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Peuchot H, Jacquet C, Fabre-Aubrespy M, Ferguson D, Ollivier M, Flecher X, Argenson JN. No benefit of direct anterior over posterolateral approach in total hip arthroplasty using dual-mobility acetabular component for femoral neck fracture. Bone Joint J 2024; 106-B:133-138. [PMID: 38688506 DOI: 10.1302/0301-620x.106b5.bjj-2023-0832.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in femoral neck fractures (FNFs). In osteoarthritis, the direct anterior approach (DAA) has been promoted for improving early functional results compared with the posterolateral approach (PLA). The aim of this study was to compare these two approaches in FNF using DMC-THA. Methods A prospective continuous cohort study was conducted on patients undergoing operation for FNF using DMC by DAA or PLA. Functional outcome was evaluated using the Harris Hip Score (HHS) and Parker score at three months and one year. Perioperative complications were recorded, and radiological component positioning evaluated. Results There were 50 patients in the DAA group and 54 in the PLA group. The mean HHS was 85.5 (SD 8.8) for the DAA group and 81.8 (SD 11.9) for the PLA group (p = 0.064). In all, 35 patients in the DAA group and 40 in the PLA group returned to their pre-fracture Parker score (p = 0.641) in both groups. No statistically significant differences between groups were found at one year regarding these two scores (p = 0.062 and p = 0.723, respectively). The DAA was associated with more intraoperative complications (p = 0.013). There was one dislocation in each group, and four revisions for DAA and one for PLA, but this difference was not statistically significant. There were also no significant differences regarding blood loss, length of stay, or operating time. Conclusion In DMC-THA for FNF, DAA did not achieve better functional results than PLA, either at three months or at one year. Moreover, DAA presented an increased risk of intra-operative complications.
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Affiliation(s)
- Henri Peuchot
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Christophe Jacquet
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - David Ferguson
- Trauma & Orthopaedic Department, Royal London Hospital, London, UK
| | - Matthieu Ollivier
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Xavier Flecher
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
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Teramoto J, Homma Y, Watari T, Hayashi K, Baba T, Hasegawa N, Kubota D, Takagi T, Ishijima M. Non-metastatic hip fractures surgery in patients with active cancer: benefit and risk. INTERNATIONAL ORTHOPAEDICS 2024; 48:1089-1096. [PMID: 38332113 DOI: 10.1007/s00264-024-06111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Although rare, non-metastatic proximal femoral fracture (PFF) can develop in patients with active cancer. However, little data are available regarding the risks and benefits of surgical treatment in such patients. The purpose of his study was to investigate the risks and benefits of surgical treatment of PFF in patients with and without cancer. METHODS We retrospectively examined the medical records of all patients treated for PFF, excluding those with pathological fracture, at our hospital from July 2013 to December 2020. The patients were divided into two groups; The active cancer group and the standard group. We investigated in both groups about surgical and medical complications during the perioperative period, walking ability two weeks postoperatively, and one-year postoperative mortality rate. RESULT After the inclusion and exclusion criteria, 39 patients in the active cancer group and 331 patients in the standard group were finally investigated. There were no statistically significant differences between the two groups. The complication rate did not appear statistical significance between two groups (16.7% in active cancer group vs 10.7% in standard group: p = 0.272). Walking ability was also similar in two groups. Mortality rate at one year was significantly higher in the active cancer group. (41.2% in active cancer group vs 6.0% in standard group: p < 0.05). CONCLUSION Although the active cancer group had a higher mortality rate at one year, which was influenced by the prognosis of the cancer, the benefits of surgical intervention, such as regaining walking ability, were the same in patients with and without active cancer.
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Affiliation(s)
- Juri Teramoto
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, Japan.
