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Rougereau G, Hollier-Larousse B, Bauer T, Genêt F, Salga M, Cale F. Anterior-approach total hip arthroplasty in patients with poliomyelitis: Long-term outcomes. Orthop Traumatol Surg Res 2024:103964. [PMID: 39074552 DOI: 10.1016/j.otsr.2024.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 09/04/2023] [Accepted: 10/16/2023] [Indexed: 07/31/2024]
Abstract
OBJECTIVE In patients with residual poliomyelitis-related impairments, total hip arthroplasty (THA) is challenging due to the high frequency of risk factors such as hip dysplasia, dislocation, muscle weakness, and fracture. The objective of this study was to assess the long-term functional and radiographic outcomes of anterior-approach THA with a ceramic-ceramic, dual-mobility, or constrained implant in patients with poliomyelitis sequelae. HYPOTHESIS THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable technique that is not associated with excess risks of instability or aseptic loosening. MATERIAL AND METHODS This single-centre retrospective study included consecutive patients with poliomyelitis sequelae who underwent THA between January 1998 and September 2019 via the anterior approach, with implantation of a ceramic-ceramic, dual-mobility, or constrained implant. The Harris Hip Score (HHS), implant position, and complications (e.g., infection and loosening) were collected during the most recent in-person visit. RESULTS The study included 19 patients (23 hips). Mean follow-up was 5.2 ± 4.2 years (range, 2.0-10.6 years). Only six of the 23 procedures were done on the side with greater muscle weakness. The mean HHS at last follow-up was 80.4 ± 10.4. A single procedure (1/23, 4%) was followed by a complication, consisting in intra-prosthetic dislocation 2 years after implantation of a dual-mobility cup. At last follow-up, the HHS was not associated with psoas and gluteus muscle strength (rs = 0.35, p = 0.11 and rs = 0.37, p = 0.09, respectively) and was not significantly different between the weaker vs. stronger side (82.7 ± 8.0 vs. 79.5 ± 11.3, respectively; p = 0.53). Cup position was more horizontal, thereby optimising function, when the procedure was done on the weaker vs. the stronger side (39.9° ± 4.3 vs. 45.0° ± 6.8, respectively; p = 0.02). CONCLUSION THA is a good option for improving function in patients with poliomyelitis sequelae. THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable method that is not associated with an excess risk of instability or loosening. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France; Département de chirurgie orthopédique et traumatologique, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
| | - Bernard Hollier-Larousse
- Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - Thomas Bauer
- Département de chirurgie orthopédique et traumatologique, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - François Genêt
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France; Université Versailles Saint-Quentin-en-Yvelines (UVSQ), UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France; Université Versailles Saint-Quentin-en-Yvelines (UVSQ), UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Fabien Cale
- Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France
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McCormick KL, Mastroianni MA, Kolodychuk NL, Herndon CL, Shah RP, Cooper HJ, Sarpong NO. Complications and Survivorship After Aseptic Revision Total Hip Arthroplasty: Is There a Difference by Surgical Approach? J Arthroplasty 2024:S0883-5403(24)00651-X. [PMID: 38936438 DOI: 10.1016/j.arth.2024.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) has traditionally been performed through the posterolateral approach (PA). Anterior approaches (AA) for rTHA are increasingly being utilized. The purpose of this study was to compare complications and survivorship from re-revision and reoperation after aseptic rTHA performed using an AA versus a PA. METHODS We retrospectively reviewed patients who underwent aseptic rTHA either through an AA (direct anterior approach [DAA], anterior-based muscle sparing [ABMS]) or PA from January 2017 to December 2021. There were 116 patients who underwent AA-rTHA (DAA 50, ABMS 66) or PA-rTHA (n = 105). Patient demographics, complications, and postoperative outcomes were collected. RESULTS The most common indication in both groups was aseptic loosening (n = 26, 22.4% AA, n = 28, 26.7% PA). Acetabular revision alone was most common in the AA group (n = 33, 28.4%), while both components were most commonly revised in the PA groups (n = 47, 44.8%). In all the AA-rTHA group, the index total hip arthroplasty was performed through a PA in 51% of patients, while the PA-rTHA group had the index procedure performed via AA in 4.8%. There was no statistically significant difference in re-revision rate between the DAA, ABMS, or PA groups (9.55 versus 5.3% versus 11.4%, respectively, P = .11). The most common overall reason for re-revision was persistent instability, with no difference in incidence of postoperative hip dislocation (n = 4, 6.8% DAA, n = 3, 5.3%, n = 10, 9.5% PA; P = .31). CONCLUSIONS This study demonstrates no difference in complication or re-revision survivorship after aseptic rTHA performed through a DAA, ABMS approach, or PA, nor between anterior or posterior-based approaches. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael A Mastroianni
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nicholas L Kolodychuk
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Rice SJ, D’Abarno A, Luu HH. Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review. Hip Pelvis 2024; 36:87-100. [PMID: 38825818 PMCID: PMC11162869 DOI: 10.5371/hp.2024.36.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 06/04/2024] Open
Abstract
Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.
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Affiliation(s)
- Steven J. Rice
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Hue H. Luu
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA
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Shah VI, Pachore JA, Patel S, Shetty GM, Patil J, Kshatriya A, Gujjar P. Sexual activity at 1 year after total hip arthroplasty in Indian patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1987-1996. [PMID: 38492014 DOI: 10.1007/s00590-024-03873-2] [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: 09/24/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE This study aimed to report changes in sexual activity and related difficulties and concerns among Indian patients at the end of 1-year after primary total hip arthroplasty (THA). MATERIALS AND METHODS A detailed questionnaire related to sexual difficulty, frequency, position, satisfaction, stress, and concerns pre- and postoperatively was administered through an in-person interview at 1-year post-THA. RESULTS Preoperatively, 77% of patients reported difficulties in sexual activities, which reduced significantly (p < 0.0001) to 30% at the end of 1-year post-operatively. A majority of patients reported no change in the frequency (56.5%) or satisfaction with their sexual activity (54%), and moderate to severe stress (53%) related to sexual activity at 1 year postoperatively. A significantly higher percentage (p = 0.01) of female patients (63%) reported changing their coital position postoperatively due to difficulty in leg positioning when compared to male patients (37.5%). Most patients (69%) were not able to procure information on sexual activity after THA surgery. and only 17.5% of patients discussed the topic with their surgeon. CONCLUSION Although THA significantly reduced difficulty in sexual activity, most patients reported no change in the frequency of sexual activity or sexual satisfaction, had moderate to severe stress regarding sex, and were primarily concerned about safety of coital position and fear of dislocation at the end of 1-year postoperatively. Pre- and postoperative counselling by their surgeons will provide the patient with relevant information and help reduce anxiety and stress, improve satisfaction, and enhance the overall sexual health of the patient undergoing primary THA.
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Affiliation(s)
- Vikram I Shah
- Shalby Ltd., Ahmedabad, India.
- Shalby Multispeciality Hospital, Sarkhej-Gandhinagar Highway, Opposite Karnavati Club, Ramdev Nagar, Ahmedabad, Gujarat, 380015, India.
| | | | - Shrikunj Patel
- Joint Replacement & Trauma Surgery, Shalby Hospital, Ahmedabad, India
| | | | - Jayesh Patil
- Joint Replacement & Trauma Surgery, Shalby Hospital, Ahmedabad, India
| | - Amish Kshatriya
- Joint Replacement & Trauma Surgery, Shalby Hospital, Ahmedabad, India
| | - Pranay Gujjar
- Joint Replacement & Trauma Surgery, Shalby Hospital, Ahmedabad, India
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Dai H, Deng Z, Yang L, Song C, Yu G, Luo J, Xu J. Endoscopic Arthroplasty via Mini-open Direct Anterior Approach Improves Postoperative Complications and Acetabular Components of Total Hip Arthroplasty in Obese Patients. Orthop Surg 2024; 16:998-1009. [PMID: 38384138 PMCID: PMC10984812 DOI: 10.1111/os.14015] [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: 06/26/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
To overcome the high-risk complications and poor alignment of acetabular components in obese patients associated with direct anterior approach (DAA) for total hip arthroplasty (THA), we innovated an endoscopic arthroplasty via mini-open direct anterior approach technique (Endo-DAA). The purpose of this study was to compare the clinical and radiographic outcomes in obese patients subjected to THA between Endo-DAA, Bikini DAA, and conventional DAA. In this retrospective controlled study, a total of 360 consecutive primary THA on obese patients (body mass index greater than 28 kg/m2) via Endo-DAA, Bikini DAA, and conventional DAA performed from October 2017 to October 2022 by different surgeons and in a single center were included. Assessments including perioperative parameters, clinical outcomes, complications, and radiologic measurements were retrieved from patients before the surgery, perioperative period and the latest follow-up. A total of 360 consecutive THA (Endo-DAA = 108, Bikini DAA = 116, Conventional DAA = 136) with complete follow-up data were analyzed. Compared to Bikini DAA or conventional DAA, Endo-DAA significantly shortened the length of incision (5.46 ± 0.53), the duration of operation (64.47 ± 12.38), and postoperative hospital stay (2.15 ± 0.89). Endo-DAA significantly reduces wound related complications compared with conventional DAA. Besides, Endo-DAA achieved a significantly better alignment of acetabular components compared to Bikini DAA or conventional DAA. Furthermore, Endo-DAA improved postoperative pain at the activity at 24 h postoperatively and early functional scores. The Endo-DAA THA technique provides better short-term clinical and radiographic results in obese patients with a low rate of postoperative complications compared to Bikini DAA or conventional DAA.
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Affiliation(s)
- Hanhao Dai
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
| | - Zhibo Deng
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
| | - Linhai Yang
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
| | - Chao Song
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
| | - Guoyu Yu
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
| | - Jun Luo
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
| | - Jie Xu
- Department of OrthopedicsShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of OrthopedicsFujian Provincial HospitalFuzhouChina
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Melman WPR, Ettema HB, Edens MA, Verheyen CCPM. Mid-term results of cemented hip arthroplasties through the direct anterior approach in the lateral decubitus position: a retrospective cohort study. J Orthop Surg Res 2024; 19:206. [PMID: 38561763 PMCID: PMC10983692 DOI: 10.1186/s13018-024-04696-x] [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: 11/12/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Reports show a high complication rate when starting with the Direct Anterior Approach (DAA) in a supine position for hip arthroplasty. The DAA with the patient in lateral decubitus position may avoid this problem because it supposedly provides better visibility, especially on the femoral side. However, this approach did show a rather high complication rate during the adoption of the approach at 1 year follow up in our previous report. We were interested what the overall 7 year survival estimate would be and whether improvement could be seen with growing experience. METHODS A cohort of patients undergoing total hip arthroplasty right from the start of applying the DAA in lateral decubitus position was analysed. RESULTS In total 175 hip prostheses (162 patients) were evaluated. The 7-year survival estimate was 95.1%, 95 CI: 91.8-98.4%. In 6 of 8 revisions there was aseptic loosening of the stem. By dividing the cohort into 3 consecutive groups in time we did not see a significantly improving revision rate. CONCLUSIONS In our experience, the adoption of the direct anterior approach in lateral decubitus position caused a relatively low 7-year survival estimate without an apparent decrease with growing experience, however given the low number of cases further research is needed to investigate the long-term risk of adopting a new approach.
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Affiliation(s)
- Wietse P R Melman
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands.
