1Kamran Chaudhary, 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, docahsanulhaq@gmail.com
4PIMS
5PIMS
Abstract
Background: Total Hip Replacement is described as a safe surgery of reconstructing the hip joint in patients with severe hip joint conditions. In the conventional posterior surgical procedures for THR, considerable amount of muscle is dissected and by this, patients usually experience postoperative muscle weakness and hospitalization period. This review focuses on the piriformis muscle-sparing posterior approach (PMSPA) which tries to retain musculature in theory, thus may give patients better chance at recovery.
Aim: This work aims to assess the efficiencies of PMSPA in THR on patients’ postoperative results, the time required to return to normal activities, and the gains observed over the posterior approach.
Method: In this strategy, a prospective, randomized controlled trial was planned and applied to 200 patients who are candidates for THR for two years. Patients were randomly divided into the PMSPA group and the TPA group. Sample demographic data included age, gender, BMI, DD, and ASA score; intraoperative details were noted and VAS scores, HHS, WOMAC, time to mobilization, and length of the hospital stay and complications. Subsequent evaluation was made after 6 months, 1 year and 2 years of the surgery. The statistical analyses that were used include Independent Samples T-tests, cross tabulations/chi square tests and analysis of variance (repeated measures tests).
Results: PMSPA group had reduced intraoperative blood loss which recorded 350 mL compared to TPA group which recorded 480 mL (P < 0. 01), less postoperative pain which recorded a mean VAS on day one of 4. 2 as compared to 5. 8 in the TPA group (P < 0. As for the long-term results the outcomes were even more favorable for the PMSPA patients, the Harris Hip Scores at 1 and 2 years were significantly higher than those of TS patients (54,5 vs. 40,5; 57 vs. 43, p < 0. 01), and patient satisfaction was also higher (90% compared to 75%, p < 0. The PMSPA group also, experienced less dislocations (1 vs five, p < 0. 05) and had better muscle sparing based on MRI.
Conclusion: The use of the piriformis muscle-sparing posterior approach in the THR procedure substantially improves intraoperative and postoperative results, stimulates better long-term functional recovery, and increases patients’ satisfaction as compared to the standard posterior approach. These findings justify the implementation of PMSPA as a favorable solution to THR practice which can enhance surgical work and patients’ outcomes.
Keywords: Total Hip Replacement, THR, Piriformis Muscle Sparing, Posterior Approach, Postoperative Outcomes, Functional Recovery, Muscle Preservation.
