Conjoint Tendon Release in Direct Anterior Total Hip Arthroplasty: No Impact on Patient Outcomes

摘要

The direct anterior (DA) approach for total hip arthroplasty (THA) has become increasingly popular. However, femoral access can be more technically challenging in difficult cases as compared with other approaches. Conjoint tendon release can improve proximal femoral exposure, but its effect on patient function and pain has not been studied. This study evaluated the effect of conjoint tendon release on length of stay (LOS), inpatient pain medication requirements, and functional outcomes of patients undergoing DA THA. The authors retrospectively reviewed charts of all primary DA THAs conducted by a single surgeon between August 2012 and July 2015. Patient demographics, bilateral THA cases, intraoperative conjoint tendon or other soft tissue releases, intraoperative complications, LOS, and inpatient pain medication data were evaluated. One-year functional outcome scores, including the Western Ontario and McMaster Universities Osteoarthritis Index and the Harris Hip Scores, were also reviewed. The authors identified 312 primary DA THAs, with 29 concurrent bilateral THAs. The conjoint tendon was released in 180 cases, whereas a tensor fascia lata (TFL) was released for 29 cases. Mean LOS was 1.3 +/- 1.1 days, with patient age (P=.002), bilateral THA (P.001), TFL release (P=.005), and intraoperative complications (P=.002) predictive of LOS. Mean daily morphine equivalent dose narcotic use was 43.2 +/- 48.2 mg, with age being a negative predictor of narcotic use (P=.019). Conjoint tendon release was not predictive of LOS, inpatient pain medication requirements, or outcome scores. Given that conjoint release improves femoral exposure but does not affect LOS or 1-year patient-reported outcomes, intraoperative thresholds for conjoint release should be low.