- Department of Orthopedic Surgery and Traumatology, Saxenburgh Medisch Centrum, Jan Weitkamplaan 4a, Hardenberg, 7772 SE, The Netherlands.
| | - Harmen B Ettema
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
| | - Mireille A Edens
- Epidemiology Unit, Department Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Cees C P M Verheyen
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
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Pansard E, Vigan M, Bauer T. Do the sizes of total hip arthroplasty implants match between 3D planning software and 2D templating? Orthop Traumatol Surg Res 2024; 110:103744. [PMID: 37923177 DOI: 10.1016/j.otsr.2023.103744] [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: 07/26/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION The use of three-dimensional (3D) planning before a total hip arthroplasty (THA) procedure is becoming increasingly popular as it offers several theoretical benefits: better restoration of a patient's anatomy, fewer intraoperative problems, and lower THA cost. It is said to be more accurate than two-dimensional (2D) planning, but as far as we know, no study has investigated how well the implant sizes match between 3D and 2D planning for a surgeon who is just starting to use 3D planning. Consistent implant sizes would make it easier for a surgeon to transition from one system to another. This led us to conduct a retrospective comparative study to: (1) compare how well the implant sizes match between a 3D planning system and a 2D planning method (conventional radiography using templates); (2) determine if the sizes planned on the 3D system match the implants that were used in the patient; (3) determine if the sizes planned with the 2D method match the implants that were used in the patient. HYPOTHESIS There is a good match in the implant sizes between the 3D and 2D planning. METHODS A retrospective observational, single-surgeon study was done with patients who underwent THA between January 2019 and September 2021 at a single teaching hospital. For each patient, the size of the THA implants was planned preoperatively in 3D using proprietary software (Optimized Positioning System™, Corin) and 2D templating. These patients were the first to be operated on by this surgeon based on 3D planning. RESULTS Forty-nine patients were included. The implant size matched exactly between the two planning methods for 20% (10/49) of cups [one size larger with 3D in 35% of hips (17/49) and two sizes larger in 20% of hips (10/49)], for 53% (26/49) of femoral stems [one size smaller with 3D in 53% of hips (26/49)] and for 14% (7/49) of complete THA implant systems (cup, femoral stem, femoral head). The size planned in 3D was the same as the cup size implanted in 51% (25/49) of hips, as the femoral stem size in 65% (32/49) and as the complete THA system in 22% (11/49). The cup was within one size in 88% (43/49) of hips and the femoral stem was within one size in 98% (48/49) of hips. The size planned in 2D was the same as the cup size implanted in 45% (22/49) of hips, as the femoral stem size in 63% (32/49) and as the complete THA system in 18% (9/49). The cup was within one size in 86% (42/49) of hips and the femoral stem was within one size in 96% (47/49) of hips with 2D templating. There was no statistically significant difference in the size matching between the 2D and 3D techniques for either the implanted cup (p=0.5) or the implanted femoral stem (p=0.8). CONCLUSION There is a poor match between the implant sizes determined by 3D and 2D planning. Based on our findings, the shift from 2D templating to 3D planning must be done gradually given the learning curve associated with 3D systems. LEVEL OF EVIDENCE III; comparative retrospective study.
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Affiliation(s)
- Erwan Pansard
- Hôpital Ambroise-Paré, Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Clinique de Domont, Groupe RAMSAY, 95460 Domont, France; Clinique Claude-Bernard, Groupe RAMSAY, 95120 Ermont, France.
| | - Marie Vigan
- Hôpital Ambroise-Paré, Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Thomas Bauer
- Hôpital Ambroise-Paré, Hôpitaux Universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Stofferin H, Gmeiner R, Pfitscher K, Hörmann R, Thaler M. The Anatomical Course of the Superior Gluteal Vessel Bundle with Regard to Different Approaches in Total Hip Arthroplasty. J Arthroplasty 2024; 39:1088-1092. [PMID: 37918488 DOI: 10.1016/j.arth.2023.10.046] [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: 08/30/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Iatrogenic vascular injury during total hip arthroplasty (THA) is rare, reported at rates of 0.05 to 0.3%, but a potentially limb-threatening and life-threatening complication. We aimed to describe safe and danger zones for the superior gluteal vessel bundle (SGV bundle) with reference to different THA approaches. METHODS There were 27 formalin-fixed cadavers with 49 hemipelves dissected. The course and distribution of the SGV bundle were investigated with the help of anatomical landmarks like the greater trochanter, the iliac tubercle (IT), and the ischial tuberosity. RESULTS We found and exposed the SGV bundle in all 49 specimens with no sex-specific differences. No SGV bundle was encountered up to 28 mm from the greater trochanter and up to 16 mm below the IT. The zone with the highest probability of finding the vessels was 25 to 65 mm below the IT in 39 (80%) cases - defining a danger zone (in relation to the skin incision) in the proximal fourth for the direct anterior approach, in the proximal half for the antero-lateral approach, in the proximal fifth for the direct lateral approach, and almost no danger zone for the posterior approach. CONCLUSIONS Special care in proximal instrument placement should be taken during THA. When extending one of the surgical approaches, manipulations in the proximal, cranial surgical window should be performed with the utmost care to avoid SGV bundle injury.
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Affiliation(s)
- Hannes Stofferin
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raphael Gmeiner
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Pfitscher
- Department of Obstetrics and Gynecology, Schwaz County Hospital, Schwaz, Austria
| | - Romed Hörmann
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Thaler
- Arthroplasty Center, Helios Klinikum Munich West, Munich, Germany; Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, Greifswald, Germany
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Obada B, Iliescu DM, Popescu IA, Petcu LC, Iliescu MG, Georgeanu VA. Clinical outcomes of modified direct lateral approach of Hardinge for total hip arthroplasty. Acta Orthop Belg 2023; 89:625-633. [PMID: 38205752 DOI: 10.52628/89.4.10942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The aim of the study was to evaluate a modified direct lateral approach for total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization. We retrospectively reviewed the data of 526 patients with THA operated in our department between January 2017 and December 2021. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively and postoperatively at 3 days, 6 weeks, 12 weeks and 1 year and we registered surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index. Low intraoperative blood loss, short operation time, short hospitalization, early mobilization of the patient and good range of motion imposed the modified direct lateral approach as a valuable procedure for the patients with THA. VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results. Trendelenburg gait and abductor weakness, traditionally related with direct lateral approach, were not significant statistically and complete reversible. We registered a very low complication rates with good functional outcome. The modified direct lateral approach can lead to superior outcomes, improved quality of life, with reduced intra and postoperative complications rate.
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Viamont-Guerra MR, Ramos-Pascual S, Saffarini M, Laude F. Satisfactory clinical and radiographic outcomes following revision total hip arthroplasty by direct anterior approach using primary femoral stems at 2-8 years of follow-up. Arch Orthop Trauma Surg 2023; 143:6393-6402. [PMID: 36935414 DOI: 10.1007/s00402-023-04838-6] [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: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION To report clinical and radiographic outcomes of revision total hip arthroplasty (THA) through the direct anterior approach (DAA) using primary stems. MATERIALS AND METHODS The authors assessed a consecutive series of revision THAs operated by DAA using primary (cemented and uncemented) stems between 1/1/2010 and 30/06/2017. The initial cohort comprised 47 patients (50 hips), aged 65 ± 10 years with BMI of 25 ± 4 kg/m2. Clinical assessment included modified Harris Hip Score (mHHS) and satisfaction with surgery. Radiographic assessment included radiolucent lines > 2 mm, bone remodelling, cortical hypertrophy, pedestal formation, and osteolysis. Linear regression analyses were performed. RESULTS Of the 50 hips (47 patients) in the initial cohort, intraoperative complications that did not require re-revision occurred in 5 hips. At a follow-up of > 2 years: 5 hips (10%) were lost to follow-up and 3 hips (6%) required stem re-revision, leaving a final cohort of 42 hips (40 patients). Postoperative complications that did not require re-revision occurred in 4 hips (8%). At 4.3 ± 1.6 years, post-revision mHHS was 89 ± 14 (range 47-100) and 38 patients were satisfied or very satisfied with revision surgery. Bone remodelling was observed in 8 hips (16%), cortical hypertrophy in 6 hips (12%), grade I heterotopic ossification in 7 hips (14%), and grade II in 1 hip (2%). There were no cases of radiolucent lines, pedestal formation, or osteolysis. Regression analyses revealed that post-revision mHHS was not associated with any variable. CONCLUSIONS Revision THA performed through the DAA using primary stems grants satisfactory clinical and radiographic outcomes at a minimum follow-up of two years.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Clinique du Sport, Ramsay Santé, 36 Boulevard Saint-Marcel, 75005, Paris, France
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Morumbi, São Paulo, SP, 05652-000, Brazil
| | | | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Frederic Laude
- Clinique du Sport, Ramsay Santé, 36 Boulevard Saint-Marcel, 75005, Paris, France
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Messina JC, Magnuson JA, Melnic CM, Frisch NB, Krueger CA, Grosso MJ. Total Hip Arthroplasty Learning Curves Based on Approach for New Fellowship-trained Surgeons. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202307000-00003. [PMID: 37410811 PMCID: PMC10328697 DOI: 10.5435/jaaosglobal-d-23-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION There is concern that the direct anterior (DA) approach is associated with a steeper learning curve than the posterolateral (PL) approach in total hip arthroplasty (THA). The purpose of this study was to investigate if the learning curve is similar for newly trained arthroplasty fellowship-trained surgeons using the DA and PL approaches. METHODS The first 100 primary THA cases of six DA and PL fellowship-trained arthroplasty surgeons were identified and divided into 50 case cohorts. Demographics, indications for surgery, and 90-day Hip Society standardized complications were collected. Variables were analyzed using independent sample t tests, chi-square tests, or Fisher exact tests. RESULTS In total, there were 600 patients, and no notable differences were observed in revision surgeries, surgical complications, and total complications between the DA and PL groups. Both groups had lower revision surgery rates, surgical complications, and total complications during their second 50 cases. Higher revision surgeries, and surgical and total complication rates were observed among all surgeons during the first 50 cases. DISCUSSION AND CONCLUSION No differences were observed in the learning curve when comparing the DA and PL approach. With proper training, early-career surgeons can safely perform THA with similar complication rates regardless of the approach.
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Affiliation(s)
- James C. Messina
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Justin A. Magnuson
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Christopher M. Melnic
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Nicholas B. Frisch
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Chad A. Krueger
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Matthew J. Grosso
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Messina); Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA (Dr. Magnuson and Dr. Krueger); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Melnic); the Department of Orthopedic Surgery, Ascension Providence Rochester, Rochester, MI (Dr. Frisch); and Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
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Hu X, Tan Q, Mei H, Mo S, Liu K. Research on anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip. BMC Musculoskelet Disord 2023; 24:482. [PMID: 37312176 DOI: 10.1186/s12891-023-06582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES To investigate the clinical efficacy and safety of open reduction through anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip. METHOD A total of 23 patients (25 hips) less than 2 years with developmental dysplasia of the hip treated by open reduction through anterior minimally invasive approach were treated in our hospital from August 2016 to March 2019. Through the anterior minimally invasive approach, we enter from the gap between sartorius muscle and tensor fasciae lata without cutting off rectus femoris muscle, which can effectively expose the joint capsule and reduce the damage to medial blood vessels and nerves. The operation time, incision length, intraoperative bleeding, hospital stay and surgical complications were observed. The progression of developmental dysplasia of the hip and avascular necrosis of the femoral head were evaluated by imaging examination. RESULT All patients were performed with follow-up visit for an average of 22 months. The average incision length was 2.5 cm, the average operation time was 26 min, the average intraoperative bleeding was 12ml, and the average hospital stay was 4.9 days. All patients received concentric reduction immediately after operation, and no re-dislocation occurred. At the last follow-up visit, the acetabular index was (25.8 ± 6.4°). During the follow-up visit, X-ray showed avascular necrosis of the femoral head in 4 hips (16%). CONCLUSION open reduction through anterior minimally invasive approach can achieve good clinical effect in the treatment of infantile developmental dysplasia of the hip.
