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Wang K, Zhang T, Xia R, Wang J, Yu J, Wang W. Efficacy of direct anterior approach versus posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05547-4. [PMID: 39287787 DOI: 10.1007/s00402-024-05547-4] [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: 03/31/2024] [Accepted: 09/03/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND To compare the efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in total hip arthroplasty (THA) in terms of operation time, incision length, intraoperative blood loss, postoperative pain, and incision infection rate. METHODS We systematically searched databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese sci-tech journals, Chinese Biomedical Literature Database (CBM), PubMed, and Cochrane Library up to December 2023. We included randomized controlled trials (RCTs) that compared DAA with PLA in THA, with a minimum sample size of 80 and a follow-up of at least 6 months. Studies were screened by two independent researchers, following PRISMA guidelines. Data were extracted using a pre-established feature table, capturing study design, sample size, patient demographics, and outcomes of interest. Meta-analysis was performed using RevMan 5.4.1 software. Heterogeneity was assessed using the Q-value statistical test and I² test. The fixed-effects model was used when heterogeneity was low; otherwise, the random-effects model was applied. RESULTS A total of 19 RCTs met the inclusion criteria. The Meta-analysis revealed that DAA was associated with a longer operation time [MD = 5.89, 95%CI(2.26 to 9.51), P = 0.001] but resulted in a smaller incision length [MD = -2.99, 95%CI(-3.76 to -2.22), P < 0.00001], less intraoperative blood loss [MD=-108.36, 95%CI(-131.10 to -85.62), P < 0.00001], lower incidence of postoperative incision infection [OR = 0.39, 95%CI(0.19 to 0.83), P = 0.01], and reduced hip Visual Analog Scale (VAS) scores on the 1st and 3rd days postoperatively [MD=-0.85, 95%CI(-0.96 to -0.74), P < 0.00001; MD=-0.60, 95%CI(-1.13 to -0.07), P = 0.03]. No significant difference was observed in VAS scores on the 7th postoperative day. CONCLUSION The DAA for THA offers advantages over PLA, including reduced incision size, blood loss, and postoperative pain, albeit with a longer operation time. These findings should guide clinical decision-making, considering the benefits and potential increased complexity of the DAA.
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Affiliation(s)
- Kunhao Wang
- Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China
| | - Tao Zhang
- Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China
| | - Ruiyang Xia
- Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China
| | - Jiankai Wang
- Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China
| | - Jinliang Yu
- Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China
| | - Wenbo Wang
- Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China.
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Revelt N, Sleiman A, Kurcz B, George E, Kleinsmith R, Feibel B, Thuppal S, Delfino K, Allan DG. Acute Surgical Site Complications in Direct Anterior Total Hip Arthroplasty: Impact of Local Subcutaneous Tissue Depth and Body Mass Index. Arthroplast Today 2024; 28:101465. [PMID: 39100419 PMCID: PMC11295467 DOI: 10.1016/j.artd.2024.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 04/27/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Body mass index (BMI) is an imperfect measure of patients' adiposity and operative risk. Radiographic and direct subcutaneous measurements have been utilized in attempts to more accurately characterize the risk of postoperative complications, including surgical site infection. This study aims to evaluate whether direct tissue depth measurement is a more accurate predictor of skin complication following direct anterior total hip arthroplasty (THA). Methods A retrospective chart review of patients who underwent elective THA between April 30, 2020, and January 31, 2023, was performed. Baseline demographics, antibiotics, anticoagulation, and intraoperatively measured tissue depths at proximal, middle, and distal portions of the incision were recorded. Patient follow-up was reviewed to assess the development of skin complication in the acute postoperative period. Results Data were collected from 280 patients who underwent THA via direct anterior approach by a single surgeon. The mean age was 66.0 years, and 52.1% were female. A total of 18/280 (6.4%) patients developed an abrasion (5/18) or superficial surgical site infection (13/18) within the first 60 days postoperatively. Patients who developed skin complications had a significantly higher BMI (33.7 kg/m2 vs 29.9 kg/m2; P = .0021). Patients with a BMI >30 kg/m2 had more than 5 times increased odds of developing a superficial skin complication in the acute 60-day postoperative period compared to those with a BMI <30 kg/m2 (Odds ratio = 5.318, P = .0059). None of the measured tissue depths, nor their average together, were shown to be significant predictors of skin complications. Conclusions This study showed that BMI is a significant predictor of acute skin complications in direct anterior THA patients. No other significant predictors were found to be associated with increased risk, including proximal, middle, and distal tissue depths.
