Optimising femoral head extraction to preserve the tensor fasciae latae in direct anterior hip arthroplasty: a technical note.

Abstract

The direct anterior approach (DAA) in total hip arthroplasty is widely recognised for its muscle-sparing advantages; however, it remains associated with a notable risk of injury to the tensor fasciae latae muscle (TFL), particularly during femoral head extraction. This report introduces a structured, stepwise extraction technique specifically designed to minimise TFL trauma during DAA procedures. The method utilises a Schanz pin and a corkscrew, prioritising controlled longitudinal traction while minimising lateral shear forces to preserve the structural integrity of the TFL. A total of 63 hip arthroplasties were performed, including 31 total hip arthroplasties (THAs) and 32 bipolar hemiarthroplasties (BHAs). In the THA group, the mean patient age was 51.15 ± 12 (range 36-73) years. Of these, 23 hips were classified as Ficat and Arlet stage III and 8 as stage IV. The TFL damage score during femoral head extraction was 0 in 28 hips and 1 in 3 hips. In the BHA group, the mean patient age was 76.14 ± 6.8 (range 70-87) years, and the TFL damage score was 0 in all cases. This approach is straightforward, reproducible, and safe, offering a practical adjunct for optimizing soft tissue preservation in routine DAA hip arthroplasty.