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Affiliation(s)
- Xiongke Hu
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China
| | - Qian Tan
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China
| | - Haibo Mei
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China
| | - Shasha Mo
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China
| | - Kun Liu
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, 410000, Hunan Province, China.
- Hunan Provincial Key Laboratory of Pediatric Orthopedics, Changsha, 410008, Hunan, China.
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Awad ME, Farley BJ, Mostafa G, Darwiche HF, Saleh KJ. The risk of hospital readmission, revision, and intra- and postoperative complications between direct anterior versus posterior approaches in primary total hip arthroplasty: a stratified meta-analysis and a probability based cost projection. Hip Int 2023; 33:442-462. [PMID: 35437055 DOI: 10.1177/11207000211066454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study presents stratified meta-analysis and projected cost per case analysis of direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA) to determine the best surgical approach and guarantee hip joint longevity. METHODS Several online databases were searched for clinical trials comparing DAA and PA in primary THA. The stratified analysis was conducted to test for confounding and biases across the different types of included trials. The average cost and probability were used to determine projected added costs of medical and surgical management for complications. RESULTS 30 clinical trials included 11,562 patients who underwent THA. Almost 50% of these patients performed DAA. As compared to PA, both non-stratified and stratified analyses demonstrated that DAA has a significant higher incidence of the overall intra- and postoperative complications (non-stratified, OR 1.64; p = 0.003) (stratified, OR 4.12; p = 0.005), nerve injury (non-stratified, OR 22.0; p < 0.00001) (stratified, OR 0.28; p < 0.00001), higher rate of revision surgery (non-stratified; OR 1.54; p = 0.01) (stratified, OR 7.37; p = 0.006), and higher incidence of surgical wound complications (non-stratified; OR 1.67; p = 0.002) as compared to PA following primary THA. In addition, DAA demonstrated higher trends of incidence (non-statistically significant) of femur fracture (Non-stratified, OR 1.32, p = 0.10) and thrombo-embolic complications (Retrospective studies, OR 1.39, p = 0.69). However, PA demonstrated higher trends of incidence (non-statistically significant) of hip joint dislocation, as compared to DAA. (Stratified RCTs, OR 0.63, p = 0.65]. Collectively, this amounts a $421,068.68 surplus in DAA complication costs. CONCLUSIONS PA may provide a more lucrative, safer approach to those undergoing THA given its comparable postoperative outcomes, reduced complication rates, and lower overall cost relative to DAA.
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Affiliation(s)
- Mohamed E Awad
- Resident Research Partnership, Detroit, MI, USA
- Michigan State University, College of Osteopathic Medicine, Detroit, MI, USA
- FAJR Scientific, Northville, MI, USA
| | - Brendan J Farley
- Resident Research Partnership, Detroit, MI, USA
- FAJR Scientific, Northville, MI, USA
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Gamal Mostafa
- Wayne State University, School of Medicine, Detroit, MI, USA
| | - Hussein F Darwiche
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Khaled J Saleh
- Resident Research Partnership, Detroit, MI, USA
- Michigan State University, College of Osteopathic Medicine, Detroit, MI, USA
- FAJR Scientific, Northville, MI, USA
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
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Okazaki T, Imagama T, Tanaka H, Shiigi E, Hirata K, Kaneoka T, Kawakami T, Sakai T. Comparison of simultaneous versus staged bilateral total hip arthroplasty via the direct anterior approach: A propensity score matched analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231180328. [PMID: 37340640 DOI: 10.1177/10225536231180328] [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] [Indexed: 06/22/2023] Open
Abstract
PURPOSE It remains unclear whether simultaneous bilateral total hip arthroplasty (SimBTHA) or staged bilateral total hip arthroplasty (StaBTHA) is clinically superior. No study has compared these two procedures matching surgical approach and patient background. This study aimed to clarify the differences between SimBTHA using direct anterior approach (SimBTHA-DAA) and StaBTHA using the direct anterior approach (StaBTHA-DAA). METHODS Patients who underwent THA between 2012 and 2020 were enrolled, resulting in a total of 1658 hips of 1388 patients. After propensity score matching for patient background, 204 hips of 102 patients (51 patients in each group) were examined. Clinical and radiographic outcomes, complications, intraoperative blood loss and blood transfusions (BT) were evaluated. In complications, we evaluated periprosthetic fractures, pulmonary embolism, deep venous thrombosis, surgical site infection and dislocation. RESULTS At the final follow-up, clinical and radiographic outcomes and complications were not significantly different between the groups. Intraoperative blood loss was equivalent for SimBTHA and the sum in the first- and second-stage StaBTHA. The total-BT rate was significantly higher for SimBTHA-DAA than for StaBTHA-DAA (p < .0001). The allogeneic BT rate was significantly higher in SimBTHA-DAA in the supine position (32.3%) than in StaBTHA-DAA (8.3%) (p = .007). However, no patient who received autologous BT required allogeneic BT. CONCLUSIONS Clinical and radiographic outcomes were equivalent between SimBTHA-DAA and StaBTHA-DAA. The allogeneic BT rate was significantly higher in SimBTHA-DAA than in StaBTHA-DAA. Autologous BT reduced the use of allogeneic BT in SimBTHA-DAA. Auto-BT may be useful for avoiding allo-BT in SimBTHA.
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Affiliation(s)
- Tomoya Okazaki
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroshi Tanaka
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Eiichi Shiigi
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Kenji Hirata
- Department of Orthopedic Surgery, Shuto General Hospital, Yanai, Japan
| | - Takehiro Kaneoka
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takehiro Kawakami
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Wongsak S, Jarungvittayakon C, Chulsomlee K, Jaovisidha S, Sa-ngasoongsong P. Abductor muscle function after anterolateral approach in patients with unilateral end-stage hip osteoarthritis undergoing total hip arthroplasty: A prospective study. Front Surg 2023; 10:1134355. [PMID: 37035573 PMCID: PMC10079918 DOI: 10.3389/fsurg.2023.1134355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Total hip arthroplasty (THA) is a successful procedure for treating end-stage hip osteoarthritis (OA). Regarding the surgical approach for THA, the anterolateral (AL) approach, which requires anterior hemimyotomy of the gluteus medius muscle, has shown a long-term favorable outcome. However, to date, complete information related to hip abductor muscle outcomes after the AL approach is unavailable. This study therefore aimed to evaluate the postoperative outcome of patients who undergo THA using the AL approach in terms of hip abductor muscle recovery, pain, function, and muscle healing status. Methods Twenty patients diagnosed with unilateral end-stage hip OA underwent cementless THA with the AL approach. All patient procedures were performed by a single surgeon. Preoperative and postoperative data were collected at 2-week, 6-week, 3-month, and 6-month follow-up periods. Hip abductor muscle power was measured via handheld dynamometer. The healing of the musculotendinous repair was evaluated with magnetic resonance imaging at 9 months. Results After THA, hip abductor muscle power in the operated hip significantly increased as early as 3 months post-procedure when compared with the preoperative value (p < 0.05). The other parameters-including pain score, Harris hip score, and WOMAC score-significantly improved as early as 2 weeks post-operation (p < 0.05). In all patients, MRI scans showed good healing of the muscle repair site without a gap in the gluteus medius muscle. However, three patients (15%) had some fibrosis and tendon swelling at the repair site. Conclusion This study demonstrated that patients with end-stage hip OA could experience significantly improved hip abductor motor function as early as 3 months after undergoing THA with the AL approach. Moreover, despite patients experiencing anterior hemimyotomy of the gluteus medius muscle, no significant complications emerged at the muscle repair site in the AL approach.
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Affiliation(s)
- Siwadol Wongsak
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chavarat Jarungvittayakon
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Chavarat Jarungvittayakon
| | - Kulapat Chulsomlee
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paphon Sa-ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Is the Anterolateral or Posterolateral Approach More Effective for Early Postoperative Recovery after Minimally Invasive Total Hip Arthroplasty? J Clin Med 2022; 12:jcm12010139. [PMID: 36614940 PMCID: PMC9820980 DOI: 10.3390/jcm12010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Currently, various minimally invasive surgical techniques are applied for total hip arthroplasty (THA). There are few studies comparing the early postoperative clinical outcomes of minimally invasive THA between anterolateral and posterolateral approaches. In this retrospective study, 62 patients underwent minimally invasive THA via either the anterolateral approach with an intermuscular exposure using the modified Watson-Jones approach (MIS-AL, 34 hips) or mini-incision THA with a posterolateral approach (MIS-PL, 28 hips). We analyzed intraoperative data, postoperative hematological data, postoperative radiographic findings, and the postoperative recovery of muscle strength. The mean surgical time was significantly longer in the MIS-PL than in the MIS-AL group. The mean postoperative serum C-reactive protein level was significantly higher in the MIS-PL group than in the MIS-AL group only on postoperative day 3. There were no significant between-group differences in the postoperative recovery rate of muscle strength during hip abduction. The recovery rate of muscle strength during hip extension was better in the MIS-AL group than in the MIS-PL group only on postoperative day 3. In conclusion, we found no obvious advantage in early postoperative recovery between the MIS-AL and MIS-PL approaches. Therefore, the benefit of rapid postoperative recovery was comparable between the MIS-AL and MIS-PL approaches.
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Gerry AS, Iturregui JM, Carlson BJ, Hassebrock JD, Christopher ZK, Spangehl MJ, Economopoulos KJ, Bingham JS. Increased Risk of Lateral Femoral Cutaneous Nerve Injury in Patients With Previous Hip Arthroscopy Who Underwent a Direct Anterior Approach Total Hip Arthroplasty. Arthrosc Sports Med Rehabil 2022; 5:e103-e108. [PMID: 36866285 PMCID: PMC9971870 DOI: 10.1016/j.asmr.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the rates of lateral femoral cutaneous nerve (LFCN) injury in patients who underwent a direct anterior approach (DAA) total hip arthroplasty (THA) with and without previous hip arthroscopy. Methods We retrospectively investigated consecutive DAA THAs performed by a single surgeon. These cases were grouped into patients with and without a history of previous ipsilateral hip arthroscopy. LFCN sensation was assessed during the initial follow-up (6 weeks) and 1-year (or most recent) follow-up visits. The incidence and character of LFCN injury was compared between the 2 groups. Results In total, 166 patients underwent a DAA THA with no previous hip arthroscopy, and 13 had a history of previous arthroscopy. Of the 179 total patients who underwent THA, 77 experienced some form of LFCN injury at initial follow-up (43%). The rate of injury for the cohort with no previous arthroscopy was 39% (n = 65/166) on initial follow-up, whereas the rate of injury for the cohort with a history of previous ipsilateral arthroscopy was 92% (n =12/13) on initial follow-up (P < .001). In addition, although the difference was not significant, 28% (n = 46/166) of the group without history of previous arthroscopy and 69% (n = 9/13) of the group with a history of previous arthroscopy had continued symptoms of LFCN injury at most recent follow-up. Conclusions In this study, patients who underwent hip arthroscopy before an ipsilateral DAA THA were at increased risk of LFCN injury compared with patients who underwent a DAA THA without a previous hip arthroscopy. At final follow-up of patients with initial LFCN injury, symptoms resolved in 29% (n = 19/65) of patients with no previous hip arthroscopy and 25% (n = 3/12) of patients with previous hip arthroscopy. Level of Evidence Level III, case-control study.
