Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty

J Orthop Surg Res. 2021 Aug 10;16(1):485. doi: 10.1186/s13018-021-02644-7.


Background: The anterolateral muscle-sparing total hip arthroplasty (THA) in the supine position is advantageous owing to the very low-dislocation rate and excellent leg length discrepancy control. However, femur exposure is challenging. Although the conjoined external rotators tendon (CERT) release is effective in improving femoral access, the effects on clinical outcomes remain unclear. The purpose of this study was to evaluate the clinical and radiographic results of CERT release in the anterolateral muscle-sparing THA approach.

Methods: The study was performed as a retrospective cohort study and included 85 hips in 85 patients who underwent primary anterolateral THA. Clinical and radiographic outcomes were investigated 6 months and 1 year after THA (CERT-preserved and non-released patients). The Japanese Orthopaedic Association (JOA) hip score, JOA Hip-disease Evaluation Questionnaire (JHEQ), forgotten joint score (FJS), and the 36 short-form questionnaires (SF-36 mental and physical) were evaluated. The leg length discrepancy, cup inclination and stem orientation were evaluated with radiographs.

Results: Among all the included hips, 37 patients (43.5%) retained the CERT, and 48 patients (56.5%) included the released CERT. There were no significant differences in the JOA hip scores, JHEQ, FJF-12 and SF-36 between the released and non-released groups. There were significant differences in sagittal stem alignments between groups.

Conclusion: The CERT release in anterolateral muscle-sparing THA has a limited effect on post-operative clinical outcomes. The CERT release improved the femur exposure and is more invasive than the preserved CERT. We infer that the CERT should be maintained in patients with a wide range of motions, and release the CERT in inadequate femur canal preparation cases.

Keywords: Total hip arthroplasty; conjoined external rotators tendon; patient outcome.

MeSH terms

  • Arthroplasty, Replacement, Hip*
  • Hip Joint / diagnostic imaging
  • Hip Joint / surgery
  • Hip Prosthesis*
  • Humans
  • Leg Length Inequality / diagnostic imaging
  • Leg Length Inequality / etiology
  • Muscles
  • Retrospective Studies
  • Tendons / diagnostic imaging
  • Tendons / surgery
  • Tenotomy
  • Treatment Outcome