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Affiliation(s)
- Nicolas Revelt
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Anthony Sleiman
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Brian Kurcz
- Cincinnati Sports Medicine & Orthopaedic Center, Cincinnati, OH
- Mercy Health, Cincinnati, OH, USA
| | - Edgar George
- Southern Illinois University School of Medicine, Springfield, IL
| | | | - Benjamin Feibel
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sowmyanarayanan Thuppal
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kristin Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - D. Gordon Allan
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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3
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Coden GS, Olsen AA, Schoeller LE, Niu R, Pichiotino ER, Freccero DM, Smith EL. Similar incidence of postoperative sciatic nerve palsy in direct anterior and posterior approach total hip arthroplasty. Hip Int 2024; 34:452-458. [PMID: 38654687 DOI: 10.1177/11207000241232813] [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: 04/26/2024]
Abstract
BACKGROUND Sciatic nerve palsy is a rare but devastating complication following total hip arthroplasty (THA). While the use of the direct anterior approach is increasing, limited data exist regarding sciatic nerve palsy and surgical approach. The purpose of this study was to determine the factors and outcomes associated with sciatic nerve palsy (SNP) after THA. METHODS A retrospective analysis was performed at a single institution of 7 SNP that occurred in 4045 THA via direct anterior approach and 10 SNP in 8854 THA via posterior approach, being operated between 01 January 2017 and 12 December 2021. SNP patients were matched 1:5 to patients without SNP. Medical records were reviewed for demographics including age, gender, body mass index (BMI), comorbidities, and preoperative indication. Additional workup of SNP patients including advanced imaging and reoperation were documented. Recovery grades were assigned to all SNP patients at most recent clinical follow-up. RESULTS 5 of the SNP were complete and 12 partial. They occurred as frequently with the direct anterior (0.17%) and posterior approach (0.11%, p = 0.5). The presence of femur cables and reoperations were associated with SNP (p = 0.04 and p = 0.002, respecitvely). Age, gender, BMI, comorbidities, and surgical indication had no effect on SNP. 4 of the 17 affected patients had almost complete recovery at latest follow-up. CONCLUSIONS The incidence of SNP was similar in direct anterior and posterior approach. Surgeons should counsel patients regarding the risks of SNP regardless of the used approach.
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Affiliation(s)
| | - Aaron A Olsen
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - Ruijia Niu
- New England Baptist Hospital, Boston, MA, USA
| | | | - David M Freccero
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
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Carlock KD, Wilkerson JB, Yamaguchi JT, Fernando ND. A Comparison of Wound Complications Following Total Hip Arthroplasty Performed Through the Direct Anterior Versus Direct Lateral Approach. Arthroplast Today 2024; 27:101388. [PMID: 38774405 PMCID: PMC11106518 DOI: 10.1016/j.artd.2024.101388] [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: 10/09/2023] [Revised: 02/27/2024] [Accepted: 03/24/2024] [Indexed: 05/24/2024] Open
Abstract
Background Some studies have suggested the risk of wound complications may be higher using the direct anterior (DA) approach to total hip arthroplasty (THA). This study aimed to compare the risk of early postoperative wound complications between the DA and direct lateral (DL) approaches to THA and to determine patient risk factors that may contribute to this problem. Methods All patients who underwent primary THA with a single surgeon over a 5-year period were retrospectively reviewed. All patients were treated with either the DA or DL approach. Data collected included patient demographics, surgical approach, and wound status. There was a minimum follow-up of 6 weeks to allow for an adequate assessment of surgical wound healing. Univariate and multivariate analyses were used to compare the 2 approaches. Results Five hundred seventy-nine patients (77.6%) who underwent DA approach and 167 patients (22.4%) who underwent DL approach were included. Patients who underwent DL approach had a higher body mass index and a higher rate of diabetes than those treated with the DA approach. Forty patients (6.9%) in the DA cohort and 14 (8.4%) in the DL cohort experienced early wound complications, P = .523. After controlling for potential confounding variables, the surgical approach was not an independent risk factor for early postoperative wound complications. Conclusions While there have been concerns regarding use of the DA approach in patients with higher body mass index and certain medical comorbidities, the results of this study suggest the choice of surgical approach may have minimal effect on the rate of early postoperative wound complications.