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Affiliation(s)
| | | | - Brian J. Carlson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | | | - Zachary K. Christopher
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona,Address correspondence to Zachary K. Christopher, M.D., Department of Orthopedic Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, U.S.A.
| | - Mark J. Spangehl
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona
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A Bibliometric Analysis of the 50 Most Commonly Cited Studies of the Direct Anterior Approach in Total Hip Arthroplasty. Adv Orthop 2022; 2022:1974090. [PMID: 35756356 PMCID: PMC9232372 DOI: 10.1155/2022/1974090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The direct anterior approach (DAA) has garnered a lot of attention and surgical popularity for total hip arthroplasty in recent years. Some of the postulated advantages for the increase in popularity of this approach include better pain control and earlier recovery in the immediate postoperative period. The amount of literature available on this topic has rapidly increased over the last 10 years requiring the need for an updated guide to best navigate the topic. Methods The ISI Web of Knowledge database was used to search for research articles regarding the DAA surgical technique. The Boolean operative that yielded the largest search results was ([direct anterior approach hip] OR [anterior hip] OR [anterior hip arthroplasty] NOT [spine]). Results 92% of the highest cited articles on the DAA were published within the past two decades. One author, Keggi K, published 4 or more articles, with the highest citation average (110.5 citations). Recent articles were more strongly correlated with higher citation counts (R2 = 0.21 v. 0.19). Conclusion This review clearly outlines the increasing trend in the most influential publications regarding DAA being published in the past two decades. This review allows interested surgeons to understand the historic literature pertaining to this topic. This review can assist future researchers in identifying trends in UKA as well as help clinicians navigate this body of literature.
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Gulbrandsen TR, Muffly SA, Shamrock A, O’Reilly O, Bedard NA, Otero JE, Brown TS. Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:127-136. [PMID: 35821938 PMCID: PMC9210397] [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 The direct anterior approach (DAA) for total hip arthroplasty (THA) has been popularized as a less invasive technique, however outcomes within the first year of practice after fellowship have not been investigated. The primary aim was to determine differences in complications and outcomes between DAA and posterior approach (PA) in the first year of practice. The secondary aim was to determine if there was a learning curve factor in DAA and PA after fellowship training. Methods THA cases performed by two surgeons during their first year of practice were reviewed. Overall, 181 THAs (91 DAA, 90 PA) in 168 patients, were performed. Intraoperative differences (blood loss, operative time), hospital stay, complications, reoperations, and revisions were compared. Results Overall surgical complications were similar between DAA and PA (11% vs. 9%, p=0.64), but complication profiles were different: dislocation (1% vs. 4%, p=0.17), intraoperative femoral fracture (2% vs. 1%, p=0.32), postoperative periprosthetic fractures (2% vs. 3%, p=0.64). neuropraxia (3% vs. 0%, p=0.08). There was no difference in rate of reoperation (1% vs. 3%, p=0.31). There was a difference in rate of revision at final follow-up (0% vs. 6%, p=0.02). DAA consisted of longer operative time (111 vs. 99 minutes; p<0.001), however was only significant in the first 50 cases (p<0.001), while the subsequent cases were similar (p=0.31). There was no difference in the first 50 cases compared to the subsequent cases for either approach regarding blood loss, complications, reoperations, or revisions. Conclusion DAA and PA for THA performed within the first year of practice exhibit similarly low complication rates, but complication profiles are different. In our series, PA did demonstrate a higher risk of revision at final follow-up. A learning curve is not unique to the DAA. Both DAA and PA THA exhibited a learning curve in the first 50 cases performed at the start of a surgeon's practice. Level of Evidence: III.
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Affiliation(s)
- Trevor R. Gulbrandsen
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott A. Muffly
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan Shamrock
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Olivia O’Reilly
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Nicolas A. Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jesse E. Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Timothy S. Brown
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Hartford JM, Graw BP, Frosch DL. Reduced Incidence of Perioperative Periprosthetic Fractures Using Hybrid Rasp-Impaction Broaching Over Impaction Broaching When Using the Direct Anterior Approach for Total Hip Arthroplasty. Arthroplast Today 2022; 15:75-80. [PMID: 35464339 PMCID: PMC9018540 DOI: 10.1016/j.artd.2022.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background A not infrequent complication encountered with the direct anterior approach is perioperative fracture. The purpose of this study was to compare the incidence of perioperative fractures using a hybrid rasp-impaction broach vs an impaction broach for a similarly designed stem. Methods Retrospective study of 798 primary total hip replacements by 1 surgeon performed using noncollared dual tapered femoral stems, including 457 implanted using hybrid rasp-impaction broaching and 341 implanted using impaction broaching. Intraoperative and 90-day postoperative fractures were identified in each group. Bivariate tests and multivariate regression analysis were used to compare the 2 groups. Results There were 33 (4.1%) fractures in the sample, 13 (2.8%) with hybrid rasp-impaction broaching and 20 (5.8%) with impaction broaching (P = .034). Three (0.7%) intraoperative fractures occurred with hybrid rasp-impaction broaching and 12 (3.5%) with impaction broaching (P = .003). Five (1.1%) total calcar fractures occurred with hybrid rasp-impaction broaching and 11 (3.2%) with impaction broaching (P = .034). Intraoperative calcar fractures occurred with 1 (0.2%) hybrid rasp-impaction broaching and 6 (1.8%) impaction broaching (P = .021). In multivariate analyses, hybrid rasp-impaction broaching had a statistically lower odds ratio (OR) for total fracture (OR 0.45 [0.22 to 0.93]); total intraoperative fracture (OR 0.17 [0.05 to 0.60]); total calcar fracture (OR 0.33 [0.11 to 0.97]); intraoperative calcar fracture (OR 0.11 [0.01 to 0.98]); and rate of readmission (OR 0.27 [0.10 to 0.78]). Conclusion The use of a hybrid rasp-impaction broach compared with impaction broach led to a reduced incidence of periprosthetic fractures when using a dual tapered stem through the direct anterior approach.
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Affiliation(s)
- James M. Hartford
- Center for Total Joint Replacement, Department or Orthopedic Surgery, Palo Alto Medical Foundation, Palo Alto, CA, USA
- Corresponding author. Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA. Tel.: +1 650 853 4848.
| | - Bradley P. Graw
- Center for Total Joint Replacement, Department or Orthopedic Surgery, Palo Alto Medical Foundation, Palo Alto, CA, USA
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Goh GS, Parvizi J. Nerve Injuries Following Total Hip Arthroplasty: The Influence of Surgical Approach. Orthop Clin North Am 2022; 53:129-137. [PMID: 35365257 DOI: 10.1016/j.ocl.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Nerve injuries following total hip arthroplasty are rare but devastating complications. The most important modifiable risk factor remains the choice of hip approach and surgical technique applied. The risk of nerve injuries is related to technical complexity of the procedure and anatomic variability of the nerves. Surgeons should remain cognizant of inherent risk factors, variations in the course and branching patterns of different nerves, and technical considerations of the surgical approach to mitigate risks. This article reviews the literature on postsurgical nerve injuries following total hip arthroplasty and characterizes the influence of surgical approach on the risk of this complication.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
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22
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Sexual activity resumption after total hip arthroplasty: A satisfaction survey in 101 patients. Orthop Traumatol Surg Res 2022; 108:103171. [PMID: 34890863 DOI: 10.1016/j.otsr.2021.103171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND We are not aware of studies conducted in France to assess information provided by surgeons about the impact of total hip arthroplasty (THA) on sexual activity or sexual activity resumption after THA. The objectives of this study in a cohort of patients seen after THA were to evaluate: (1) the time to sexual activity resumption, (2) whether sexual activity resumption was discussed with the surgeon and whether the patients wanted information on this point, and (3) the modalities and experience of sexual activity resumption according to demographic features. HYPOTHESIS Age and sex influence the timing and modalities of sexual activity resumption after THA. METHODS We conducted a single-centre prospective cohort study in consecutive patients who received follow-up for 6months after THA. Each patient completed an anonymised questionnaire on preoperative sexual activity, modalities of postoperative sexual activity resumption, information delivered by the surgeon, and expectations regarding the delivered information. The patients also specified their age and sex on the questionnaire. RESULTS Of 101 included patients, 49 were still sexually active before surgery. Of these 49 patients, 35 (71.4%) reported no difference in the frequency of sexual activity before and after THA. Only 4 (8.2%) patients did not resume sexual activity during follow-up. Older age was associated with a lower demand for information [odds ratio, 0.95; 95% confidence interval: 0.91-0.99 (p=0.01)]. Compared to the females, the males more often recovered similar sexual activity to that before surgery regarding frequency [18/20 vs. 17/29 (p=0.02)] and quality of sexual positions [15/20 vs. 9/29 (p=0.003)]. Males resumed sexual activity on average during the first 3weeks [10/20 (p=0.02)], compared to after 6weeks for most females [13/29 (p=0.03)]. Age was not associated with the time to sexual activity resumption [ρ=0.0868; 95% confidence interval: -0.205 to 0.365 (p=0.56)]. DISCUSSION Among patients who were sexually active before surgery, 71.4% reported having resumed the same frequency of sexual activity 6months after surgery. The main difficulty in both males and females was fear of prosthetic hip dislocation, which was related in part to insufficient preoperative information. Males resumed sexual activity earlier than did females. In patients who were sexually active before surgery, age was not associated with the resumption of sexual activity after surgery. LEVEL OF EVIDENCE IV, prospective study with no control group.
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The direct anterior approach to the hip: a useful tool in experienced hands or just another approach? ARTHROPLASTY 2022; 4:1. [PMID: 35236507 PMCID: PMC8796471 DOI: 10.1186/s42836-021-00104-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023] Open
Abstract
The direct anterior approach (DAA) to the hip was initially described in the nineteenth century and has been used sporadically for total hip arthroplasty (THA). However, recent increased interest in tissue-sparing and small incision arthroplasty has given rise to a sharp increase in the utilization of the DAA. Although some previous studies claimed that this approach results in less muscle damage and pain as well as rapid recovery, a paucity in the literature exists to conclusively support these claims. While the DAA may be comparable to other THA approaches, no evidence to date shows improved long-term outcomes for patients compared to other surgical approaches for THA. However, the advent of new surgical instruments and tables designed specifically for use with the DAA has made the approach more feasible for surgeons. In addition, the capacity to utilize fluoroscopy intraoperatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons during their learning curve. An understanding of its limitations and challenges is vital for the safe employment of this technique. This review summarizes the pearls and pitfalls of the DAA for THA in order to improve the understanding of this surgical technique for hip replacement surgeons.
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Defining the Learning Curve of Anterior Total Hip Arthroplasty After Fellowship-specific Training. J Am Acad Orthop Surg 2022; 30:e131-e138. [PMID: 34534151 DOI: 10.5435/jaaos-d-21-00232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/11/2021] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To investigate the learning curve associated with performing direct anterior total hip arthroplasty (THA) immediately after fellowship training in this approach. METHODS This was a multicenter, retrospective study that collected data on all direct anterior THAs performed by four fellowship-trained arthroplasty surgeons in their first year of practice. Demographic data, surgical time, blood loss, surgical complications, and medical complications were recorded. Regression models were created to evaluate the outcomes of interest. A generalized linear mixed model was used to estimate the effect of the number of THA procedures performed, a proxy for surgical experience with this procedure, on the variables of interest. RESULTS A total of 286 patients undergoing direct anterior THA were included in this study. A decrease in surgical complications after approximately 40 cases and a decrease in medical complications at 25 to 50 cases were observed. Both surgical time and blood loss showed no learning curve. CONCLUSION Extensive training with a direct anterior approach during fellowship minimizes the learning curve for blood loss and surgical time, but it continues to exist regarding perioperative surgical and medical complications. Recent fellowship graduates should be cautious and expect a learning curve of around 40 cases before complication rates begin to normalize.
