Velde, K.M. van der (2019) Internal obturator muscle assessment and urinary incontinence in women following total hip arthroplasty: a comparison of two surgical approaches. thesis, Medicine.
Full text available on request.Abstract
Introduction Osteoarthritis (OA) is a common degenerative joint disease and the hip is one of the most frequently affected joints. Over 1 million total hip arthroplasties (THA) are carried out annually worldwide, with more than 90% of these on account of advanced hip OA. Several surgical approaches are described for performing THA, among which the direct lateral approach (DLA) and the posterolateral approach (PA). The most important difference between these two approaches taken into account in this study is that the short external rotators (SER) are tenotomized using PA and are kept intact using DLA. The aim of this study is to investigate the effect of THA using DLA vs. PA on the volume and fatty infiltration of the obturator internus (OI) muscle, one of the SER and on urinary incontinence (UI) in women. Methods 74 patients were selected from a database containing 391 female patients who underwent Metal-on-Metal (MoM) THA in Isala Hospital in Zwolle, the Netherlands, between January 2005 to June 2010. Patients were categorized according to the used surgical procedure (DLA or PA) performing THA. OI muscle volume was measured using the Tumor Tracking tool of Philips IntelliSpace Portal version 9.0 and fatty infiltration was evaluated using the Goutallier scale, both on a postoperative CT scan. UI was assessed using a questionnaire composed of the Urogenital Distress Inventory (UDI), the Defecation Distress Inventory (DDI) and the Incontinence Impact Questionnaire (IIQ). Results DLA patients had a significantly higher OI muscle volume on the operated side on a postoperative CT scan (median follow-up time 6.3 years) than PA patients, median 52.1 cm3 (41.3-58.7) vs. 40.6 cm3 (35.7-46.7) (p=0.005). The ratio of OI muscle volume on the THA side to OI muscle volume of the non-operated side was significantly higher in DLA patients than in PA patients, median 0.90 (0.83-0.96) vs. 0.64 (0.6-071) (p=0.000). All OI muscles on the operated side in the DLA group were scored Goutallier grade 1 (69.2%) or grade 2 (30.8%), whereas in the PA group 13.5% was scored grade 1, 23.0% grade 2, 41.9% grade 3 and 21.6% was scored grade 4 (p=0.000). There were no significant differences in the prevalence of the different types of UI between the DLA and PA group: stress UI p=0.602, urge UI p=0.545 and mixed UI p=1.000. Conclusion Patients who underwent THA using PA have a significantly lower OI muscle volume and significantly more fatty infiltration on postoperative CT scans than patients who underwent THA using DLA. There was no significant difference in self-reported UI after THA between DLA and PA in this study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Under supervision of and Ettema, H.B. M.D. and Boomsma, M.F. and Statistical supervision by and Nijholt, I.M. Ph.D. and Department of Orthopaedics & Department of Radiology, Isala |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1899 |
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