Determining the incidence of abductor tears in total hip arthroplasty via direct lateral approach: a prospective analysis.

Abstract

Introduction: Each surgical approach for primary THA has unique advantages. The direct lateral approach (DLA) offers increased visualisation of the gluteus medius and minimus tendons and, consequently, has been suggested to facilitate management of intraoperatively identified abductor tears. However, there remains a paucity of data exploring the frequency of abductor tears in patients undergoing primary THA via DLA. The purpose of this prospective study was to: (1) report the incidence of abductor tears in the DLA patients; and (2) identify risk factors for abductor tears in patients undergoing primary THA.

Methods: All patients undergoing primary THA for osteoarthritis via the DLA by 3 high-volume, fellowship-trained arthroplasty surgeons from September 2023 to March 2024 were enrolled. Data on patient demographics and preoperative functional outcome scores were collected. The location, size, and tissue quality for patients with an abductor tear intraoperatively was also recorded. Receiver operating characters (ROC) curve analysis was utilised to determine abductor tear risk factors.

Results: Of the 346 patients included in the analysis, 63 (18.2%) had an abductor tear. There was no difference in BMI, laterality, and preoperative functional outcome scores between groups. However, patients with an abductor tear were more likely to be older (70.1 ± 7.9 versus 65.0 ± 9.5 years, p < 0.001), Women (68.3% vs. 31.7%, p = 0.027), and have a higher age-adjusted Charlson comorbidity index score (4.0 ± 1.7 vs. 3.3 ± 1.9, p = 0.002). Using ROC curve analysis, patients 68 years of age or older were 2.99 times more likely to have a tear identified. Of all tears, 87.3% of tears were at the anterior aspect of the greater trochanter with a mean size of 26.6 ± 12.1 by 12.9 ± 11.5 mm.

Conclusions: In the present study, the incidence of abductor tears in patients undergoing primary THA via the DLA was 18.2%. Future studies are needed to compare the implications of abductor tears encountered in primary THA.