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Chughtai M, Samuel LT, Acuña AJ, Kamath AF. Algorithmic soft tissue femoral release in anterior approach total hip arthroplasty. Arthroplast Today 2019; 5:471-476. [PMID: 31886391 PMCID: PMC6921189 DOI: 10.1016/j.artd.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/13/2019] [Accepted: 10/20/2019] [Indexed: 01/29/2023] Open
Abstract
Although the anterior approach for total hip arthroplasty has gained increasing utilization, some studies have suggested a higher risk of femoral complications, as well as difficulty with femoral exposure. Techniques of soft tissue releases have been described to offer better femoral exposure, and to help mitigate complications. The purpose of the study is to describe an algorithmic soft tissue femoral release in direct anterior approach total hip arthroplasty and to assess the clinical outcomes of patients upon which this algorithm of femoral soft tissue releases was utilized. Clinical outcomes with the Harris Hip Score, reoperation rates, component survivorship, and complications were analyzed.
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Affiliation(s)
- Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Yadav CS, Mittal S, Singh S, Gamanagatti S, Anand S, Kumar A. A novel single myocapsular sleeve (SMS) repair technique to reduce dislocation in posterior approach to the hip: A clinico-radiographic study. J Clin Orthop Trauma 2019; 10:S247-S251. [PMID: 31700214 PMCID: PMC6823894 DOI: 10.1016/j.jcot.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To assess a new modification of posterior approach to the hip and its effect on stability and functional outcome in total hip arthroplasty. MATERIAL & METHODS A comparative retrospective study was done to assess the functional outcome and rate of dislocation among 233 hips (Group A) operated by conventional posterior approach and 567 hips (Group B) by our novel modified posterior approach. In this technique, 2-3 stay sutures are applied in external rotators, then a single conjoint-myocapsular sleeve is raised linearly over the capsule with adherent fibers of gluteus minimus to piriformis tendon, short rotators and part of quadratus for exposure of femoral head. After inserting the definite prosthesis, upper part of sleeve (capsule, piriformis tendon) is sutured at the lower part of tip of greater trochanter & lower part with lateral trochanteric bone. Fifty patients, using randomised tables, in group B underwent MRI to evaluate the efficacy of the repair at 1 and 12 weeks postoperatively. RESULTS Average Harris hip score at minimum 3.9 year follow up was 83.2 in Group A & 88.7 in Group B. Group B had only one dislocation (0.176%) while Group A had 12 dislocations (5.15%). MRI showed intact repair in 47 patients (94%); fibrous continuity in 2 patients (6%) in group B patients. CONCLUSION Intermediate results shows that this technique provides enhanced stability and improved functional outcome. But more prospective and randomised controlled studies with long term followup are required to confirm its role in prevention of hip dislocations.
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Affiliation(s)
- Chandra Shekhar Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Swapnil Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shivanand Gamanagatti
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sumit Anand
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ashok Kumar
- Department Orthopaedics, Saudi German Hospital, Dubai, United Arab Emirates,Corresponding author.
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Kuijpers MFL, Hannink G, Vehmeijer SBW, van Steenbergen LN, Schreurs BW. The risk of revision after total hip arthroplasty in young patients depends on surgical approach, femoral head size and bearing type; an analysis of 19,682 operations in the Dutch arthroplasty register. BMC Musculoskelet Disord 2019; 20:385. [PMID: 31438921 PMCID: PMC6706879 DOI: 10.1186/s12891-019-2765-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/15/2019] [Indexed: 01/09/2023] Open
Abstract
Background Total hip arthroplasty (THA) is used increasingly in younger patients. There is little knowledge about the effect of THA characteristics on risk of revision, especially in young patients. Therefore, we studied the influence of both patient-related and surgical factors on the risk of revision using data from the Dutch Arthroplasty Registry (LROI). Methods All patients younger than 55 years with a primary THA implanted in the Netherlands between 2007 and 2017 were selected (n = 19,682). The covariates age, sex, primary diagnosis, ASA-classification, surgical approach, fixation method, bearing type, head size and year of surgery were entered into Cox proportional hazards models to calculate hazard ratios for the risk of revision. Results The overall 5-year survival of primary THA was 95.3% (95% CI, 94.9–95.6). Use of the anterior approach resulted in a lower risk of revision than the use of the posterolateral approach (HR: 0.66, 95% CI: 0.47–0.92). THAs with a head diameter ≥ 38 mm had a higher risk of revision (HR: 1.90, 95% CI: 1.33–2.72) than THAs with 32 mm heads. Use of MoM bearings resulted in an increased risk when compared to C-PE (HR: 1.76, 95% CI: 1.27–2.43). Conclusion The risk of revision in patients younger than 55 years depends on surgical approach, head size and bearing type. The anterior approach resulted in a decreased risk of revision, whereas use of ≥38 mm heads and MoM bearings resulted in an increased risk of revision for any reason.
