Work

Iatrogenic tensor fascia lata damage during direct anterior approach total hip arthroplasty: a prospective study of frequency, timing, and risk factors

Year: 2026

Type: article

Abstract: The tensor fascia lata (TFL) muscle is prominent during the direct anterior approach (DAA) for THA and can be injured. This study aimed to determine patient or procedure-related risk factors for damage. One hundred consecutive THAs from November 2024 through March 2025 performed by a fellowship-trained surgeon were prospectively observed. Patient demographics and intraoperative data including choice of femoral fixation, and amount, location, and timing of TFL damage were collected. Femoral neck-shaft angle, femoral neck length, and iliac wing width relative to the femoral intramedullary canal were measured using preoperative radiographs. Iatrogenic TFL damage was classified as none (0%), minimal (< 10%), moderate (10–20%), and severe (> 20%). A multivariate linear regression determined if patient demographics, operative variables, or pelvic anatomy correlated with damage. Ninety-two of 100 cases (92%) demonstrated minimal to no TFL damage. Seven (7%) cases had moderate and one (1%) had severe damage. Five (71%) of the moderately damaged TFLs occurred during femoral exposure/preparation, while the other two (29%) occurred during femoral neck cut/head removal. The one severely damaged TFL also occurred during neck cut/head removal. A varus femoral neck-shaft angle ( P = 0.006), wide iliac crest ( P = 0.001), and choice of cemented femoral fixation ( P < 0.001) were associated with TFL damage (R 2 = 0.326, F(7, 92) = 5.72, P < 0.001). Severe TFL damage was uncommon in this exploratory single-surgeon series using a careful protective technique. A wide iliac wing, varus femoral neck-shaft angle, and cemented femoral stem were associated with increased risk of TFL damage.

Source: Journal of Orthopaedic Surgery and Research

DOI: 10.1186/s13018-026-07228-x

Authors: Catelyn A. Woelfle, Krithi Pachipala, Alexander L. Neuwirth, H. John Cooper

Institution: Columbia University Irving Medical Center

Language: English

Topic: Orthopaedic implants and arthroplasty

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090