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Affiliation(s)
- Kurtis D. Carlock
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jacob B. Wilkerson
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jonathan T. Yamaguchi
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Navin D. Fernando
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA
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5
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Muffly BT, Hegeman EM, Hartline BE, Singh K, Premkumar A, Guild GN. Total Hip Arthroplasty With Subtrochanteric Osteotomy for Crowe IV Dysplasia Using an Extensile Direct Anterior Approach: A Surgical Technique. Arthroplast Today 2024; 27:101374. [PMID: 39071821 PMCID: PMC11282430 DOI: 10.1016/j.artd.2024.101374] [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: 09/11/2023] [Revised: 01/04/2024] [Accepted: 03/04/2024] [Indexed: 07/30/2024] Open
Abstract
The direct anterior approach (DAA) has been increasing in popularity for primary total hip arthroplasty (THA). Despite previously documented anatomic limitations to its direct distal extension, alternative exposure methods have been described to safely access the femoral diaphysis and facilitate increasingly complex primary and revision THA scenarios. The DAA has several purported advantages compared to alternative approaches (eg, posterior and lateral-based), including its muscle-sparing nature, use of an internervous plane, and preservation of posterior stabilizing structures. Proponents of the DAA cite decreased postoperative pain, quicker recovery times, potentially lower dislocation rates, ease of intraoperative fluoroscopy, and improved implant placement/restoration of leg lengths. The current literature, however, is sparse when considering the use of this approach in the setting of severely dysplastic hips necessitating a concurrent subtrochanteric shortening osteotomy. When utilizing a posterior approach in this population, previous work from Ollivier and colleagues demonstrated high rates of cementless implant osseointegration and significantly improved clinical outcomes at long-term follow-up. Although relatively few reports of addressing this pathology via the DAA currently exist, initial results are promising. This study seeks to provide a detailed description of a surgical technique for performing primary THA and ipsilateral subtrochanteric shortening osteotomy in this patient population utilizing an extensile DAA.
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Affiliation(s)
- Brian T. Muffly
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Erik M. Hegeman
- Department of Orthopaedics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Braden E. Hartline
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, TX, USA
| | - Keerat Singh
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ajay Premkumar
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - George N. Guild
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
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6
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Oliveira BGD, Costa VHRD, Gama IR, Beskow MH, Santos ERSD. Diagnosis and Prevention of Periprosthetic Joint Infections by Staphylococcus aureus after Hip Fracture: A Systematic Review of the Literature. Rev Bras Ortop 2024; 59:e21-e28. [PMID: 38524719 PMCID: PMC10957261 DOI: 10.1055/s-0043-1776019] [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: 07/15/2022] [Accepted: 11/08/2022] [Indexed: 03/26/2024] Open
Abstract
Hip arthroplasties are surgical procedures widely performed all over the world, seeking to return functionality, relieve pain, and improve the quality of life of patients affected by osteoarthritis, femoral neck fractures, osteonecrosis of the femoral head, among other etiologies. Periprosthetic joint infections are one of the most feared complications due to the high associated morbidity and mortality, with a high number of pathogens that may be associated with its etiology. The aim of the present study was to analyze aspects correlated with the occurrence of infection, diagnosis and prevention of periprosthetic joint infections in the hip associated with Staphylococcus aureus after corrective surgery for hip fractures. This is a systematic review of the literature carried out in the databases indexed in the Medical Literature Analysis and Retrieval System Online (MEDLINE) carried out in accordance with the precepts established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Twenty studies that addressed the diagnosis and prevention of periprosthetic joint infections after hip fractures were selected for analysis. It is observed that there is no consensus in the literature on preventive measures for the occurrence of such infectious processes. Among the risk factors for the occurrence and severity of infections by S. aureus after hip arthroplasties, obesity, longer surgical time, older age, immunosuppression, recent use of antibiotics, and multicomorbidities were mentioned. The use of biomarkers for early diagnosis, as well as screening, decolonization, and antibiotic prophylaxis processes are among the preventive procedures proposed in the literature.