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Nobuhiko Hasegawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Daisuke Kubota
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Tatsuya Takagi
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, Japan
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Homma Y, Baba T, Watari T, Hayashi K, Kobayashi H, Matsumoto M, Banno S, Ozaki Y, Ochi H, Jinnai Y, Ishii S, Tanabe H, Shirogane Y, Zhuang X, Yuasa T, Kaneko K, Ishijima M. Recent advances in the direct anterior approach to total hip arthroplasty: a surgeon's perspective. Expert Rev Med Devices 2023; 20:1079-1086. [PMID: 37942898 DOI: 10.1080/17434440.2023.2280986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique. AREAS COVERED In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application. EXPERT OPINIONS The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Mikio Matsumoto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Sammy Banno
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuta Jinnai
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Seiya Ishii
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Tanabe
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Xu Zhuang
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takahito Yuasa
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
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Takemoto N, Yoshitani J, Saiki Y, Numata H, Nambu K. Effect of Postoperative Non-Weight-Bearing in Trochanteric Fracture of the Femur: A Retrospective Cohort Study Using Propensity Score Matching. Geriatr Orthop Surg Rehabil 2023; 14:21514593231160916. [PMID: 36875966 PMCID: PMC9974619 DOI: 10.1177/21514593231160916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction The effects of postoperative early weight-bearing (WB) on walking ability, muscle mass, and sarcopenia have been investigated. Postoperative WB restriction is also reportedly associated with pneumonia and prolonged hospitalization; however, its effect on surgical failures has not been studied. This study aimed to assess whether WB restriction after surgery for trochanteric fracture of the femur (TFF) is useful in preventing surgical failure, considering the unstable fracture type, quality of intraoperative reduction, and tip-apex distance. Patients and Methods This retrospective analysis included 301 patients admitted to a single institution between January 2010 and December 2021, diagnosed with TFF, and who underwent femoral nail surgery. Eight patients were excluded, and finally 293 patients were included in the study. Propensity score (PS) matching yielded 123 cases; 41 patients in the non-WB (NWB) group and 82 patients in the WB group were included in the final analysis. The primary outcome was surgical failure (cutout, nonunion, osteonecrosis, and implant failure). The secondary outcomes were medical complications (pneumonia, urinary tract infection, stroke, and heart failure), change in walking ability, period of hospitalization, and sliding distance of the lag screw. Results Five surgical complications occurred in the NWB group and two in the WB group, with significantly more surgical complications in the NWB group (P = .041). Cutout occurred in two cases, each in the NWB and WB groups. Two cases of nonunion and one case of implant failure occurred in the NWB group, but not in the WB group. Osteonecrosis did not occur in both groups. The secondary outcomes were not significantly different between the two groups. Conclusions The results of this retrospective cohort study using a PS matching approach showed that WB restriction after TFF surgery could not decrease the incidence of surgical failures.
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Affiliation(s)
- Naoki Takemoto
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
| | - Yoshitomo Saiki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Hitoaki Numata
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
| | - Koshi Nambu
- Department of Orthopaedic Surgery, Toyamakensaiseikaitakaoka Hospital, Takaoka, Toyama, Japan
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Singh V, Thomas J, Arraut J, Oakley CT, Rozell JC, Davidovitch RI, Schwarzkopf R. Similar Outcomes Achieved Between Anterior and Posterior Approach Total Hip Arthroplasty Using Dual Mobility Implants. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:137-143. [PMID: 35821937 PMCID: PMC9210419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dual mobility (DM) bearings for total hip arthroplasty (THA) have been proposed to reduce the risk of instability in high-risk patients; however, their utility in primary THA remains relatively unexplored. No previous reports have described whether surgical approach influences outcomes associated with DM implant systems. This study aims to compare patient reported outcomes and post-operative groin pain between patients undergoing anterior approach versus posterior approach following primary THA with DM implants. METHODS We retrospectively reviewed all patients who underwent primary THA and received a DM implant between 2011-2021. Patients were stratified into two cohorts based on surgical approach (anterior vs. posterior approach). Primary outcomes included the presence of substantial postoperative groin pain as well as readmission and revision rates. Demographic differences were assessed using chi-square and independent sample t-tests. Outcomes were compared using multilinear and logistic regressions. RESULTS Of the 495 patients identified, 55 (11%) underwent THA via the anterior approach and 440 (89%) via the posterior approach. Surgical time (100.24 vs. 109.42 minutes, p=0.070), length of stay (2.19vs.2.67 days,p=0.072), discharge disposition (p=0.151), and significant postoperative groin pain (1.8%vs.0.7%,p=0.966) did not statistically differ between the cohorts. 90-day readmission (9.1%vs.7.7%,p=0.823) and revision rate (0.0%vs.3.0%,p=0.993) did not significantly differ as well. Specifically, readmission (p=0.993) and revision (p=0.998) for instability did not significantly differ between the cohorts. We found no statistical difference in HOOS, JR (p=0.425), VR-12 PCS (p=0.718), and VR-12 MCS (p=0.257) delta score improvement from preoperative to 1-year follow-up between the two groups. CONCLUSION Comparable outcomes following implantation of DM constructs may be achievable irrespective of the surgical approach employed. The incidence of iliopsoas injections for groin pain did not significantly differ between anterior and posterior approaches. Future investigation is needed to determine whether surgical approach influences long-term outcomes in patients receiving DM implants. Level of Evidence: III.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Jerry Arraut
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Christian T. Oakley
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Joshua C. Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Roy I. Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Alberio RL, Rusconi M, Martinetti L, Monzeglio D, Grassi FA. Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants. Geriatrics (Basel) 2021; 6:geriatrics6030070. [PMID: 34287327 PMCID: PMC8293229 DOI: 10.3390/geriatrics6030070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.
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Affiliation(s)
- Riccardo L. Alberio
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
| | - Mattia Rusconi
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
- Correspondence:
| | - Loris Martinetti
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
| | - Diego Monzeglio
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
| | - Federico A. Grassi
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
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