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Affiliation(s)
- M F L Kuijpers
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands.
| | - G Hannink
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen, The Netherlands
| | - S B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - L N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, the Netherlands
| | - B W Schreurs
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands
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Perioperative complications and causes of 30- and 90-day readmission after direct anterior approach primary total hip arthroplasty. J Orthop 2019; 17:69-72. [PMID: 31879477 DOI: 10.1016/j.jor.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/09/2019] [Indexed: 01/03/2023] Open
Abstract
We aimed to report causes of readmission 30 and 90 days following a total hip arthroplasty (THA) using the direct anterior approach (DAA). METHODS Three hundred and two patients (335 hips) underwent a DAA-THA for primary osteoarthritis. RESULTS The main reasons for 30 and 90-day readmission were wound related problems, dislocation (rate: 0.9%) and deep infection. The readmission rates at 30 and 90 days were 1.8% and 2.7%, respectively. Age over 60 years and morbidly obese patients were at risk for complications. CONCLUSION The DAA-THA was associated with low readmission rates. Obesity should be adressed preoperatively.
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Lu Y, Xiao H, Xue F. Causes of and treatment options for dislocation following total hip arthroplasty. Exp Ther Med 2019; 18:1715-1722. [PMID: 31410129 PMCID: PMC6676097 DOI: 10.3892/etm.2019.7733] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
The second most common complication following total hip arthroplasty (THA) is dislocation. The majority of dislocations occur early in the post-operative period and are due to either patient-associated or surgical factors. The patient-associated factors that have been implicated as causes of post-operative dislocation include previous surgery, lumbar spine fusion surgery and/or neurological impairment. The surgical factors include surgical approach, component orientation and prosthetic and/or bony impingement. In order to delineate the cause of the hip instability a thorough history and physical and a radiographic assessment (possibly including advanced imaging) needs to be performed. Approximately two thirds of cases are successfully treated; one third of cases will require surgical treatment (e.g., revision arthroplasty (including constrained liners, the use of elevated rim liners and dual mobility implants or trochanteric advancement). In this review, we discuss the causes leading to dislocation following THA and evaluate the different treatment options available.
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Affiliation(s)
- Yian Lu
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
| | - Haijun Xiao
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
| | - Feng Xue
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
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56
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Gondusky JS, Lee JH. The anterior approach for conversion hip arthroplasty. Arthroplast Today 2019; 5:477-481. [PMID: 31886392 PMCID: PMC6920725 DOI: 10.1016/j.artd.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022] Open
Abstract
Conversion of prior proximal femoral fracture fixation to hip arthroplasty is a fairly common and successful procedure, necessitated by various modes of failure. The procedure is well described utilizing a posterior or anterolateral surgical approach. The anterior approach for total hip arthroplasty has gained in popularity. The approach allows for supine positioning and facilitates live fluoroscopic imaging. We present possible advantages and disadvantages, as well as the surgical technique, of conversion to total hip arthroplasty via the direct anterior approach.
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Affiliation(s)
| | - Jeong H Lee
- Department of Psychiatry and Neurobehavioral Science, University of Virginia Health System, Charlottesville, VA, USA
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Paxton EW, Cafri G, Nemes S, Lorimer M, Kärrholm J, Malchau H, Graves SE, Namba RS, Rolfson O. An international comparison of THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States. Acta Orthop 2019; 90:148-152. [PMID: 30739548 PMCID: PMC6461092 DOI: 10.1080/17453674.2019.1574395] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - International comparisons of total hip arthroplasty (THA) practices and outcomes provide an opportunity to enhance the quality of care worldwide. We compared THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States. Patients and methods - Primary THAs due to osteoarthritis were identified using Swedish (n = 159,695), Australian (n = 279,693), and US registries (n = 69,641) (2003-2015). We compared patients, practices, and implant usage across the countries using descriptive statistics. We evaluated time to all-cause revision using Kaplan-Meier survival curves. We assessed differences in countries' THA survival using chi-square tests of survival probabilities. Results - Sweden had fewer comorbidities than the United States and Australia. Cement fixation was used predominantly in Sweden and cementless in the United States and Australia. The direct anterior approach was used more frequently in the United States and Australia. Smaller head sizes (≤ 32 mm vs. ≥ 36 mm) were used more often in Sweden than the United States and Australia. Metal-on-highly cross-linked polyethylene was used more frequently in the United States and Australia than in Sweden. Sweden's 5- (97.8%) and 10-year THA survival (95.8%) was higher than the United States' (5-year: 97.0%; 10-year: 95.2%) and Australia (5-year: 96.3%; 10-year: 93.5%). Interpretation - Patient characteristics, surgical techniques, and implants differed across the 3 countries, emphasizing the need to adjust for demographics, surgical techniques, and implants and the need for global standardized definitions to compare THA survivorship internationally.
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Affiliation(s)
- Elizabeth W Paxton
- Department of Clinical Analysis, Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, CA, USA; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Correspondence:
| | - Guy Cafri
- Department of Clinical Analysis, Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, CA, USA;
| | - Szilard Nemes
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;
| | - Johan Kärrholm
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Sahlgrenska University Hospital, Gothenburg, Sweden;
| | - Henrik Malchau
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Sahlgrenska University Hospital, Gothenburg, Sweden;
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;
| | - Robert S Namba
- Southern California Permanente Medical Group, Irvine, CA, USA
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Sahlgrenska University Hospital, Gothenburg, Sweden;
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Gromov K, Troelsen A, Modaddes M, Rolfson O, Furnes O, Hallan G, Eskelinen A, Neuvonen P, Husted H. Varying but reduced use of postoperative mobilization restrictions after primary total hip arthroplasty in Nordic countries: a questionnaire-based study. Acta Orthop 2019; 90:143-147. [PMID: 30739539 PMCID: PMC6461082 DOI: 10.1080/17453674.2019.1572291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Mobilization has traditionally been restricted following total hip arthroplasty (THA) in an attempt to reduce the risk of dislocation and muscle detachment. However, recent studies have questioned the effect and rationale underlying such restrictions. We investigated the use of postoperative restrictions and possible differences in mobilization protocols following primary THA in Denmark (DK), Finland (FIN), Norway (NO), and Sweden (SWE). Patients and methods - All hospitals performing primary THA in the participating countries were identified from the latest national THA registry report. A questionnaire containing questions regarding standard surgical procedure, use of restrictions, and postoperative mobilization protocol was distributed to all hospitals through national representatives for each arthroplasty registry. Results - 83% to 94% (n = 167) of the 199 hospitals performing THA in DK, FIN, NO, and SWE returned correctly filled out questionnaires. A posterolateral approach was used by 77% of the hospitals. 92% of the hospitals had a standardized mobilization protocol. 50%, 41%, 19%, and 38% of the hospitals in DK, FIN, NO, and SWE, respectively, did not have any postoperative restrictions. If utilized, restrictions were applied for a median of 6 weeks. Two-thirds of all hospitals have changed their mobilization protocol within the last 5 years-all but 2 to a less restrictive protocol. Interpretation - Use of postoperative restrictions following primary THA differs between the Nordic countries, with 19% to 50% allowing mobilization without any restrictions. There has been a strong tendency towards less restrictive mobilization over the last 5 years.
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Affiliation(s)
- Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark; ,Danish Hip Arthroplasty Registry; ,Correspondence:
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark;
| | - Maziar Modaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Swedish Hip Arthroplasty Register;
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ,Swedish Hip Arthroplasty Register;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Norway;
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Norway;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; ,Finnish Hip Arthroplasty Registry
| | - Perttu Neuvonen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; ,Finnish Hip Arthroplasty Registry
| | - Henrik Husted
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark;
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Miller LE, Martinson MS, Gondusky JS, Kamath AF, Boettner F, Bhattacharyya SK. Ninety-day postoperative cost in primary total hip arthroplasty: an economic model comparing surgical approaches. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:145-149. [PMID: 30799943 PMCID: PMC6370072 DOI: 10.2147/ceor.s196545] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background While primary total hip arthroplasty (THA) is a safe and effective procedure, it is unclear whether choice of surgical approach influences health care cost. Methods We developed an economic model in which patients receiving THA via the anterior approach (AA) by high volume anterior hip surgeons were compared to a propensity-score matched cohort of primary THA cases performed by high volume surgeons that were identified from Medicare claims (Control). Cost elements included the procedure and hospital stay, postacute care, readmission, and outpatient care through 90 days postoperatively. Costs were derived from Medicare claims and adjusted to account for nationwide payer mix. Results Health care costs over 90 days postoperative were $17,763 with AA and $23,969 with Control, a difference of $6,206 (95% CI: $5,210–$7,204) per patient. The cost savings with AA were mainly attributable to lower per-patient costs of the index hospitalization ($13,578 vs $16,017), postacute care ($3,123 vs $6,037), and hospital readmissions ($700 vs $1,584). Conclusion The AA for primary THA was found to lower 90-day health care costs when compared to a matched sample of THA cases. These study findings may be used to inform hospitals and health care payers regarding the cost implications associated with selection of different surgical approaches to primary THA.
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Affiliation(s)
- Larry E Miller
- Miller Scientific Consulting, Inc., Asheville, NC 28803, USA,
| | | | - Joseph S Gondusky
- Department of Orthopaedic Surgery, Jordan-Young Institute, Virginia Beach, VA 23462, USA
| | - Atul F Kamath
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Friedrich Boettner
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA
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Balato G, Barbaric K, Bićanić G, Bini S, Chen J, Crnogaca K, Kenanidis E, Giori N, Goel R, Hirschmann M, Marcacci M, Amat Mateu C, Nam D, Shao H, Shen B, Tarabichi M, Tarabichi S, Tsiridis E, Tzavellas AN. Hip and Knee Section, Prevention, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S301-S307. [PMID: 30348555 DOI: 10.1016/j.arth.2018.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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