crowe IV DDH患者神经损伤的特征。方法：回顾性分析149例行THA的Crowe IV DDH患者，根据手术入路分为两组（DAA组68例，PA组81例）。术后对神经损伤进行临床和电生理评价。比较分析两组神经损伤及受累神经的发生率、严重程度及预后。结果：DAA组总神经损伤发生率为30.88% (21/68)，PA组总神经损伤发生率为29.63% (24/81)（p = 0.868）。PA组运动神经损伤发生率（12.35%,10/81）高于DAA组（2.94%,2/68,p = 0.036）。坐骨神经损伤在PA手术中更为常见（总发生率：27.16% vs. 8.82%, p = 0.004）。DAA神经损伤主要累及股神经（总发生率：25.00% vs. 11.11%, p = 0.026）。症状性神经损伤的独立危险因素为DAA既往手术史（OR 7.075）和体重指数（OR 1.598）， PA既往手术史（OR 9.143）、手术时间（OR 1.029）和肢体延长量（OR 1.104）。结论：Crowe IV DDH继发性骨关节炎患者行THA手术可采用DAA。然而，与后路入路相比，股骨神经损伤的发生率增加。为了防止症状性神经损伤，DAA不应用于肥胖患者，可能需要更广泛的术中软组织释放。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIP International 医学-整形外科

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

2 months

期刊介绍： HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology