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Han S, Byrd Z, Ismaily SK, Delgadillo LE, Freedhand AM, Rodriguze-Quintana D, Noble PC. Contributions of capsular releases to femoral exposure in total hip arthroplasty via the direct anterior approach. Clin Biomech (Bristol, Avon) 2024; 118:106303. [PMID: 38991405 DOI: 10.1016/j.clinbiomech.2024.106303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND In total hip arthroplasty via the direct anterior approach, appropriate exposure is critical to allow preparation of the femur. The objective of this study was to explore the optimal soft tissue releases needed to allow broaching of the femur through a combination of experimental tests and computer simulations. METHODS Fourteen full-body cadaveric specimens were included in this study. Total hip arthroplasty was performed via the direct anterior approach with the femur at 20° adduction and 20°extension. Soft tissue releases were performed sequentially, namely, the transverse iliofemoral ligament, descending iliofemoral ligament, ischio-femoral ligament, conjoint tendon, and obturator externus. After each release, the femur mobility was assessed by applying a 6 Nm external rotation torque and a 120 N distraction force. Subsequently, using specimen-specific models and models of the broach and handle, the broach passage after each release was simulated, and the release that allowed broach passage was analyzed. FINDINGS The average external rotation after releasing the transverse and descending iliofemoral ligaments increased by 14.1° ± 6.1° and 13.8° ± 5.3°. With subsequent soft tissue releases, the rotational mobility increased incrementally, though the impact decreased. Impingement between the broach passage and the pelvis was mainly at the anterior superior iliac spine and the anterior inferior iliac spine. The volume of impingement decreased from 4.8 ± 4.5 cm3 after resection of the femoral head to 1.8 ± 1.6 cm3 and 1.2 ± 1.9 cm3 after release of the transverse and descending iliofemoral ligament, respectively. INTERPRETATION With sequential soft-tissue releases, the femur mobility increased incrementally. However, the number of releases needed for each femur varied extensively between specimens. Most (10/14) femurs became accessible after the release of the ilio-femoral or ischio-femoral ligament.
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Affiliation(s)
- Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA.
| | - Zackary Byrd
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Adam M Freedhand
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - David Rodriguze-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA; Institute of Orthopedic Research and Education, Houston, USA.
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Ramadanov N, Voss M, Hable R, Prill R, Hakam HT, Salzmann M, Dimitrov D, Diquattro E, Ostojic M, Królikowska A, Becker R. Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis. J Orthop Surg Res 2024; 19:384. [PMID: 38951886 PMCID: PMC11218227 DOI: 10.1186/s13018-024-04852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/13/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT. METHODS PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. RESULTS The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = - 0.60, 95% CI - 1.19 to - 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates. CONCLUSION Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified. LEVEL OF EVIDENCE Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
| | - Maximilian Voss
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mikhail Salzmann
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Dobromir Dimitrov
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Emanuele Diquattro
- Orthopaedics,Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marko Ostojic
- Department of Orthopaedics and Traumatology, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Wroclaw Medical University, Wrocław, Poland
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Nitiwarangkul L, Hongku N, Pattanaprateep O, Rattanasiri S, Woratanarat P, Thakkinstian A. Which approach of total hip arthroplasty is the best efficacy and least complication? World J Orthop 2024; 15:73-93. [PMID: 38293261 PMCID: PMC10824060 DOI: 10.5312/wjo.v15.i1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function. Approaches of the hip have been exhaustively explored about pros and cons. The efficacy and the complications of hip approaches remains inconclusive. This study conducted an umbrella review to systematically appraise previous meta-analysis (MAs) including conventional posterior approach (PA), and minimally invasive surgeries as the lateral approach (LA), direct anterior approach (DAA), 2-incisions method, mini-lateral approach and the newest technique direct superior approach (DSA) or supercapsular percutaneously-assisted total hip (SuperPath). AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials (RCTs). METHODS MAs were identified from MEDLINE and Scopus from inception until 2023. RCTs were then updated from the latest MA to September 2023. This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score (HHS), dislocation, intra-operative fracture, wound complication, nerve injury, operative time, operative blood loss, length of hospital stay, incision length and VAS pain. Data were independently selected, extracted and assessed by two reviewers. Network MA and cluster rank and surface under the cumulative ranking curve (SUCRA) were estimated for treatment efficacy and safety. RESULTS Finally, twenty-eight MAs (40 RCTs), and 13 RCTs were retrieved. In total 47 RCTs were included for reanalysis. The results of corrected covered area showed high degree (13.80%). Among 47 RCTs, most of the studies were low risk of bias in part of random process and outcome reporting, while other domains were medium to high risk of bias. DAA significantly provided higher HHS at three months than PA [pooled unstandardized mean difference (USMD): 3.49, 95% confidence interval (CI): 0.98, 6.00 with SUCRA: 85.9], followed by DSA/SuperPath (USMD: 1.57, 95%CI: -1.55, 4.69 with SUCRA: 57.6). All approaches had indifferent dislocation and intraoperative fracture rates. SUCRA comparing early functional outcome and composite complications (dislocation, intra-operative fracture, wound complication, and nerve injury) found DAA was the best approach followed by DSA/SuperPath. CONCLUSION DSA/SuperPath had better earlier functional outcome than PA, but still could not overcome the result of DAA. This technique might be the other preferred option with acceptable complications.
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Affiliation(s)
- Lertkong Nitiwarangkul
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Orthopaedics Surgery, Police General Hospital, Bangkok 10330, Thailand
| | - Natthapong Hongku
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok 10300, Thailand
| | - Oraluck Pattanaprateep
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sasivimol Rattanasiri
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ammarin Thakkinstian
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Chen P, Liu W, Wu C, Ruan P, Zeng J, Ji W. Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position. BMC Musculoskelet Disord 2023; 24:884. [PMID: 37957622 PMCID: PMC10644644 DOI: 10.1186/s12891-023-07014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE The position of the acetabular and femoral components is critical for stability and wear resistance. The aim of this study is to investigate whether the fluoroscopy-guided direct anterior approach in the supine position (S-DAA) is more helpful in improving the position of acetabular and femoral components than the fluoroscopy-guided direct anterior approach in the lateral decubitus position (L-DAA). METHODS A retrospective analysis of 76 cases of fluoroscopy-guided direct anterior approach total hip arthroplasty (38 cases in the S-DAA and 38 cases in the L-DAA group) was performed in one hospital from 2019 to 2021. The differences in inclination, anteversion, femoral offset (FO), global offset (GO), and leg length discrepancy (LLD) measurements during and after surgery were analyzed. The postoperative femoral offset (FO), global offset (GO), leg length discrepancy (LLD), and preoperative and postoperative Harris hip score were compared between the two groups. RESULTS In the S-DAA group, there were no significant differences in the mean intraoperative inclination angle anteversion angle, FO, GO, and LLD compared to the postoperative values, whereas in the L-DAA group, there were significant differences between the intraoperative and postoperative measurements (P < 0.001, P = 0.009, P<0.001, P<0.001 and P = 0.008, respectively). Additionally, there were significant differences in the accuracy of LLD, FO, and GO between the two groups (P < 0.001). Compared with the L-DAA group, the average differences of inclination, anteversion, LLD, FO, and GO during and after operation in the S-DAA group were smaller, and the consistency was higher. There was a significant difference in Harris hip score between the two groups at 1 week after surgery (P = 0.033). There was no significant difference in Harris hip score between 1 month and 3 months after surgery (P = 0.482 and P = 0.797, respectively). CONCLUSIONS In the supine group, the direct anterior approach (DAA) provides more accurate positioning of the acetabular and femoral components. However, there was no significant difference in hip joint function and activity between the two groups at follow-up.
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Affiliation(s)
- Penglei Chen
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Wangxin Liu
- Chuzhou Hospital of Integrated Chinese and Western Medicine, 788 Huifeng East Road, Langya District, 239000, Chuzhou, Anhui Province, China
| | - Cong Wu
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Pengfei Ruan
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Jicheng Zeng
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Weifeng Ji
- The First Affiliated Hospital of Zhejiang Chinese Medical University, No9,9th Street, Qiantang District, 310020, Hangzhou, Zhejiang Province, China.
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Ang JJM, Onggo JR, Stokes CM, Ambikaipalan A. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2773-2792. [PMID: 37010580 PMCID: PMC10504117 DOI: 10.1007/s00590-023-03528-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce further heterogeneity and bias to the evidence presented. This meta-analysis aims to present level I evidence by comparing functional outcomes, peri-operative parameters and complications of direct anterior approach (DAA) versus posterior approach (PA) or lateral approach (LA) in THA. PATIENTS AND METHODS A comprehensive multi-database search (PubMed, OVID Medline, EMBASE) was conducted from date of database inception to 1st December 2020. Data from randomised controlled trials comparing outcomes of DAA versus PA or LA in THA were extracted and analysed. RESULTS Twenty-four studies comprising 2010 patients were included in this meta-analysis. DAA has a longer operative time (MD = 17.38 min, 95%CI: 12.28, 22.47 min, P < 0.001) but a shorter length of stay compared to PA (MD = - 0.33 days, 95%CI: - 0.55, - 0.11 days, P = 0.003). There was no difference in operative time or length of stay when comparing DAA versus LA. DAA also had significantly better HHS than PA at 6 weeks (MD = 8.00, 95%CI: 5.85, 10.15, P < 0.001) and LA at 12 weeks (MD = 2.23, 95%CI: 0.31, 4.15, P = 0.02). There was no significant difference in risk of neurapraxia for DAA versus LA or in risk of dislocations, periprosthetic fractures or VTE between DAA and PA or DAA and LA. CONCLUSION The DAA has better early functional outcomes with shorter mean length of stay but was associated with a longer operative time than PA. There was no difference in risk of dislocations, neurapraxias, periprosthetic fractures or VTE between approaches. Based on our results, choice of THA approach should ultimately be guided by surgeon experience, surgeon preference and patient factors. LEVEL OF EVIDENCE I Meta-analysis of randomised controlled trials.
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Affiliation(s)
- James Jia Ming Ang
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800 Australia
| | - James Randolph Onggo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800 Australia
- Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
| | - Christopher Michael Stokes
- Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Victoria, Australia
| | - Anuruban Ambikaipalan
- Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Victoria, Australia
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Ramadanov N, Ostojic M, Lazaru P, Liu K, Hable R, Marinova-Kichikova P, Dimitrov D, Becker R. Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials. J Clin Med 2023; 12:5895. [PMID: 37762836 PMCID: PMC10531834 DOI: 10.3390/jcm12185895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To investigate and identify risk factors and predictors for the difference in functional outcome and complications between total hip arthroplasty (THA) through minimally invasive and conventional approaches, using a meta-regression analysis of randomized controlled trials (RCTs). METHODS A systematic review of the literature up to 31 July 2022 was performed. A meta-regression was conducted based on a random effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method. RESULTS A total of 41 RCTs with 3607 patients were found. The following predictors of HHS ≥ 6 months postoperatively were identified: patient age (predictor estimate = 0.14; p < 0.01), avascular necrosis of the femoral head (predictor estimate = -0.03; p = 0.04); incision length (predictor estimate = -0.82; p < 0.01). The following predictors of complication rate were identified: osteoarthritis (predictor estimate = 0.02; p = 0.02); femoral neck fracture (predictor estimate = -0.02; p = 0.02); SuperPATH (predictor estimate = -1.72; p < 0.01). CONCLUSIONS Patient age, avascular necrosis of the femoral head, and incision length were identified as predictors of the effect size of the HHS ≥ 6 months postoperatively; and osteoarthritis, femoral neck fracture, and SuperPATH as predictors of the effect size of the complication rate. Based on these findings, we recommend that more frequent use of minimally invasive THA in elderly patients should be considered. LEVEL OF EVIDENCE I a systematic review of all relevant randomized controlled trials. Registered in PROSPERO on 10 August 2022 (CRD42022350287).
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany;
| | - Marko Ostojic
- Department of Orthopedics, University Hospital Mostar, 88000 Mostar, Bosnia and Herzegovina;
| | - Philip Lazaru
- Department of General and Visceral Surgery, Minimally Invasive Surgery and Coloproctology, St. Marien Hospital, 12249 Berlin, Germany;
| | - Kuiliang Liu
- Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, 75179 Pforzheim, Germany;
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, 94469 Deggendorf, Germany;
| | - Polina Marinova-Kichikova
- Department of Surgical Propaedeutics, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria;
| | - Dobromir Dimitrov
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria;
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany;
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von Hertzberg-Boelch S, Mueller L, Stratos I, Arnholdt J, Holzapfel B, Rudert M. Which patient-specific parameters correlate with operation time for total hip arthroplasty? - A retrospective analysis of the direct anterior approach. INTERNATIONAL ORTHOPAEDICS 2023; 47:1975-1979. [PMID: 37269401 PMCID: PMC10345041 DOI: 10.1007/s00264-023-05841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/14/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The current study aims to identify patient-specific factors that correlate with operation time for total hip arthroplasty (THA) performed via the direct anterior approach (DAA). METHODS In this retrospective study, patient-specific factors were tabulated from the charts and measured from preoperative templating radiographs. These factors were correlated with operation time by bivariate analysis. Significant factors were used for stepwise multiple regression analysis. RESULTS Nine hundred-sixty procedures were included. BMI (R = 0.283), the distance from the superior iliac spine to the greater trochanter (DAA Plane) (R = - 0.154), patients age (R = 0.152) and the abdominal fat flap (R = 0.134) showed the strongest correlations (p < 0.005) with operation time. The multiple regression model including BMI, Kellgren and Lawrence Score, Age, DAA Plane and the Canal to Calcar ratio had the best predictive accuracy (corrected R2 = 0.122). CONCLUSIONS Patient-specific factors that make the entry into the femur difficult correlate significantly with operation time of THA via the DAA.
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Affiliation(s)
- Sebastian von Hertzberg-Boelch
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany.
- LVR Klinik für Orthopädie Viersen, Viersen, Germany.
| | - Laura Mueller
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany
| | - Joerg Arnholdt
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Munich, Germany
| | - Boris Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Munich, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany
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Lin B, Lan Y, Lu Z, Xie S, Lin F, Weng Y, Feng E, Chen J. The compared study about femoral stem malalignment with or without the special curved rasp during DAA total hip arthroplasty. BMC Musculoskelet Disord 2023; 24:319. [PMID: 37087443 PMCID: PMC10122324 DOI: 10.1186/s12891-023-06409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 04/24/2023] Open
Abstract
OBJECTIVE To investigate whether the application of a curved rasp on the femoral side is effective in reducing the incidence of stem malalignment in total hip replacement with direct anterior approach (DAA-THA), followed by the analysis of the independent risk factors affecting stem malalignment. METHODS Retrospective analysis was carried out covering 160 patients undergoing DAA-THA from January 2019 to December 2021, with Tri-Lock (BPS, Depuy) stem applied in all 113 patients were screened according to inclusion and exclusion criteria. The data of gender, age, body mass index, preoperative diagnoses, Dorr classification, FAR ratio, pelvic morphology ratio, WOMAC scores, were analyzed to explore the independent factors influencing the malalignment of the femoral prosthesis implantation. Then data of patients were divided into group A and group B according to whether the curved rasp was taken during the operation. The chi-square test was performed to compare the incidence of femoral stem malalignment between the two groups. RESULTS There revealed two independent risk factors: BMI and FAR ratio that affected femoral stem malalignment. The increased BMI was associated with a higher probability of femoral stem malalignment (P<0.05), the probability of malalignment of femoral stem in FAR ratio<1 was 1.15 times higher than that in FAR>1(OR = 1.15, 95% CI: 1.03-1.28, P<0.05). Further grouping analysis showed that the incidence of femoral stem malalignment in patients with intraoperative application of curved rasp was 27%, while in patients without curved rasp, the incidence of femoral stem malalignment increased significantly to 48.7%(P<0.05). The placement angle of prosthesis in group A was significantly better than that in group B, especially mild femoral stem malalignment (0%) and severe femoral stem malalignment (2.70%), and the difference was statistically significant (P < 0.05). There found no significant difference in age, gander, intraoperative complications and last follow-up assessment of WOMAC scores between the two groups of patients. CONCLUSIONS In DAA-THA, BMI and FAR ratio act as the independent risk factors for femoral stem malalignment. Intraoperative use of a curved rasp significantly reduces the incidence of malalignment of the femoral stem.
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Affiliation(s)
- Bei Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
- The Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Yiping Lan
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Zhiming Lu
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
- The Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Shiwei Xie
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
- The Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Yan Weng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China.
- The Department of Clinical Medicine, Fujian Medical University, Fuzhou, China.
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China.
| | - Jinhua Chen
- Follow-Up Center, Fujian Medical University Union Hospital, Fuzhou, China
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Yan L, Ge L, Dong S, Saluja K, Li D, Reddy KS, Wang Q, Yao L, Li JJ, Roza da Costa B, Xing D, Wang B. Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2023; 6:e2253942. [PMID: 36719679 PMCID: PMC9890287 DOI: 10.1001/jamanetworkopen.2022.53942] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Each approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon's choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and individual patient characteristics. OBJECTIVE To assess the efficacy and safety associated with different surgical approaches for THA. DATA SOURCES A comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022; reference lists of eligible trials; and related reviews. STUDY SELECTION Randomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses. MAIN OUTCOMES AND MEASURES The outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle. RESULTS Of 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years; median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04; 95% CI, 1.92 to 6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43 to 5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05 to 5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60 to 7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87 to 6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58 to 9.42; high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13 to 2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04 to 1.76; moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, -23.85 minutes; 95% CI, -36.60 to -11.10 minutes; high certainty), DAA (MD, -13.94 minutes; 95% CI, -18.79 to -9.08 minutes; moderate certainty), DLA (MD, -10.50 minutes; 95% CI, -16.07 to -4.94 minutes; high certainty), MIS-ALA (MD, -6.76 minutes; 95% CI, -12.86 to -0.65 minutes; moderate certainty), and SuperPath (MD, -13.91 minutes; 95% CI, -21.87 to -5.95 minutes; moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches. CONCLUSIONS AND RELEVANCE In this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.
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Affiliation(s)
- Lei Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Long Ge
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shengjie Dong
- Orthopedic Department, Yantaishan Hospital, Yantai, China
| | - Kiran Saluja
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dijun Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - K. Srikanth Reddy
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- World Health Organization, Geneva, Switzerland
| | - Qi Wang
- Health Policy PhD Program and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Bruno Roza da Costa
- Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Dan Xing
- Arthritis Clinic & Research Center, Peking University People’s Hospital, Peking University, Beijing, China
| | - Bin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Some aspects of the choice of surgical approach for triple pelvic osteotomy in the treatment of hip dysplastic instability in children. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022. [DOI: 10.17816/2311-2905-1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aim - on the basis of clinical and laboratory data, to analyze the degree of muscle injury during triple pelvic osteotomy with various approaches in patients with hip dysplasia
Matherials and methods.
The study included 70 patients aged 12 to 18 years with dysplasia Crowe I grade treated between 2020 and 2021. All children were divided into two groups - I - 35 patients who underwent triple pelvic osteotomy from an anterolateral approach, group II - 35 patients who underwent triple pelvic osteotomy from two approaches (medial and bikini"). In addition to standard radiometry of hip joints, such indicators as the severity of pain syndrome on the VAS scale were evaluated, as well as biochemical analysis of markers of muscle injury (LDH, CPK, creatinine, AST, C-reactive protein) before surgery and on the 3rd and 7th days after surgery.
Results.
The intensity of the pain syndrome according to the questionnaire data was more pronounced (p0.05) in patients who underwent surgery from an anterolateral access, and the values of CPK and C-reactive protein significantly (p0.05) exceeded those in patients who underwent triple pelvic osteotomy from two surgical approaches. The data obtained indicate greater surgical aggression against the muscles of the hip joint area during the anterolateral approch for triple pelvic osteotomy.
Conslusion.
A comparative analysis of the traumaticity of surgical approaches during triple pelvic osteotomy in children with hip dysplasia Crowe I degree, based on the assessment of biochemical indicators of markers of muscle injury and the intensity of pain syndrome in the postoperative period showed that the use of anteriorlateral approach significantly (p0.05) has a greater injury to muscle tissue than the use of two surgical accesses (medial and bikini), as evidenced by significant increases in CPK and CRP in the blood, as well as a more pronounced pain syndrome in the immediate postoperative period.