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Moerenhout K, Benoit B, Gaspard HS, Rouleau DM, Laflamme GY. Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial. Orthop Traumatol Surg Res 2021; 107:102709. [PMID: 33132093 DOI: 10.1016/j.otsr.2020.08.011] [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: 06/21/2019] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Greater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections? HYPOTHESIS Our hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA. PATIENTS AND METHODS A secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the anterior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach. Study outcomes were Modified Harris Hip Score (MHHS), satisfaction score, pain when lying on the affected side, and requiring an injection. Hip offset, femur lateralization and leg lengthening were measured before and after surgery. RESULTS Forty-five patients were available for complete follow-up at a mean of 62 months (range: 48-74). The incidence of GTP was higher in the posterior approach [PA: 6/21 (29%) vs DAA 4/24 (17%)) (p=0.3). Patients operated through a PA experienced more pain [5/21 (24%) of patients; VAS=mean 5.3] when lying on their operated side, compared to DAA patients [2/24 (8%) of patients; VAS=mean 2) (p=0.2)]. However, MHHS, patient satisfaction with surgery, radiological assessment for hip offset, femur lateralization or leg lengthening, and injections required were similar for both approaches. Overall, satisfaction and functional outcome with surgery was significantly lower in GTP patients, regardless of the approach. CONCLUSIONS GTP impacts patient satisfaction and functional outcome in total hip arthroplasty patients. PA patients reported more trochanteric pain than DAA patients, which affected their clinical outcome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kevin Moerenhout
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada; Department of Orthopaedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - Benoit Benoit
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
| | - Henry S Gaspard
- Orthopedic Surgery, Hull Hospital, 116, boulevard Lionel-Émond, J8Y 1W7 Gatineau, Québec, Canada
| | - Dominique M Rouleau
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
| | - G Yves Laflamme
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
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Iatrogenic femoral nerve injuries: Analysis of medico-legal issues through a scoping review approach. Ann Med Surg (Lond) 2021; 72:103055. [PMID: 34815865 PMCID: PMC8593564 DOI: 10.1016/j.amsu.2021.103055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Accidental femoral nerve injury is a well-known iatrogenic complication of orthopaedic, abdominal, and pelvic surgery. Because of the largely transitory nature of the symptoms associated with nerve damage, its true incidence is in all likelihood underestimated. This work aims to illustrate the surgical contexts within which this nerve injury is reported, based on the evidence obtained from a Scoping Review of the literature of the last 20 years, with specific reference to the underlying etiopathogenetic mechanisms and prognostic outcomes, to highlight the evaluation issues of medico-legal interest related to this pathology. Methods We conducted a Scoping Review of iatrogenic femoral nerve injuries reported between 2000 and 2021 by searching the electronic databases Pubmed, Scopus, Ovid Medline, Ovid Emcare, and Web of Science.We conducted the review according to the five-step methodology outlined by Arksey and O'Malley. Results The literature search identified 104 papers, including case reports, case series, and retrospective studies. Surgical contexts within which iatrogenic femoral nerve injuries were reported include orthopaedic, abdominal, gynaecological, urological, vascular, and plastic surgery, as well as locoregional anaesthesiological procedures. The long-term prognosis was generally favourable. Conclusions Because of its frequent iatrogenic genesis, femoral nerve injury is a topic of intense medico-legal interest. From the perspective of estimating the patient's disability, the mostly favourable nature of the prognosis makes the medico-legal assessment, in some respects, complex, thus requiring a precise evaluation methodology.
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Singh G, Khurana A, Gupta S. Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review. Hip Pelvis 2021; 33:109-119. [PMID: 34552888 PMCID: PMC8440135 DOI: 10.5371/hp.2021.33.3.109] [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: 01/17/2021] [Revised: 03/21/2021] [Accepted: 04/03/2021] [Indexed: 12/03/2022] Open
Abstract
The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.
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Affiliation(s)
- Gurvinder Singh
- Department of Orthopaedics, Dr. Baba Saheb Ambedkar Medical College and Hospital (BSAMCH), Rohini, Delhi, India
| | - Ankit Khurana
- Department of Orthopaedics, ESI Hospital, Rohini, Delhi, India
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Phruetthiphat OA, Sangthumprateep V, Trakulngernthai S, Aegakkatajit N, Chotanaphuti T, Chanpoo M. Functional outcome and complication following THA through modified direct anterior approach correlated to cadaveric study: are there any differences in Asian hip? J Orthop Surg Res 2021; 16:513. [PMID: 34416884 PMCID: PMC8377820 DOI: 10.1186/s13018-021-02661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Direct anterior approach (DAA) has several advantages including shorter length of hospital stay, faster recovery, and better functional outcome while this approach may cause damage to the lateral femoral cutaneous nerve (LFCN) as high as 81% in the works of literature. Not much data has identified the LFCN pattern in the Asian population. Therefore, the purpose of our study was to identify characteristics of the LFCN patterns representing an Asian hip, which would aid to provide the most appropriate incision of modified direct anterior approach (MDAA) for total hip arthroplasty (THA), and to identify the clinical outcome and complications following THA through MDAA correlated with cadaveric hip in the Asian population. METHODS After IRB approval, a cadaveric study was done to identify pattern and course of the LFCN in Asian population. The MDAA defined as the incision 2 fingerbreadths posteriorly to anterior superior iliac spine to avoid injury to the LFCN. The clinical phase identified 32 patients who underwent THA because of late-stage osteoarthritis of the hip. The anterolateral skin numbness was measured along tensor fascia lata between 2 weeks until 2 years. The functional outcome assessed by Harris Hip Score (HHS) and complications were evaluated in all patients. RESULTS The characteristics of the LFCN from cadaveric study (phase 1) was predominantly in sartorius type (60.0%) followed by posterior type (26.6%), fan type (6.7%), and variant type (6.7%). The clinical phase demonstrated that 23 patients (71.9%) had no numbness while 9 patients (28.1%) came with numbness after undergoing THA through the MDAA. Finally, a small area of skin numbness remained in only 3 patients (9.4%) at 2 years follow-up. Additionally, there was no significant difference in functional score at 2 years follow-up (89.0 vs 91.2, p = 0.422) between those with LFCN injury and those without LFCN injury. CONCLUSIONS The LFCNs were divided into four types. Modified direct anterior approach, which is an alternative approach for THA, allowing for a lower rate of skin numbness and faster recovery without hip dislocation, abductor weakness, and serious nerve complication. Functional outcome was comparable with and without LFCN injury. LEVEL OF EVIDENCE Level II, prospective observation study.
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Affiliation(s)
- Ong-art Phruetthiphat
- Orthopedic Department, Phramongkutklao Hospital, 315 Ratchvidhi Road, Thung Phaya Thai, Ratchathewee, Bangkok, 10400 Thailand
| | - Vasin Sangthumprateep
- Orthopedic Department, Phramongkutklao Hospital, 315 Ratchvidhi Road, Thung Phaya Thai, Ratchathewee, Bangkok, 10400 Thailand
| | - Songpol Trakulngernthai
- Orthopedic Department, Phramongkutklao Hospital, 315 Ratchvidhi Road, Thung Phaya Thai, Ratchathewee, Bangkok, 10400 Thailand
| | - Noppadol Aegakkatajit
- Orthopedic Department, Phramongkutklao Hospital, 315 Ratchvidhi Road, Thung Phaya Thai, Ratchathewee, Bangkok, 10400 Thailand
| | - Thanainit Chotanaphuti
- Orthopedic Department, Phramongkutklao Hospital, 315 Ratchvidhi Road, Thung Phaya Thai, Ratchathewee, Bangkok, 10400 Thailand
| | - Malee Chanpoo
- Department of Anatomy, Phramongkutklao College of Medicine, Bangkok, Thailand
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Randelli F, Fioruzzi A, Scaltrito L, Brioschi M, Ayeni OR, Randelli PS. Direct anterior approach and dual mobility cup: the "head-first" reduction technique: a technical note and early case series. Musculoskelet Surg 2021; 105:201-206. [PMID: 31993974 DOI: 10.1007/s12306-020-00641-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Less invasive direct anterior approach (DAA) and dual mobility cup (DMC) are increasingly adopted in practice over the last decade. Their use aims to reduce, as much as possible, soft tissue dissection and dislocation rate. This study aims to present a novel surgical technique to reduce a DMC prosthesis during a DAA easily. METHODS A mildly modified version of the direct anterior approach is proposed. When leg lengths, stability, impingement, and tension have been checked, the trial stem is disassembled in situ, dislocated, and removed, leaving the space to exchange the trial double mobility head with the definitive one. When the definitive stem is inserted, the surgeon guides and helps the assistant to match the trunnion in the double mobility head. As soon as the components are matched, the traction is released, and the unit is impacted by an alternation of axial traction and release. RESULTS Of 164 patients who underwent primary total hip arthroplasty (December 2016-May 2017) by a single surgeon, a double mobility cup through DAA and the "head-first" technique was performed in 26 patients (15.8%). The mean operative time was 130 min (85-220 min; SD 34.28). No significant complications occurred during the mean follow-up of 23.6 months. CONCLUSIONS Specific difficulties can be anticipated when pairing dual mobility cup and direct anterior approach. The "head-first" technique is a useful technique in reducing the possible difficulties related to the reduction of double mobility cup through a less invasive direct anterior approach.
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Affiliation(s)
- F Randelli
- Hip Department, Orthopedics and Trauma, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Milan, MI, 20097, Italy
| | - A Fioruzzi
- Hip Department, Orthopedics and Trauma, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Milan, MI, 20097, Italy.
| | - L Scaltrito
- Hip Department, Orthopedics and Trauma, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Milan, MI, 20097, Italy
| | - M Brioschi
- Hip Department, Orthopedics and Trauma, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Milan, MI, 20097, Italy
| | - O R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - P S Randelli
- 1st Department, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
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Nairn L, Gyemi L, Gouveia K, Ekhtiari S, Khanna V. The learning curve for the direct anterior total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:1971-1982. [PMID: 33629172 DOI: 10.1007/s00264-021-04986-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) is a muscle-sparing approach thought to have less post-operative pain and quicker recovery, with similar functional outcomes to other approaches. However, it is technically challenging and transitioning surgeons may experience increased complication rates. The purpose of this systematic review is to identify reported learning curves associated with the DAA. METHODS Three databases (MEDLINE, Embase, and Web of Science) were searched using terms including "total hip arthroplasty," "direct anterior approach," and "learning curve." Study characteristics, patient demographics, learning curve analyses, and complications were abstracted. RESULTS Twenty-one studies met inclusion criteria, with a total of 9738 patients (60% female), an average age of 63.7 years (range: 13-94), body mass index of 27.0 kg/m2 (range: 16.8-58.9), and follow-up of 19 months (range: 1.5-100). There were five retrospective cohort studies and 13 case series representing fair methodological quality. Six studies depicted a true learning curve, with mean operative time of 156.59 ± 41.71 minutes for the first case, 93.18 ± 14.68 minutes by case 30, and 80.45 ± 12.28 minutes by case 100. Mean complication rate was 20.8 ± 12.7% in early groups and decreased to 7.6 ± 7.1% in late groups. CONCLUSION This review demonstrated a substantial learning curve associated with the DAA to THA. Operative time plateaued after approximately 100 cases. Complication rates decreased substantially from early to late groups.
