A New Retractor Minimizes Muscle Damage and Reduces Total Hip Arthroplasty-related Inflammatory Response via Direct Anterior Approach

Abstract

Abstract Background Total hip arthroplasty (THA) is the most effective treatment for severe hip disease. Orthopedic surgeons prefer using the Direct Anterior Approach (DAA) technique for THA as it is muscle-sparing and less invasive for the hip joint. It is noted that muscular damage, especially to the tensor fascia lata muscle (TFLM), elicits an inflammatory response, negating DAA's beneficial effects. To prevent damage to the TFLM and reduce inflammation during surgical procedures, a specialized retractor was explicitly developed and intended for use during the operation. Purpose To investigate whether the new retractor may reduce muscle injury and post-operative inflammation. Methods Fifty-six patients undergoing DAA-based THA were randomly divided into two groups. The observation group used the new retractor to prevent muscle strain during femur lifting. In the control group, gauze was the only protection during the surgery. The two groups were compared over time by measuring their C-reactive protein (CRP), interleukin-6 (IL-6), and creatine kinase (CK) serum levels. The Harris hip score and the visual analog scale (VAS) were used to assess the difference between the two groups. Result No significant differences were found in the CRP, IL-6, and CK pre-operative levels. Moreover, the observation group exhibited significantly lower serum levels of the tested parameters than the control group on days 1, 3, and 5 post-operation (p < 0.05). Additionally, the VAS score in the control group was significantly lower than in group A (p < 0.05). A month post-surgery, the Harris score of the control group exhibited a significantly greater value than the observation group (p < 0.05). However, no significant differences were observed at 3 and 6 months post-surgery. Conclusion Utilizing the self-designed retractor system in DAA THA mitigates the risk of muscle damage and reduces the extent of post-operative inflammatory reaction.