Preserving the medial arm of the iliofemoral ligament in total hip arthroplasty using the anterolateral approach: Surgical outcomes and patient-reported outcome measure with 2 years follow-up

Abstract

Purpose

Iliofemoral ligament (ILFL) is a capsular ligament located in the anterosuperior part of the hip joint capsule and contributes to hip joint stability. The purpose of this study was to compare the surgical outcomes of resection versus preservation procedure of the medial arm of the ILFL in total hip arthroplasty (THA) using the anterolateral approach.

Methods

Perioperative outcomes, complication, implant placement and patient-reported outcome measures (PROMs) were evaluated in 42 patients in the resection group and 38 patients in the preservation group. As a PROM, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), was administered at 6 months, 1 year and 2 years postoperatively.

Results

There was no significant difference in perioperative outcomes, complication and implant placement between the two groups. Satisfaction for the hip joint condition (80.6 ​± ​22.4 vs 89.2 ​± ​20.1), JHEQ pain score (21.5 ​± ​4.5 vs 24.1 ​± ​5.2) at 6 months, and JHEQ pain score (21.6 ​± ​5.1 vs 23.5 ​± ​5.5) at 1 year were significantly better in the preservation group than in the resection group. At 2 years postoperatively, no significant difference was found in PROMs between the two groups.

Conclusion

Our results indicate that preservation of the medial arm of the ILFL in THA improves pain during the first postoperative year without increased complications or disadvantages of implant placement. Preserving the medial arm of the ILFL may be a safe and effective option to improve the early clinical outcomes after THA using the anterolateral approach.