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Affiliation(s)
- Leah Nairn
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Lauren Gyemi
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
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Flick TR, Ross BJ, Sherman WF. Instability After Total Hip Arthroplasty and the Role of Advanced and Robotic Technology. Orthop Clin North Am 2021; 52:191-200. [PMID: 34053564 DOI: 10.1016/j.ocl.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Instability remains the leading cause of reoperation following total hip arthroplasty (THA). In this article, the risk factors for instability after THA are reviewed, including patient-related characteristics, surgical techniques, positioning of implants, and the role of advanced technology and robotics as a platform that may reduce the incidence of instability.
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Affiliation(s)
- Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - William F Sherman
- Adult Reconstruction Hip/Knee, Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
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Anterior Supine Intermuscular Total Hip Arthroplasty at an Ambulatory Surgery Center Versus Hospitalization: Cost and Adverse Events. Orthop Clin North Am 2021; 52:209-214. [PMID: 34053566 DOI: 10.1016/j.ocl.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study compares anterior supine intermuscular total hip arthroplasty performed at an ambulatory surgery center with the same procedure performed in a hospital setting in regard to complications and costs. The ambulatory surgery center had significantly shorter postoperative stays and superior visual analog pain scores at 3 months. No differences were noted in operative time, blood loss, or complications. Costs were significantly different between groups, with significant cost savings noted in the ambulatory surgery center group.
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Moschetti WE, Kunkel S, Keeney BJ, Jevsevar D. Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? Arthroplast Today 2021; 10:6-11. [PMID: 34195315 PMCID: PMC8226394 DOI: 10.1016/j.artd.2021.05.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/09/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is focus on the direct anterior approach (DAA) for total hip arthroplasty because of perceived postoperative functional improvement. We compared baseline, short-term, and long-term outcomes between the DAA and the posterior approach focusing on baseline function. Material and methods Multivariate linear and logistic regression models were used to analyze prospective data on 1457 total hip arthroplasties comparing baseline characteristics, operative time, 90-day reoperation, length of stay (LOS), extended LOS (>3 days), and facility discharge. The Patient-Reported Outcome Measurement Information System-Global Health (PROMIS-10) was used to determine physical component score (PCS) and mental component score (MCS), with clinically significant improvement defined as >5 points. Adjusters included age, sex, race/ethnicity, year, Charlson Comorbidity Index, body mass index, alcohol, and tobacco use. Results DAA patients had higher preoperative MCS (DAA 50.4 vs posterior approach 47.4, P < .001), PCS (40.7 vs 38.5, P < .001), and postoperative PCS scores (48.9 vs 46.7, P < .001). There was no difference in mean PCS improvement (8.1 vs 8.2; P = .798) or clinically significant PCS change (P = .963). DAA was associated with shorter LOS by 0.49 days (95% confidence interval [CI] = 0.32-0.65, P < .001), lower odds of extended LOS (odds ratio = 0.33, 95% CI = 0.21-0.50, P < .001), and lower odds of facility discharge (odds ratio = 0.54, 95% CI = 0.37-0.79, P < .001). No difference in operative time (86 vs 87 minutes; P = .812) or 90-day reoperations (1 vs 1%; P = .347) was observed. Conclusion DAA patients presented with higher preoperative PCS and MCS scores, yet both groups experienced significant improvement. DAA was associated with decreased LOS and lower odds of extended LOS and facility discharge. There was no difference in operative time or reoperation.
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Affiliation(s)
- Wayne E Moschetti
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Samuel Kunkel
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - David Jevsevar
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Awad ME, Farley BJ, Mostafa G, Saleh KJ. Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty : a meta-analysis of functional outcomes and cost. Bone Joint J 2021; 103-B:1078-1087. [PMID: 34058867 DOI: 10.1302/0301-620x.103b6.bjj-2020-1271.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. METHODS This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. RESULTS The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the 12-Item Short Form Survey (SF-12) physical score at six weeks (p = 0.580) and one year (p = 0.360), SF-12 mental score at six weeks (p = 0.170) and one year (p = 0.960), and University of California and Los Angeles (UCLA) activity scale at 12 weeks (p = 0.250). The mean non-stratified and stratified difference in costs for the operating theatre time and blood transfusion were $587.57 (95% CI 263.83 to 1,010.29) to $887.04 (95% CI 574.20 to 1,298.88) and $248.38 (95% CI 1,003.40 to 1,539.90) to $1,162.41 (95% CI 645.78 to 7,441.30), respectively, more for the DAA group. However, the mean differences in costs for the time in hospital were $218.23 and $192.05, respectively, less for the DAA group. CONCLUSION The use of the DAA, rather than the PA, in THA has earlier benefits for function and pain. However, these are short-lasting, with no significant differences seen at later intervals. In addition the limited benefits were obtained with higher cumulative costs for DAA. Cite this article: Bone Joint J 2021;103-B(6):1078-1087.
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Affiliation(s)
- Mohamed E Awad
- Resident Research Partnership, Detroit, Michigan, USA.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Brendan J Farley
- Resident Research Partnership, Detroit, Michigan, USA.,College of Medicine, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Gamal Mostafa
- School of Medicine, Wayne State University, Detroit, Michigan, USA.,Surgical Outcomes Research Institute, Detroit, Michigan, USA
| | - Khaled J Saleh
- Resident Research Partnership, Detroit, Michigan, USA.,Surgical Outcomes Research Institute, Detroit, Michigan, USA.,College of Osteopathic Medicine, Michigan State University, Detroit, Michigan, USA
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Evaluation of femoral anteversion, hip rotation, and lateral patellar tilt after total hip arthroplasty using a changeable neck system. J Artif Organs 2021; 24:492-497. [PMID: 33899127 DOI: 10.1007/s10047-021-01269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
In patients with secondary osteoarthritis due to acetabular dysplasia, femoral anteversion has many variations. A changeable neck system is one useful option to adjust the femoral anteversion. Retroverted necks can effectively adjust anatomical anteversion (AA), femoral rotational angle (FRA), and functional anteversion (FA); however, effectiveness of anteverted necks for these adjustments has not been investigated. Moreover, although the lateral patellar tilt after total hip arthroplasty (THA) has been reported to externally rotate, the influence on lateral patellar tilt using a changeable neck system remains unknown. To clarify the effectiveness of anteverted necks in THA, 96 consecutive patients (111 hips) who underwent THA using anatomical short stem with a changeable neck system were retrospectively investigated using pre- and post-operative computed tomography. Patients were divided into the straight (ST) group using straight and 4-mm-high-offset neck (N = 34) and the anteverted (AV) group using 15°-anteverted and 15°-anteverted/3-mm-high-offset neck (N = 34) after age, body mass index, and surgical approach were matched using propensity scores. AA did not change in the ST group, while it increased by 14.0° in the AV group. FRA decreased after surgery in both groups. FA decreased after surgery in the ST group, while it did not change in the AV group. Lateral patella tilt did not significantly change in both groups between pre- and post-operative position. In conclusion, with a changeable neck system, straight and anteverted necks can adjust AA to achieve pre-operative planning while not influencing lateral patellar tilt.
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Patel AH, Kreuzer SW, Sherman WF. Bilateral Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip and Extreme Hip Flexion Requirements due to Phocomelia. Arthroplast Today 2021; 8:262-267.e1. [PMID: 34095402 PMCID: PMC8167324 DOI: 10.1016/j.artd.2021.01.005] [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: 10/15/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
Phocomelia is a rare congenital birth defect marked by hypoplastic or markedly absent limbs. Developmental dysplasia of the hip (DDH) is a congenital disorder with a failure of the native acetabulum to provide complete coverage over the femoral head. The secondary osteoarthritis that develops from DDH is technically challenging for orthopedic surgeons because of distorted anatomy. The present case describes the diagnosis of Crowe 3 DDH in a phocomelia patient with hyperflexion requirements who successfully underwent staged bilateral total hip arthroplasty via a direct anterior approach. It highlights the utility of preoperative computerized tomography and intraoperative computer navigation to assist in implant placement. Recognizing difficult arthroplasty cases in advance is imperative as these cases may require great expertise and more extensive surgical planning.
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Affiliation(s)
- Akshar H. Patel
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Kaseb MH, Shafiee SH, Shamabadi A, Aminjavaheri SA, Mortazavi SMJ. Cementless total hip arthroplasty in haemophilia patients through direct anterior approach. Haemophilia 2021; 27:e239-e244. [PMID: 33529379 DOI: 10.1111/hae.14224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) has become the treatment of choice for patients with severe haemophilic arthropathy of the hip. However, the intraoperative and postoperative complications, including blood loss and infection, are significant concerns. Direct Anterior Approach (DAA) might be beneficial in THA of patients with haemophilia. AIM The present study was conducted to assess outcomes of THA using DAA in patients with haemophilia. METHODS We retrospectively reviewed our joint replacement database. From January 2010 to December 2015, we had 12 patients with haemophilia who underwent 14 THAs by DAA and followed for an average of 69 months. RESULTS All patients were male with a mean age of 36 ± 7 years at the time of THA. The mean Harris Hip Score improved from 46 preoperatively to 89 at the final follow-up visit. One dislocation and one infection occurred. Only one patient with simultaneous bilateral THA needed a transfusion. All components were radiologically well fixed at the final follow-up visit except one acetabular loosening that needed revision. All patients were satisfied with the outcome of the surgery at the final follow-up visit. CONCLUSION In this study, it was observed that complications of cementless THA using DAA in haemophilia patients with hip arthropathy are comparable to other surgical approaches. However, the complication of bleeding in this approach might be less.
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Affiliation(s)
- Mohammad Hasan Kaseb
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiee
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Shamabadi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Garavaglia G, Gonzalez A, Barea C, Peter R, Hoffmeyer P, Lübbeke A, Hannouche D. Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation. INTERNATIONAL ORTHOPAEDICS 2021; 45:575-583. [PMID: 33427897 PMCID: PMC7892742 DOI: 10.1007/s00264-020-04910-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Short stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation. METHODS Between April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2-9.73 years). RESULTS During the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2-7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between - 10 and 0 was associated with lower HHS pain subscore (p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1. CONCLUSION Patients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.
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Affiliation(s)
- Guido Garavaglia
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Amanda Gonzalez
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Barea
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Peter
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
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Banno S, Baba T, Tanabe H, Homma Y, Ochi H, Watari T, Kobayashi H, Kaneko K. Use of traction table did not increase complications in total hip arthroplasty through direct anterior approach performed by novice surgeon. J Orthop Surg (Hong Kong) 2021; 28:2309499020923093. [PMID: 32583712 DOI: 10.1177/2309499020923093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the surgical outcomes of total hip arthroplasty (THA) through direct anterior approach (DAA) performed by beginners by comparing the outcomes after the introduction of DAA-THA between using a normal operating table and a traction table. METHODS The total subjects were 200 patients, there were 120 cases from the introduction of three surgeons using a normal table and 80 cases from two surgeons using a traction table. The surgical procedure was standardized, and a surgeon skilled in DAA entered the operating room and instructed the novice surgeons of DAA in all cases. RESULTS The mean operative time was no significant difference between the two groups (p = 0.093). The difference in slope of the operative time was no significant difference between the two groups (p value = 0.089). The mean fluoroscopy time and the mean blood loss were significant difference between the two groups (p < 0.05). The difference in slope of the fluoroscopy time and blood loss were significant difference between the two groups (p < 0.05). There were no intraoperative complications and no reoperations for any reason. CONCLUSIONS At the facility with a surgeon skilled in DAA, the use of a traction table in DAA did not increase the complication rate compared with the use of a normal operating table when the exclusion criteria for DAA were set and surgery was performed using intraoperative fluoroscopy under supervision by a skilled surgeon.