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11
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Gazendam A, Bozzo A, Ekhtiari S, Kruse C, Hiasat N, Tushinski D, Bhandari M. Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis. Arch Orthop Trauma Surg 2022; 142:2893-2902. [PMID: 34410479 DOI: 10.1007/s00402-021-04131-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The direct anterior approach (DAA) has increased in popularity in recent years. Proponents cite its muscle-sparing approach and purported reduction in pain and improvement in function when compared to the traditional surgical approaches. There remains controversy surrounding the validity of these claims. The objective of this study was to compare the common total hip surgical approaches in terms of pain scores, functional outcomes, opioid use and complications within the first 12 weeks postoperatively. METHODS A network meta-analysis of randomized controlled trials (RCT) comparing postoperative outcomes of different surgical approaches in primary THA up to 12 weeks was performed. PubMed, MEDLINE, Embase, Web of Science and SCOPUS were systematically searched from inception to May 2020. Outcomes included pain scores, functional outcome scores, length of stay (LOS), complications and opioid consumption. RESULTS Twenty-five RCTs (n = 2339) were included. The DAA demonstrated statistically significant improvement in Harris Hip Scores at 6 weeks when compared to the posterior and direct lateral approaches. The DAA reduced pain scores on postoperative day 2 and at 2 weeks compared to the direct lateral approach. The anterolateral approach was found to have a significantly shorter LOS compared to the other major surgical approaches. The differences in functional outcomes or pain scores did not surpass conventional cutoffs for a minimal clinically important difference. CONCLUSION The DAA led to functional improvements at 6 weeks compared to the posterior and direct lateral approaches and reduced postoperative pain compared to the direct lateral approach. However, these improvements failed to reach clinical significance. All major surgical approaches led to large improvements in function by 12 weeks with relatively low complication rates. Whether a short-term statistically significant improvement in function is sufficiently patient important to recommend DAA as a standard remains uncertain.
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Affiliation(s)
- Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Anthony Bozzo
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Colin Kruse
- McMaster Medical School, McMaster University, Hamilton, ON, Canada
| | - Nancy Hiasat
- Near East University Hospital, North Nicosia, Turkey
| | - Daniel Tushinski
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
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12
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Anterior total hip arthroplasty outcomes in the treatment of femoral neck fractures: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Serum biomarkers for the assessment of muscle damage in various surgical approaches in primary total hip arthroplasty: a systematic review of comparative studies. INTERNATIONAL ORTHOPAEDICS 2022; 46:1681-1692. [PMID: 35641792 DOI: 10.1007/s00264-022-05442-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Using serum biomarkers, this systematic review assessed soft tissue injury following different total hip arthroplasty surgical approaches. The purposes were to determine if there is any advantage between the standard and minimal invasive approaches, and to compare tissue damage of the respective surgical approaches using biomarkers such as creatine kinase, myoglobin, c-reactive protein, erythrocyte sedimentation rate, skeletal troponin and interleukins. METHOD A search in Pubmed/MEDLINE, Scopus and Web of Science databases was conducted in October 2021 with the use of PRISMA guidelines. Search items were ("biomarkers" OR "markers" OR "tissue damage" OR "muscle damage") AND "approach" AND ("total hip arthroplasty" OR "total hip replacement"). Inclusion criteria were prospective, randomized, controlled trials or prospective, comparative studies, comparing serum markers for muscle damage in two or more surgical approaches for primary total hip arthroplasty. Exclusion criteria were study protocols, case reports, systematic reviews, meta-analyses, studies in non-English language or without available full text, and studies not recording biomarkers of muscle damage. RESULTS Initial search revealed 508 studies; after subtraction of duplicates, and exclusion criteria, 31 studies remained for analysis. No advantage between different approaches was found when evaluating biomarkers, and no specific biomarkers had a distinct role in tissue damage in total hip arthroplasty. Anterior and minimally invasive approaches were associated with lower values of soft tissue (creatine kinase) and inflammation (c-reactive protein) biomarkers compared to the standard approaches. CONCLUSION Measurement of serum biomarkers after primary total hip arthroplasty for the estimation of tissue damage has unclear or little clinical value. TRIAL REGISTRATION PROSPERO Registration: CRD42022303959.
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Iorio R, Viglietta E, Mazza D, Iannotti F, Nicolosi I, Carrozzo A, Speranza A, Ferretti A. Do serum markers correlate with invasiveness of the procedure in THA? A prospective randomized study comparing direct anterior and lateral approaches. Orthop Traumatol Surg Res 2021; 107:102937. [PMID: 33895386 DOI: 10.1016/j.otsr.2021.102937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Advantages of minimally invasive approaches for total hip arthroplasty are still matter of debate. Serum markers have been assessed as objective method to quantify muscle damage after surgery but in literature ambiguous results have been reported. The aim of this prospective randomized study was to: 1) compare serum markers elevation between a minimally invasive direct anterior approach (DAA) and a direct lateral approach (DLA); 2) to establish a correlation between serum markers increase and other perioperative variables. HYPOTHESIS A lesser elevation of markers could be found in patients who underwent a minimally invasive DAA. PATIENTS AND METHODS Seventy patients were enrolled and randomly divided in two groups according to the type of the approach. All patients were treated with the same implant by the same surgeon and received the same rehabilitation protocol. Demographic data, preoperative Harris Hip Score (HHS) and operative time were recorded. Myoglobin, creatine kinase MB (CK-MB), troponin I, C-reactive protein (CRP), haemoglobin (HB) and pain levels were measured pre- and postoperatively. RESULTS Mean postoperative rise were 524.9±134.6 and 667.8±409.5 for myoglobin, 4.8±2.5 and 6.6±3.7 for CK-MB, and 16.9±5.3 and 15.4±6.4 for PCR, in DAA and DLA groups, respectively. In both groups, postoperatively values were significantly higher than preoperatively (p<0.05). Comparing the two groups, no significant differences in serum markers elevations were found. A significantly lower postoperative pain was found in DAA group than in DLA group (2.9 vs. 4.2 and 2.7 vs. 3.6 in second and third day, respectively (p<0.05)). No significant correlation was present between the serum marker elevations and age, BMI, HHS, operative time, HB or pain levels (p>0.05). CONCLUSION Serum markers of muscle damage and inflammation increased in the postoperative period without significant differences between DAA and DLA, even though overall trend was higher in DLA group. The DAA group had significantly lower levels of postoperative pain. No significant correlation between pain and serum markers levels was found. LEVEL OF EVIDENCE I; randomized study.
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Affiliation(s)
- Raffaele Iorio
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - Edoardo Viglietta
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy.
| | - Daniele Mazza
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - Ferdinando Iannotti
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - Ilaria Nicolosi
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - Alessandro Carrozzo
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - Attilio Speranza
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
| | - Andrea Ferretti
- University of Rome "Sapienza", Sant'Andrea Hospital, via di Grottarossa, 1035, 00189 Rome, Italy
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15
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Ramadanov N, Bueschges S, Lazaru P, Dimitrov D. A meta-analysis on RCTs of direct anterior and conventional approaches in total hip arthroplasty. Sci Rep 2021; 11:20991. [PMID: 34697357 PMCID: PMC8546071 DOI: 10.1038/s41598-021-00405-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022] Open
Abstract
To conduct a systematic review and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional approaches (CAs) in treatment of hip diseases and fractures. We performed a systematic literature search up to March 1, 2021 to identify RCTs, comparing THA through DAA with THA through CAs. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the DerSimonian and Laird method and a random effects model. We calculated odds ratios (ORs) with 95% CIs for dichotomous outcomes, using the Mantel–Haenszel method and a random effects model. Ten RCTs met the criteria for final meta-analysis, involving 1053 patients. Four studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. DAA had a longer operation time than CAs (MD = 17.8, 95% CI 4.8 to 30.8); DAA had similar results compared to CAs for incision length (MD = − 1.1, 95% CI − 4.1 to 1.8), for intraoperative blood loss (MD = 67.2, 95% CI − 34.8 to 169.1), for HHS 3 months postoperatively (MD = 2.4, 95% CI − 0.7 to 5.5), for HHS 6 months postoperatively (MD = 0.8, 95% CI − 1.9 to 3.5), for HHS 12 months postoperatively (MD = 0.9, 95% CI − 0.7 to 2.5), for pain VAS 1 day postoperatively (MD = − 0.9, 95% CI − 2.0 to 0.15), for acetabular cup anteversion angle (MD = − 4.3, 95% CI − 5.2 to − 3.5), for acetabular cup inclination angle (MD = − 0.5, 95% CI − 2.1 to 1.1) and for postoperative complications (OR = 2.4, 95% CI 0.5 to 12.4). Considering the overall results of our meta-analysis, we can conclude that THA through DAA showed similar short-term surgical, functional, radiological outcomes and postoperative complications compared to THA through CAs.
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Affiliation(s)
- Nikolai Ramadanov
- Department of Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
| | - Simon Bueschges
- Faculty of Medicine, Department of Statistics, University of Salamanca, Calle Espejo 2, 37007, Salamanca, Spain
| | - Philip Lazaru
- Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Albert-Schweitzer-Str. 40-44, 14974, Ludwigsfelde, Germany
| | - Dobromir Dimitrov
- Department of Surgical Propaedeutics, Faculty of Medicine, Medical University of Pleven, Bulgaria, ul. Sveti Kliment Ohridski 1, 5800, Pleven, Bulgaria
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16
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Lazaru P, Bueschges S, Ramadanov N. Direct anterior approach (DAA) vs. conventional approaches in total hip arthroplasty: A RCT meta-analysis with an overview of related meta-analyses. PLoS One 2021; 16:e0255888. [PMID: 34428236 PMCID: PMC8384214 DOI: 10.1371/journal.pone.0255888] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Several systematic reviews and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional (including anterior, anterolateral, lateral transgluteal, lateral transtrochanteric, posterior, and posterolateral) approaches (CAs) in treatment of hip diseases and fractures showed contradicting conclusions. Our aim was to draw definitive conclusions by conducting both a fixed and random model meta-analysis of quality randomized controlled trials (RCTs) and by comparison with related meta-analyses. DESIGN We performed a systematic literature search up to May 2020 to identify RCTs, comparing THA through DAA with THA through CAs and related meta-analyses. We conducted risk of bias and level of evidence assessment in accordance with the Cochrane's Risk of Bias 2 tool and with the guidelines of the Centre for Evidence-Based Medicine. We estimated mean differences (MD) with 95% confidence intervals (CI) through fixed and random effects models, using the DerSimonian and Laird method. Heterogeneity was assessed using tau-square (τ2). Our conclusions take into account the overall results from related meta-analyses. RESULTS Nine studies on THA through DAA met the criteria for final meta-analysis, involving 998 patients. Three studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. We came to the following results for THA through DAA compared to THA through CAs: operation time (I2 = 92%, p<0.01; fixed: MD = 15.1, 95% CI 13.1 to 17.1; random: MD = 18.1, 95% CI 8.6 to 27.5); incision length (I2 = 100%, p<0.01; fixed: MD = -2.9, 95% CI -3.0 to -2.8; MD = -1.1, 95% CI -4.3 to 2.0); intraoperative blood loss (I2 = 87%, p<0.01; fixed: MD = 51.5, 95% CI 34.1 to 68.8; random: MD = 51.9, 95% CI -89.8 to 193.5); VAS 1 day postoperatively (I2 = 79%, p = 0.03; fixed: MD = -0.8, 95% CI -1.2 to -0.4; random: MD = -0.9, 95% CI -2.0 to 0.15); HHS 3 months postoperatively (I2 = 52%, p = 0.08; fixed: MD = 2.8, 95% CI 1.1 to 4.6; random: MD = 3.0, 95% CI -0.5 to 6.5); HHS 6 months postoperatively (I2 = 0%, p = 0.67; fixed: MD = 0.9, 95% CI -1.1 to 2.9; random: MD = 0.9, 95% CI -1.1 to 2.9); HHS 12 months postoperatively (I2 = 0%, p = 0.79; fixed: MD = 0.7, 95% CI -0.9 to 2.4; random: MD = 0.7, 95% CI -0.9 to 2.4). We compared our findings with 7 related meta-analyses. CONCLUSIONS Considering the results of our meta-analysis and the review of related meta-analyses, we can conclude that short-term outcomes of THA through DAA were overall better than THA through CAs. THA through DAA had a shorter incision length, a tendency towards a lower pain VAS 1 day postoperatively and better early postoperative functional outcome than THA through CAs. The intraoperative blood loss showed indifferent results. THA through DAA had a longer operation time than THA through CAs.
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Affiliation(s)
- Philip Lazaru
- Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Ludwigsfelde, Germany
| | - Simon Bueschges
- Faculty of Medicine, Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Nikolai Ramadanov
- Department of Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Jena, Germany
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Kaszuba SV, Behrens KM, Anderson CB, Gordon AC. A Workflow Change in Anterior Approach Total Hip Arthroplasty Leads to Improved Accuracy of Biomechanical Reconstruction Without Increased Risk of Complications. Arthroplast Today 2021; 10:99-104. [PMID: 34337115 PMCID: PMC8318915 DOI: 10.1016/j.artd.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background During anterior approach total hip arthroplasty (THA), the femur may be an impediment for acetabular access, pushing reamers proximally and consequently altering the hip center. In an effort to address this, the senior author changed the surgical workflow from acetabulum first (AF) to femur first (FF). The objective of this study was to compare the precision of biomechanical hip reconstruction and clinical outcomes between the FF and AF techniques. Methods This is a retrospective, case-control study of 267 anterior THAs (132 AF and 135 FF). A normal, contralateral hip was used to determine the native biomechanical parameters. Using a calibrated software program, radiographic measurements were performed to calculate the hip center position, femoral offset, global offset, and leg length of the operative and native hips using 2-week postoperative anteroposterior pelvis radiographs. Demographics, operative information, hemoglobin change, and complication data were obtained. Functional outcomes were assessed with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement survey at 1 year postoperatively. Results The groups exhibited similar demographic characteristics. The FF group demonstrated significantly more accurate and more precise reconstruction of horizontal and vertical hip centers, femoral offset, and leg length. There was no significant difference in operative time, hemoglobin change, complication rate, or Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores between groups. Conclusions The FF technique allowed for more accurate and precise reconstruction of the hip center, leg length, and offset in THA than the AF workflow. Furthermore, the FF approach demonstrated no significant differences in complication rate or blood loss, nor in clinical outcomes. Level of Evidence Therapeutic Study Level III.
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Affiliation(s)
- Stephanie V. Kaszuba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Kyle M. Behrens
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Chad B. Anderson
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
| | - Alexander C. Gordon
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
- Corresponding author. Department of Orthopedic Surgery, Illinois Bone & Joint Institute, 9000 Waukegan Road, Suite 200, Morton Grove, IL 60053, USA. Tel.: +1 847-375-3000.
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The Direct Anterior Approach to Primary Total Hip Replacement: Radiological Analysis in Comparison to Other Approaches. J Clin Med 2021; 10:jcm10112246. [PMID: 34064295 PMCID: PMC8196856 DOI: 10.3390/jcm10112246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Total hip arthroplasty (THA) is currently considered the most effective treatment for end-stage hip osteoarthritis (OA). The surgery can be performed via a number of different approaches, including direct anterior (DAA; Smith–Petersen; Hueter), anterolateral (ALA; Watson–Jones), direct lateral (LA; Bauer), posterior (PA; Kocher–Langenbeck), and posterolateral (PLA). There is still a dispute over the optimal technique. The aim of this systematic review was to assess how different surgical approaches toward a THA influence the prosthesis elements’ positioning. We conducted a literature search of Scopus, ScienceDirect, PubMed, Embase, and The Cochrane Library. We evaluated studies in terms of the first author’s name, country, publication year, type of surgical approach being compared to the direct anterior approach, any significant differences at baseline, sample size, and radiographic analysis. A subanalysis of each approach in comparison to the DAA revealed differences in terms of all analyzed implant positioning radiographic parameters. There is still an insufficient number of randomized controlled studies that include radiological analyses comparing THRs (total hip replacements) performed using DAA with other approaches. Implant placement is a crucial step during a THR and surgeons must be aware that the approach they use might impact their judgment on angles and spaces inside the joint and thus alter the implant positioning.
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Ramadanov N, Bueschges S, Liu K, Lazaru P, Marintschev I. Comparison of short-term outcomes between direct anterior approach (DAA) and SuperPATH in total hip replacement: a systematic review and network meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16:324. [PMID: 34016136 PMCID: PMC8136223 DOI: 10.1186/s13018-021-02315-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Two minimally invasive approaches showed some advantages in outcomes compared to conventional approaches (CAs)-the direct anterior approach (DAA) and the supercapsular percutaneously assisted approach in THA (SuperPATH). To the best of our knowledge, DAA and SuperPATH have never been compared, neither in clinical studies, nor in a meta-analysis. To conduct a systematic review and network meta-analysis of randomized controlled trials comparing short-term outcomes of DAA and SuperPATH in total hip joint arthroplasty (THA). METHODS A systematic literature search up to May 2020 was performed to identify randomized controlled trials (RCTs) comparing SuperPATH with CAs and DAA with CAs in THA. We measured surgical, functional, and radiological outcomes. A network meta-analysis, using frequentist methods, was performed to assess treatment effects between DAA and SuperPATH. Information was borrowed from the above-mentioned RCTs, using the CA group as a common comparator. RESULTS A total of 16 RCTs involving 1392 patients met the inclusion criteria, three trials with a level I evidence, 13 trials with a level II evidence. The overall network meta-analysis showed that SuperPATH reduced operation time (fixed effect model: MD = 12.8, 95% CI 9.9 to 15.7), incision length (fixed effect model: MD = 4.3, 95% CI 4.0 to 4.5; random effect model: MD = 4.3, 95% CI 0.2 to 8.4), intraoperative blood loss (fixed effect model: MD = 58.6, 95% CI 40.4 to 76.8), and early pain intensity (VAS 1 day postoperatively with a fixed effect model: MD = 0.8, 95% CI 0.4 to 1.2). The two approaches did not differ in acetabular cup positioning angles and in functional outcome. CONCLUSIONS Our overall findings suggested that the short-term outcomes of THA through SuperPATH were superior to DAA. SuperPATH showed better results in decreasing operation time, incision length, intraoperative blood loss, and early pain intensity. DAA and SuperPATH were equal in functional outcome and acetabular cup positioning.
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Affiliation(s)
- Nikolai Ramadanov
- Clinic for Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
| | - Simon Bueschges
- Faculty of Medicine, Department of Statistics, University of Salamanca, Calle Espejo 2, 37007, Salamanca, Spain
| | - Kuiliang Liu
- Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, Wilferdinger Str. 67, 75179, Pforzheim, Germany
| | - Philip Lazaru
- Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Albert-Schweitzer-Str. 40-44, 14974, Ludwigsfelde, Germany
| | - Ivan Marintschev
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
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Sarraj M, Chen A, Ekhtiari S, Rubinger L. Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review. Hip Int 2020; 30:662-672. [PMID: 31994425 DOI: 10.1177/1120700019900987] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. METHODS The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. RESULTS Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table (n = 4402) and 100.1 ± 32.6 minutes for traction table (n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard (n = 2992) and 531.7 ± 364.3 mL for traction table (n = 2675). Intra-operative fracture rate was 1.3% for standard table (n = 3940) and 1.7% for traction table (n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. CONCLUSION Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.
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Affiliation(s)
- Mohamed Sarraj
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Aaron Chen
- Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Luc Rubinger
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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21
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Tottas S, Tsigalou C, Ververidis A, Kougioumtzis IE, Karaglani M, Tilkeridis K, Chatzipapas C, Drosos GI. Supercapsular Percutaneously Assisted total hip arthroplasty versus lateral approach in Total Hip Replacement. A prospective comparative study. J Orthop 2020; 21:406-415. [PMID: 32921949 DOI: 10.1016/j.jor.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 01/06/2023] Open
Abstract
Background Supercapsular Percutaneously Assisted total hip arthroplasty (SuperPATH approach) is a relatively new minimal invasive approach which has been associated with encouraging postoperative outcomes. The aim of this study is to compare the minimal invasive (MIS) SuperPATHapproach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data. Material and methods Forty eight (48) consecutive patients undergone primary total hip arthroplasty (THA) by the same surgeon (GD), were enrolled in our study. From this study population, the modified Hardinge approach was performed in 23 patients and the SuperPATH approach was performed in 25 patients. Soft tissue impairment was studied based on three representative markers, C-reactive-protein (CRP) and two enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH). We measured these markers 10 min after surgery, on 1st and 2nd postoperative day. The levels of the perceived pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS) score which was registered 6 h, 12 h, 1 day and 2 days postoperatively. The functional and clinical evaluation of the patients was achieved with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9) and neuropathic pain questionnaire (DN-4) 6 months and 1 year postoperatively. The rest of the collected data included patient's age, gender, body mass index (BMI), other comorbitities, the American Society of Anesthiologists score (ASA), Charlson Index score, the pre-operative diagnosis, implant positioning through radiographic evaluation, the type of anesthesia, the days of hospitalization, the operating time, incision length, blood loss and blood transfusion requirements and complication rates. Results SuperPATH approach was related with statistically considerable lower levels of CRP at 10 min (p = 0,001) and at 24 h (p = 0,047) postoperatively, as well as lower LDH levels in all time points postoperatively. It was also associated with shorter incision length (p < 0.001), longer operating time (p < 0.001), higher mean cup inclination p < 0.001, decreased postoperative pain levels the first 6 and 12 h (p < 0.001) and relatively better clinical and functional results 6 months after surgery, but not at 12 months. Conclusion Our study revealed some advantages in favor of the SuperPATH approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is required in order to further elucidate its efficacy.