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Affiliation(s)
- Sammy Banno
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Tanabe
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Vandeputte FJ, Vanbiervliet J, Sarac C, Driesen R, Corten K. Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial. Bone Joint J 2021; 103-B:321-328. [PMID: 33517727 DOI: 10.1302/0301-620x.103b2.bjj-2020-0529.r2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). METHODS In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. RESULTS At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). CONCLUSION No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321-328.
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Affiliation(s)
| | - Jens Vanbiervliet
- Hip Unit, Limburg Orthopaedic Center, East Limburg Hospital, Genk, Belgium.,Jan Yperman Hospital, Ypres, Belgium
| | - Cigdem Sarac
- Hip Unit, Limburg Orthopaedic Center, East Limburg Hospital, Genk, Belgium.,European Hip Clinic, Herselt, Belgium
| | - Ronald Driesen
- Hip Unit, Limburg Orthopaedic Center, East Limburg Hospital, Genk, Belgium
| | - Kristoff Corten
- Hip Unit, Limburg Orthopaedic Center, East Limburg Hospital, Genk, Belgium.,European Hip Clinic, Herselt, Belgium
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Moslemi A, Kierszbaum E, Descamps J, Sigonney F, Biau D, Anract P, Hardy A. Does using the direct anterior approach with a standard table for total hip arthroplasty reduce leg length discrepancies? Comparative study of traction table versus standard table. Orthop Traumatol Surg Res 2021; 107:102752. [PMID: 33316445 DOI: 10.1016/j.otsr.2020.102752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/20/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Primary total hip replacement (THR) comes with a risk of leg length discrepancy (LLD), which occurs in 25 % of cases, especially when the surgery is done using an anterior approach on a traction table, since it is not easy to verify the lengths of the legs. By doing the anterior approach on a standard table an intraoperative visual evaluation of leg lengths can be done after the trial implants are in place. As far as we know, the ability to set the leg length has not been compared between procedures done on a standard table or a traction table. This led us to carry out a retrospective comparative study to determine whether using a standard table for anterior THR will 1) allow better control over leg length, 2) increase the risk of incorrect implant positioning, 3) increase the surgical complication rate. HYPOTHESIS Anterior THR on a standard table will allow better control over leg length than anterior THR on a traction table. MATERIAL AND METHODS This single center retrospective study included 266 THRs done between January 1, 2018 and November 2, 2019 for primary (n=219) or secondary (n=47) hip osteoarthritis. The 137 cases done with a traction table were compared to the 129 cases with a standard table. The two groups were comparable in terms of age, sex, body mass index, indication and bilateral implants. They were not comparable in the surgeon experience (more junior surgeons in the standard table group [p<0.001]) and types of implants used (more cementless cups and stems in the standard table group [p=0.001]). Radiographs were used to measure the LLD, cup inclination, and femoral stem placement in the frontal plane. Any early complications were documented. The target was for the operated leg to be the same length as the contralateral leg, which was defined as within 10mm of each other. RESULTS The mean postoperative LLD was comparable between the traction table group 1.56±7.32 mm (min -15.6 max 17.2) and the standard table group 0.53±6.93 mm (min -16.4 max 13.7) (p=0.24). In the traction table group, 81 % (111/137) of patients had legs of the same length, versus 84 % (109/129) in the standard table group (p=0.7). Cup inclination was comparable with a mean of 40.4±7.1 degrees (min 23.4; max 58.5) in the traction table group versus 39.3±7.5 degrees (min 19.9; max 60.9) in the standard table group (p=0.21). The frontal position of the femoral stem was comparable between groups with a mean of 0.09±0.45 degrees (min -1; max 3.98) in the traction table group versus 0.08±0.59 degrees (min -4.97; max 1.93) in the standard table group (p=0.86). There were 5 complications (3.7 %) in the traction table group versus 11 (8.5 %) in the standard table group (p=0.16). CONCLUSION Use of a standard table to carry out THR by the direct anterior approach does not provide better control over leg length than using a traction table, subject to preoperative planning. When doing the procedure on a standard table, the implant placement is at least comparable, with a similar risk of complications. LEVEL OF EVIDENCE III; case matched study.
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Affiliation(s)
- Aymane Moslemi
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Elliott Kierszbaum
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Jules Descamps
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - François Sigonney
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - David Biau
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Philippe Anract
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandre Hardy
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Ishii S, Homma Y, Baba T, Jinnai Y, Zhuang X, Tanabe H, Banno S, Matsumoto M, Watari T, Ozaki Y, Ochi H, Kaneko K. Does total hip arthroplasty via the direct anterior approach using dual mobility increase leg length discrepancy compared with single mobility? ARTHROPLASTY 2021; 3:2. [PMID: 35236437 PMCID: PMC8796478 DOI: 10.1186/s42836-020-00060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Total hip arthroplasty (THA) via the direct anterior approach (DAA) using dual mobility cup (DMC) is considered to effectively prevent postoperative dislocation. However, the dislocation and reduction procedure using a trial implant during the surgery is difficult because of high soft tissue tension. Thereby, leg length discrepancy (LLD) is difficult to assess when using DM via the DAA. Purpose To compare the LLD between cases using conventional SM and those using DMC in THA via the DAA with fluoroscopy. Patients and methods We retrospectively investigated 34 hips treated with DMC (DMC-DAA group) and 31 hips treated with SM (SM-DAA group). The LLD was defined as the difference in the distance from the teardrop to the medial-most point of the lesser trochanter between the operative and nonoperative sides at immediate postoperative X-ray. Results The mean LLD in the DMC-DAA group and SM-DAA group was 0.68 ± 7.7 mm and 0.80 ± 5.5, respectively, with no significant difference. The absolute value of the LLD in the DMC-DAA group and SM-DAA group was 6.3 ± 4.4 mm and 5.9 ± 5.5, respectively, with no significant difference. Conclusion Despite the difficulty in assessment of the LLD during THA via the DAA using DMC, this technique does not increase the LLD compared with the use of SM. Level of evidence III, matched case-control study.
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Affiliation(s)
- Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuta Jinnai
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Xu Zhuang
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Tanabe
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sammy Banno
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Mikio Matsumoto
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Taiji Watari
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yu Ozaki
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, 1-1-2, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Wernly D, Wegrzyn J, Lallemand G, Mahlouly J, Tissot C, Antoniadis A. Total hip arthroplasty through the direct anterior approach with and without the use of a traction table: a matched-control, retrospective, single-surgeon study. J Orthop Surg Res 2021; 16:45. [PMID: 33430917 PMCID: PMC7802295 DOI: 10.1186/s13018-020-02184-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip surgeons performing total hip arthroplasty (THA) through the direct anterior approach (DAA) commonly use a traction table to facilitate exposure. Even though performing THA through DAA without a traction table could be technically more demanding, this technique offers the advantage of intraoperative leg length comparison. Therefore, this study aimed to compare clinical outcomes, complication rates, component positioning, and leg length discrepancy (LLD) after THA through the DAA performed with or without a traction table. METHODS A single-surgeon continuous series of 75 patients who underwent DAA THA performed with a traction table was matched for gender, age, and BMI with 75 patients who underwent DAA THA performed without a traction table (male, 62; female, 88, with an average age of 68 years old). Clinical and radiological outcomes, intra- and postoperative complications, and LLD were retrospectively assessed. RESULTS No statistically significant difference was detected in surgical time, hospital stay, Harris Hip Score (HHS), complication rates, and implant positioning between the two groups. Leg length restoration was significantly more accurate in the group performed without a traction table (2.4 ± 2 mm vs. 3.7 ± 3.1 mm; p value ≤ 0.05). No LLD > 10 mm was reported in the group performed without a traction table, whereas two cases (2.7%) were reported in those performed with a traction table. CONCLUSION Performing THA through DAA without a traction table was associated with a significantly more accurate leg length restoration without a significant increase in the rates of intra- and postoperative complications.
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Affiliation(s)
- Diane Wernly
- Service of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1010, Lausanne, Switzerland.
| | - Julien Wegrzyn
- Service of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1010, Lausanne, Switzerland
| | - Geoffroi Lallemand
- Service of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1010, Lausanne, Switzerland
| | - Jaad Mahlouly
- Service of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1010, Lausanne, Switzerland
| | - Christophe Tissot
- Service of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1010, Lausanne, Switzerland
| | - Alexander Antoniadis
- Service of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1010, Lausanne, Switzerland
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Tamaki T, Nakakita Y, Miura Y, Higashi H, Oinuma K, Shiratsuchi H. Radiographic factors to predict operation time of direct anterior total hip arthroplasty for dysplastic hips. Hip Int 2021; 31:90-96. [PMID: 31496293 DOI: 10.1177/1120700019873877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to identify radiographic factors that could predict surgical difficulty in direct anterior total hip arthroplasty (THA) for dysplastic hips. PATIENTS AND METHODS The clinical records of 160 patients (204 hips) who underwent primary THA for the treatment of developmental dysplasia of the hip were retrospectively investigated. All THAs were performed through a direct anterior approach by a single surgeon. A multiple regression analysis was developed to identify the independent predictor of operation time, including variables such as age, sex, height, body mass index (BMI), the use of bone cement, previous hip surgery, and radiographic references, including the pelvic horizontal to vertical ratio, the extent of proximal and horizontal migration of the femoral head, flatness of the femoral head, and the vertical distance between the tips of the greater trochanter and the femoral head. RESULTS A multiple regression analysis revealed that as radiographic factors, proximal migration of the femoral head, and lower position of the femoral head related to the greater trochanter were significantly associated with longer operation time. In addition, our results revealed that younger age, male sex, height, high BMI, cement use, and previous hip surgery were also significantly associated with longer operation time. CONCLUSIONS Our findings indicate that proximal migration of the femoral head and high-riding greater trochanter are isolated radiographic predictors of the longer operation time of direct anterior THA for dysplastic hips.
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Affiliation(s)
- Tatsuya Tamaki
- Joint Reconstruction Centre, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan.,Takai Hospital, Hirakata, Osaka, Japan
| | - Yoshiatsu Nakakita
- Joint Reconstruction Centre, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Yoko Miura
- Joint Reconstruction Centre, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Hidetaka Higashi
- Joint Reconstruction Centre, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Kazuhiro Oinuma
- Joint Reconstruction Centre, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Hideaki Shiratsuchi
- Joint Reconstruction Centre, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
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Pharr ZK, Rider CM, Bell JW, Wilde JH, Westbrooks TJ, Toy PC. Outpatient Hip Safety in an Ambulatory Surgery Center Is Independent of Approach. J Arthroplasty 2021; 36:231-235. [PMID: 32826145 DOI: 10.1016/j.arth.2020.07.068] [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: 05/06/2020] [Revised: 06/28/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are few data comparing the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in the outpatient setting. The purpose of this study is to compare 90-day complications between the 2 approaches. We hypothesized that they would be equally safe and effective. METHODS Retrospective review identified 432 THAs (346 DAA, 86 PA) performed at a single ambulatory surgery center (ASC). Outcomes compared included demographics, comorbidities, preoperative and discharge pain scores (visual analog scale [VAS]), overall time spent in the ASC, overnight stay, emergency room visits, admission, reoperation, and complications within a 90-day period. RESULTS There were no differences in mean preoperative VAS (DAA 4.7, PA 4.5), mean discharge VAS (DAA 0.8, PA 0.7), overall time spent in the ASC (DAA 9.0 hours, PA 9.3 hours), total number of overnight stays (DAA 0.9%, PA 1.2%), emergency room visits (DAA 1.7%, PA 1.2%), admissions (DAA 1.4%, PA 1.2%), reoperations (DAA 1.4%, PA 1.2%), or complications (DAA 3.5%, PA 2.3%). CONCLUSION There were no differences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon's preferred approach. This study indicates both DAA and PA are equally safe for THA in the outpatient setting, and the choice of surgical approach should be based on patient and surgeon preference.
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Affiliation(s)
- Zachary K Pharr
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis TN
| | - Carson M Rider
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis TN
| | - Jack W Bell
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - James H Wilde
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | | | - Patrick C Toy
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis TN
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Thaler M, Dammerer D, Hechenberger F, Hörmann R, Van Beeck A, Stofferin H. The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach. J Arthroplasty 2021; 36:368-373. [PMID: 32826147 DOI: 10.1016/j.arth.2020.07.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the direct anterior approach (DAA) has become a standard for primary and revision total hip arthroplasty, it involves a high risk of injuring the lateral femoral cutaneous nerve (LFCN). The aim of this study is to examine the course of the LFCN in relation to various skin incisions and approach extensions used for the DAA. METHODS We obtained 44 limbs and hemipelves from 22 formalin-preserved cadavers, in which LFCN was identified. All nerve branches of the LFCN were carefully traced. The branching pattern and the distribution in the thigh were described in relation to the standard approach for primary total hip arthroplasty, the skin crease bikini incision, the longitudinal extension, and the lazy S extension of the DAA. RESULTS We found 31 (70.5%) Sartorius-type, 6 (13.6%) posterior-type, and 7 (15.9%) fan-type branching patterns of the LFCN. We observed 2.02 branches per hemipelvis. All fan-type LFCNs had 3 or more than 3 branches. We found that the main branch of the LFCN was medial to the primary DAA approach as well as to the lazy S extended DAA approach. The bikini incision and the incision for the longitudinal extension of the DAA crosses the main branch of the LFCN in 100% of cases. CONCLUSION The fan-type pattern of the LFCN might be harmed by all skin incisions. Chances are high that LFCN branches could be jeopardized with a bikini-type incision and the longitudinal extension of the DAA. The risk of jeopardizing the LFCN with a lazy S-type distal extension is reduced.
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Affiliation(s)
- Martin Thaler
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Faro Hechenberger
- Department of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Austria
| | - Romed Hörmann
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Annelies Van Beeck
- Department of Orthopaedic Surgery and Traumatology, University Hosptial Antwerp, Antwerp, Belgium
| | - Hannes Stofferin
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
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Aichmair A, Dominkus M, Hofstaetter JG. Axial pelvic tilt in direct anterior Total hip Arthroplasty using a traction table. BMC Musculoskelet Disord 2020; 21:803. [PMID: 33272238 PMCID: PMC7713149 DOI: 10.1186/s12891-020-03837-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Direct anterior approach total hip arthroplasty may be undertaken on a traction table, but the effects that patient positioning can have on axial pelvic tilt (aPT) are unknown. The aim of this study was to assess the degree of error from patient positioning on the traction table during anterior minimally-invasive surgery (AMIS) THA. METHODS Patients were included who underwent direct anterior THA via the AMIS technique at a single institution between 11/2018 and 03/2019. Axial pelvic tilt was measured (a) in the supine position on the operating table, and (b) after positioning on the traction table, by the same consultant surgeon in all cases. RESULTS In the above-mentioned study period, 50 patients (F: 32; M: 18) with an average age of 60.6 ± 13.6 (range: 26.5 to 88.3) years, and an average BMI of 27.2 ± 5.0 (range: 17.9 to 41.5) kg/m2 met the inclusion criteria. When measured in supine position, the average aPT was - 0.2 ± 1.7 (range: - 5.6 to 3.8) degrees. After positioning on the traction table, the average aPT was - 3.5 ± 2.1 (- 8.5 to 1.6) degrees (p < 0.001). In patients with an aPT of more than 5 degrees, the caput-collum-diaphyseal (CCD) angle was significantly lower (125 ± 11° vs. 134 ± 8°, p = 0.007). CONCLUSION This study raises awareness for the potential risk of aPT during positioning of the patient on the traction table, commonly used during direct anterior THA via the AMIS technique.
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Affiliation(s)
- A Aichmair
- II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria. .,Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.
| | - M Dominkus
- II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - J G Hofstaetter
- II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
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Cailleaud M, Lalevée M, Matsoukis J, Beldame J, Masse M, Billuart F, Van Driessche S. Fatty muscle infiltration of the hip lateral rotator muscles following direct anterior minimally invasive total hip arthroplasty. Orthop Traumatol Surg Res 2020; 106:1515-1521. [PMID: 33097452 DOI: 10.1016/j.otsr.2020.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is no consensus as to the best surgical approach to use when doing total hip arthroplasty (THA). There has been renewed interest in recent years in so-called anatomic minimally invasive direct anterior approaches (DAA). However, their reduced impact has not been confirmed with imaging data. This led us to carry out a prospective study to 1) evaluate fatty infiltration (FI) of muscles around the hip joint and 2) analyze how this FI changes over time. HYPOTHESIS THA done by the DAA induces FI of the anterolateral muscles around the hip adjacent to the approach. MATERIAL AND METHODS A continuous case series of THA by DAA using a traction table was done by a single experienced surgeon. MRI images (GE Optima* MR360 1.5T) were taken preoperatively, then at 3 months and 1 year after the THA surgery. Muscle FI was classified as described by Goutallier by an independent radiologist on all the muscles around the hip joint. A Wilcoxon test was used to compare the preoperative MRI data to the data at 3 months and 1 year postoperative. RESULTS Sixty-nine MRI examinations were done in 23 patients. Two were not interpretable because the patient moved during the preoperative acquisition. No intraoperative or postoperative complications were reported. None of the patients had hip pain or limped at 1 year postoperative. The FI was significantly worse from the preoperative MRI to the 3-month postoperative MRI (p=0.02) and 1-year MRI (p=0.0007) in the internal obturator muscle and at 1 year in the piriformis muscle (p=0.04). There was no significant difference for the other muscles. The rectus femoris, superior and inferior gemellus muscles and the quadratus femoris could not be analyzed. DISCUSSION Our hypothesis was not confirmed, although we had a paradoxical finding of muscle FI in the posterior lateral rotator muscles not the anterolateral muscles after THA by DAA. These lesions may be secondary to detachment or denervation of these muscles when elevating the femur to prepare the femoral canal or insert the stem. LEVEL OF EVIDENCE IV; Prospective case series.
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Affiliation(s)
- Martin Cailleaud
- Service d'imagerie médicale Charles Nicolle, centre hospitalier universitaire de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - Matthieu Lalevée
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Rouen, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Julien Beldame
- Clinique mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Marion Masse
- Clinique mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
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Viamont-Guerra MR, Saffarini M, Laude F. Surgical Technique and Case Series of Total Hip Arthroplasty with the Hueter Anterior Approach for Crowe Type-IV Dysplasia. J Bone Joint Surg Am 2020; 102:99-106. [PMID: 32530875 DOI: 10.2106/jbjs.20.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is being increasingly performed via the Hueter anterior approach (HAA), which has proven benefits with nondysplastic hips; however, little has been published on its outcomes with dysplastic hips, where it can provide better acetabular exposure. We describe our technique for THA via the HAA in hips with Crowe type-IV developmental dysplasia and report the mid-term outcomes of cases that were performed over 5 consecutive years. METHODS We retrospectively evaluated a continuous series of 8 hips (6 patients) with Crowe type-IV dysplasia; the patient ages ranged from 44 ± 20 years (range, 17 to 65 years) at the index THA. All of the patients received uncemented implants via the HAA on a traction table to restore the hip center of rotation to the true acetabulum. Femoral head autografts (FHAs) were used to increase acetabular coverage in 6 hips, and subtrochanteric shortening osteotomies (SSOs) were performed in 5 hips. Patients were assessed clinically and radiographically at a minimum follow-up of 2 years. RESULTS There were no revisions, deaths, dislocations, or infections. Two hips (25%) had intraoperative complications, and 1 hip (13%) had a postoperative complication that required reoperation without implant removal. All of the hips were assessed clinically and radiographically at 4 ± 1 years (range, 2 to 6 years). The modified Harris hip score (mHHS) improved from 33 ± 7 to 90 ± 7, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved from 53 ± 14 to 89 ± 6; the postoperative leg-length discrepancy was 3.2 mm (range, -10 to 20 mm). None of the hips had osteolysis or radiolucent lines of >2 mm. CONCLUSIONS THA via the HAA on a traction table for hips with Crowe type-IV dysplasia yielded satisfactory mid-term outcomes. Both FHA and SSO can be adequately performed via the HAA to help restore the hip center of rotation to the true acetabulum. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Ramsay Générale de Santé, Clinique du Sport Paris V, Paris, France.,Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Frederic Laude
- Ramsay Générale de Santé, Clinique du Sport Paris V, Paris, France
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50
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Martusiewicz A, Delagrammaticas D, Harold RE, Bhatt S, Beal MD, Manning DW. Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period. Hip Int 2020; 30:695-702. [PMID: 31588801 DOI: 10.1177/1120700019881413] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Direct anterior approach total hip arthroplasty (DA THA) has been reported to improve early outcomes compared to posterior approach THA up to 6 weeks postoperatively. Limited weekly outcomes data are available prior to 6 weeks. We evaluate outcomes including when patients first drive a car, leave home, and discontinue their assist device. METHODS Patients undergoing THA for primary osteoarthritis were prospectively enrolled. Outcomes data were collected preoperatively and postoperatively at weekly intervals for 6 weeks. RESULTS 111 patients (55 DA and 56 posterior approach) were enrolled. There was no significant difference (p > 0.05) in pre-surgical Patient-Reported Outcomes Measurement Information System (PROMIS) scores or modified Harris Hip Score (mHHS).Postoperatively, the DA THA group had decreased length of stay (p = 0.0002) and increased distance walked on postoperative day 1 and 2 (p = 0.011, p = 0.0004). The DA group had lower pain scores (p < 0.05) and required less day 1 and total narcotics (p = 0.029, p = 0.01). The DA cohort had improved PROMIS Physical Function scores and mHHS up to 5 weeks postoperatively. DA patients discontinued their assistive device 8 days earlier (p = 0.01), left home 3 days earlier (p = 0.001), and drove a car 5 days earlier (p = 0.01). CONCLUSIONS Patients undergoing DA THA discontinued their assistive device, left their home, and drove a car sooner than posterior approach patients. We found improvement in physical function with DA, and it persisted up to 5 weeks postoperatively. Furthermore, DA patients had significantly shorter length of stay, improved mobilisation, decreased narcotic requirements and improved inpatient pain scores compared to posterior approach THA. Future randomised controlled study should be performed to minimise the biases inherent in this study methodology and confirm the results.
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Affiliation(s)
- Alexander Martusiewicz
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dimitri Delagrammaticas
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan E Harold
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Surabhi Bhatt
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew D Beal
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David W Manning
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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