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Affiliation(s)
- Stylianos Tottas
- Orthopaedics, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
| | - Christina Tsigalou
- Medical-Molecular Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
| | - Athanasios Ververidis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
| | - Ioannis E Kougioumtzis
- Orthopaedics, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
| | - Makrina Karaglani
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, PO Box 68100, Greece
| | - Konstantinos Tilkeridis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
| | - Christos Chatzipapas
- Orthopeadic Department, 492, General Military Hospital of Alexandroupolis, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
| | - Georgios I Drosos
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece
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Vajapey SP, Morris J, Li D, Greco NG, Li M, Spitzer AI. Outcome Reporting Patterns in Total Hip Arthroplasty. JBJS Rev 2020; 8:e0197. [DOI: 10.2106/jbjs.rvw.19.00197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kishimoto Y, Suda H, Kishi T, Takahashi T. A low-volume surgeon is an independent risk factor for leg length discrepancy after primary total hip arthroplasty: a case-control study. INTERNATIONAL ORTHOPAEDICS 2020; 44:445-451. [PMID: 31673739 DOI: 10.1007/s00264-019-04435-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Leg length discrepancy (LLD) is one of the bothersome complications that reduce patient satisfaction after total hip arthroplasty (THA). This study aimed to investigate the independent risk factors of LLD after primary THA. METHODS This is a case-control study of 163 THAs for 163 patients at our institution between April 2015 and March 2018. The relevant data about the general characteristics of the patients (age, sex, body mass index, and diagnosis), surgery (surgical approach, type of femoral stem fixation, and surgeon volume), and radiological findings (Dorr classification and pre-operative LLD) were reviewed to identify the risk factors of ≥ 5 mm post-operative LLD according to radiological measurement and to calculate odds ratios (OR) via logistic regression analysis. RESULTS The median (interquartile) absolute value of post-operative LLD was 3.9 (2.3-7.4) mm, and 57 (35.0%) patients had LLD of ≥ 5 mm. After controlling for possible confounders, a low-volume surgeon was considered the only independent risk factor of post-operative LLD (adjusted OR: 8.26; 95% confidence interval: 3.48, 19.60; P < 0.001). Among the 103 patients performed by high-volume surgeons, 82 (79.6%) had LLD of < 5 mm, whereas among the 60 patients performed by low-volume surgeons, only 24 (40.0%) achieved LLD of < 5 mm (P < 0.001). CONCLUSION A low-volume surgeon is associated with an increased risk of a post-operative LLD after primary THA, and the importance of measurements should be recognized to prevent post-operative LLD and achieve optimal outcomes. Moreover, surgeons must inform patients about the risk of developing LLD pre-operatively.
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Affiliation(s)
- Yuji Kishimoto
- Department of Rheumatology, Tottori Red Cross Hospital, 117 Shotoku-cho, Tottori-shi, Tottori, 680-8517, Japan.
- Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan.
| | - Hiroko Suda
- Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan
| | - Takahiro Kishi
- Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan
| | - Toshiaki Takahashi
- Department of Orthopedic Surgery, Tottori Red Cross Hospital, Tottori, 680-8517, Japan
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Zhao G, Zhu R, Jiang S, Xu N, Bao H, Wang Y. Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial. BMC Musculoskelet Disord 2020; 21:21. [PMID: 31926554 PMCID: PMC6955089 DOI: 10.1186/s12891-019-3035-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. METHODS Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue "pad" created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. RESULTS LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. CONCLUSIONS Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. TRIAL REGISTRATION ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.
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Affiliation(s)
- Gongyin Zhao
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Ruixia Zhu
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Shijie Jiang
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Nanwei Xu
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Hongwei Bao
- Department of Orthopedics, Jingjiang People's Hospital, 28, Zhongzhou East road, Taizhou, China
| | - Yuji Wang
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, China. .,Departments of Orthopedic Surgery and Biochemistry and Molecular Biology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. .,Department of Orthopedics, the Third Affiliated Hospital of Gansu University of Chinese Medicine, 222 Silong Road, Baiyin, 730900, China.
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25
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A meta-analysis comparing the direct anterior with other approaches in primary total hip arthroplasty. Surgeon 2019; 17:291-299. [DOI: 10.1016/j.surge.2018.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/14/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
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Jacobs CA, Kusema ET, Keeney BJ, Moschetti WE. Does the thigh circumference affect the positioning of the acetabular component when using the direct anterior approach in total hip arthroplasty? Bone Joint J 2019; 101-B:529-535. [PMID: 31038997 DOI: 10.1302/0301-620x.101b5.bjj-2018-0847.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. PATIENTS AND METHODS We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the acetabular component, radiological leg-length discrepancy, and femoral offset. The radiological outcomes were considered as continuous and binary outcome variables based on Lewinnek's 'safe zone'. RESULTS Similar trends were seen in all three thigh circumference groups. In multivariable analyses, patients in the largest 20 cm thigh circumference quartile (59 cm to 78 cm) had inclination angles that were a mean of 5.96° larger (95% confidence interval (CI) 2.99° to 8.93°; p < 0.001) and anteversion angles that were a mean of 2.92° larger (95% CI 0.47° to 5.37°; p = 0.020) than the smallest quartile. No significant differences were noted in leg-length discrepancy or offset. CONCLUSION There was an associated increase in inclination and anteversion as thigh circumference increased, with no change in the risk of malpositioning the components. THA can be performed using the DAA in patients with large thigh circumference without the risk of malpositioning the acetabular component. Cite this article: Bone Joint J 2019;101-B:529-535.
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Affiliation(s)
- C A Jacobs
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,New York University Langone Orthopedic Hospital/Insall Scott Kelly Institute, New York, New York, USA
| | - E T Kusema
- Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - B J Keeney
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Berkley Medical Management Solutions, Overland Park, Kansas, USA
| | - W E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
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Haragus H, Deleanu B, Prejbeanu R, Timar B, Levai C, Vermesan D. Cross-cultural adaptation and validation of the Romanian Hip disability and Osteoarthritis Outcome Score for Joint Replacement. Int J Qual Health Care 2019; 31:307-311. [PMID: 30052971 DOI: 10.1093/intqhc/mzy156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/12/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Perform translation, cultural adaptation and psychometric testing of the Romanian translation of the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS_JR). DESIGN Assess construct validity, reliability, internal consistency and reproducibility. SETTING Adults with chronic hip disability prior or at a minimum of 3 months after surgery. PARTICIPANTS Ninety-six patients (22 bilateral) with hip osteoarthritis or who had previous hip replacement or osteosynthesis for a fracture of the trochanteric region. INTERVENTION Complete the HOOS_JR together with the Oxford Hip Score (OHS_RO), Harris Hip Score (HHS) and Euroqol EQ-5D. 57 patients repeated the HOOS_JR after 2 days. MAIN OUTCOME MEASURE Convergent validity using Spearmans's correlation coefficient; Cronbach's alpha coefficient, intraclass correlation coefficient (ICC, two-way mixed effects model) and inter-item correlation matrix and test-retest assessment after 2 days. RESULTS The questionnaire had a high degree of reliability with a Cronbach's α of 0.923 at the initial completion and 0.924 at the second testing. The ICC was 0.923 for average measures for the first form and 0.910 for the second form. The two results were strongly, positively and significantly correlated (rs = 0.859; P < 0.001). The Romanian HOOS_JR strongly, significantly and positively correlated with the OHS_RO (rs = -0.880 initial and rs = -0.803 s; P < 0.001) and HHS (rs = -0.731 initial and rs = -0.654 s; P < 0.001) and moderately, significantly and positively correlated with the EQ-5D Index (rs = -0.580 initial and rs = -0.542 s; P < 0.001) and VAS (rs = -0.500 initial and rs = -0.690 s; P < 0.001). CONCLUSIONS The translated HOOS_JR is a reliable, reproducible and valid measure of function in patients with chronic hip disability.
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Affiliation(s)
- Horia Haragus
- Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, Romania
| | - Bogdan Deleanu
- Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, Romania
| | - Radu Prejbeanu
- Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, Romania
| | - Bogdan Timar
- Department of Functional Sciences, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Codrina Levai
- Legal Department, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Dinu Vermesan
- Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, Romania
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Tottas S, Fiska A, Kougioumtzis I, Ververidis A, Tilkeridis K, Drosos GI. Muscle Damage in Different Approaches in Total Hip Arthroplasty According to Serum Markers. Open Orthop J 2019. [DOI: 10.2174/1874325001913010097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:Total Hip Arthroplasty (THA) is the final treatment of end-stage hip osteoarthritis. Nowadays, THA has become very common, cost- effective and one of the most successful orthopaedic procedures. Recently, surgeons have shifted their interest to approaches according to Minimally Invasive Surgery (MIS). These approaches are either modifications of conventional approaches or they are designed from the beginning as MIS approaches. Muscle damage and soft tissue damage are issues that concern researchers who perform studies on THA.Objective:The aim of this study is to review the literature concerning studies by comparing different approaches using serum and inflammatory markers for muscle and soft tissue damage.Methods:We searched the PubMed database in the English language systematically for clinical studies or reviews, comparing muscle damage according to serum markers between two or more approaches in primary total arthroplasty.Results:In total, twenty-one studies were included in this review. Although the results are controversial, it seems that MIS approaches in most of the studies were related to lower levels of inflammation markers contrasting with conventional approaches. Nevertheless, this difference in muscle damage is not correlated with a difference in functional scores or other perioperative data and clinical outcomes in all studies.Conclusion:The existing literature does not lead to a safe consensus about the superiority of any approach. Therefore, there is still a need for further research with well-designed studies.
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Kyriakopoulos G, Poultsides L, Christofilopoulos P. Total hip arthroplasty through an anterior approach: The pros and cons. EFORT Open Rev 2018; 3:574-583. [PMID: 30595843 PMCID: PMC6275850 DOI: 10.1302/2058-5241.3.180023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients. Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay. No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches. Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes.
Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.
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Affiliation(s)
| | - Lazaros Poultsides
- New York University Langone Orthopedic Hospital, New York University School of Medicine, USA
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30
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Civinini R, Cozzi Lepri A, Carulli C, Matassi F, Villano M, Innocenti M. The anterior-based muscle-sparing approach to the hip: the "other" anterior approach to the hip. INTERNATIONAL ORTHOPAEDICS 2018; 43:47-53. [PMID: 30284607 DOI: 10.1007/s00264-018-4190-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/26/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate safety, efficacy, and learning curves of anterior-based muscle-sparing total hip arthroplasty (ABMS-THA) in the supine position. Furthermore, early functional outcome was evaluated and compared to direct anterior approach (DAA) by measuring surface electromyography (sEMG). METHODS We present a prospective cohort study of 343 hips. The safety and learning curve were assessed by recording operative time and peri-operative adverse events. For assessment of efficacy, functional and radiological outcomes were evaluated. A selected group of 32 patients have been studied by sEMG and compared to a matched group of 32 patients who received a THA using DAA approach. RESULTS There was one dislocation (0.3%); two (0.6%) patients had an intra-operative fractures of the greater trochanter; two patients (0.6%) experienced a self-limited femoral nerve palsy. Physical therapy milestones for hospital discharge were reached on an average of 1.7 days. sEMG showed that ABMS and DAA have a similar muscle recruitment pattern and functional recovery after THA. One patient was revised for infection, 16 were lost, and 326 hips were available with a median follow-up of 42 months (range 24-60). The mean Harris Hip Score (HSS) increased from 44.3 to 91.9. Ninety-six percent of the hips had a leg length discrepancy (LLD) < 5 mm. There were no radiological signs of mechanical loosening or osteolysis. CONCLUSIONS The ABMS approach in the supine position is clinically effective and safe; special advantages include a very low dislocation rate and a great control of LLD.
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Affiliation(s)
- Roberto Civinini
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy.
| | - Andrea Cozzi Lepri
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Marco Villano
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
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Radoicic D, Zec V, Elassuity WI, Azab MA. Patient's perspective on direct anterior versus posterior approach total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 42:2771-2775. [PMID: 29858616 DOI: 10.1007/s00264-018-4002-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Total hip arthroplasty approach comparison focused on patient's perspective. The direct anterior approach (DAA) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome. However, the question if the level of DAA promotion is justified seems to be rarely posed. METHODS A single-surgeon consecutive series of patients who underwent bilateral THA, one in DAA and the other in posterior approach (PA). The same implant design and same component sizes were used for the both sides. All the operations were performed by a single surgeon under the same pre- and post-operative care protocol. RESULTS Twenty-one patients underwent bilateral THA, mean age 60.09 years. Oxford Hip Score (OHS) was used for functional outcome assessment. There were no statistically significant differences between two approaches in terms of functional outcome (mean OHS for DAA series was 42.95 and that for the PA was 43.38, p 0.07 at an alpha level of 0.05). Fifteen patients gave the advantage to PA, and six patients favoured DAA. CONCLUSION By study design, we tried to reduce the biases and acquire approach appraisal from patient's perspective. We anticipated the outcome in favour of DAA, but the results favoring PA came as a surprise. Future prospective randomized studies on evaluation of DAA and other approaches not only from surgeon's or industry's point of view, performed on a larger and more uniform groups, are warranted to further explore the subjective differences between DAA and PA.
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Affiliation(s)
- Dragan Radoicic
- Orthopedic Surgery and Traumatology Clinic, Military Medical Academy, Belgrade, Serbia.
| | - Vladimir Zec
- Orthopedic Surgery and Traumatology Clinic, Military Medical Academy, Belgrade, Serbia
| | - Walaa Ikram Elassuity
- Exeter Bone&Joint, Abu Dhabi, United Arab Emirates.,Exeter Bone&Joint, Dubai, United Arab Emirates
| | - Mostafa Abdelmaboud Azab
- Exeter Bone&Joint, Abu Dhabi, United Arab Emirates.,Exeter Bone&Joint, Dubai, United Arab Emirates
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