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Affiliation(s)
- Bianca Gabriella de Oliveira
- Departamento da Liga Acadêmica de Ortopedia e Traumatologia da UNIFACS, Universidade Salvador (UNIFACS), Salvador, BA, Brasil
| | | | - Igor Rodrigues Gama
- Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
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7
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Thompson Z, Khoshbin A, Ward S, Brillantes J, Melo L, Waddell JP, Atrey A. The impact of operative approach and intraoperative imaging on leg length discrepancy and acetabular component angle in total hip arthroplasty: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:473-479. [PMID: 37715062 DOI: 10.1007/s00264-023-05962-z] [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: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Operative approach in total hip arthroplasty (THA) has long been a topic of debate with each approach having unique benefits and disadvantages. One purported benefit of an anterior approach to THA is that it allows for intraoperative positioning using fluoroscopy rather than manual positioning. Proper positioning allows for improved outcomes including leg length discrepancy and acetabular component angle. This study aims to examine if operative approach and use of imaging in intraoperative positioning impact LLD and cup angle post-operatively. METHODS A total of 300 hips were enrolled in the study with 100 hips per approach (anterior with fluoroscopy, lateral, and posterior). Retrospective chart review was conducted to assess patient demographics and radiographic analysis used to determine LLD and acetabular cup angle. RESULTS Of the three groups, those receiving anterior approach THAs were on average older than those in the posterior group. Analysis comparing the LLD and acetabular angle across the three groups showed no statistically significant difference in LLD (p=0.091); this was also reflected when comparing hips that received fluoroscopy with those that did not (p=0.91). For acetabular angle, while no difference existed when comparing hips that received imaging versus those that did not, statistically significant differences were observed when comparing the three intraoperative approaches (p<0.0001). CONCLUSIONS Neither intraoperative approach nor the use of intraoperative imaging in THA has a statistically significant effect on LLD post-operatively. However, approach did impact the acetabular cup angle across all three distinct approaches.
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Affiliation(s)
- Zoe Thompson
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada.
| | - Amir Khoshbin
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Sarah Ward
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Jacqueline Brillantes
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Luana Melo
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - James P Waddell
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Amit Atrey
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
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8
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Weißenberger M, Heinz T, Rak D, Stratos I, Anderson PM, Lüdemann M, Horas K, Jakuscheit A, Rudert M. Does Body Mass Index (BMI) Affect the Reconstruction of Biomechanical Parameters in Patients Undergoing Total Hip Replacement (THR) through the Direct Anterior Approach (DAA)? J Clin Med 2024; 13:467. [PMID: 38256601 PMCID: PMC10816045 DOI: 10.3390/jcm13020467] [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: 12/19/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Direct anterior approach total hip replacement (DAA-THR) is gaining increased interest due to its tissue-sparing nature and rapid recovery. Obesity has been shown to be a significant parameter influencing cup positioning in DAA-THR. It was the intention of this retrospective study to examine how obesity would influence the restoration of native hip biomechanical parameters during DAA-THR. MATERIALS AND METHODS A total of 74 patients from a high-volume university orthopedic center after unilateral DAA-THA were included. Patients were retrospectively allocated to a study group (BMI > 30 kg/m2) and a control group (BMI < 30 kg/m2). Furthermore, propensity-score matching for baseline parameters was performed, leaving 30 patients in each group. Biomechanical parameters of the hip (i.e., femoral offset (FO), abductor lever arm (ABL), acetabular offset (AO), center of rotation (COR), stem alignment (SA), body weight lever arm (BWL), cup inclination (CI), and leg length discrepancy (LLD) were evaluated on standardized plain radiographs, and parameters were compared to the native contralateral hip. RESULTS Mean BMI in the study group was 35.07 ± 5.13 kg/m2 and 25.43 ± 2.64 kg/m2 in the control group. There was a significant decrease of the ABL only in the study cohort (p = 0.01). CI and SA did not differ between both cohorts. FO was slightly increased compared to the native hip in both groups. There was a marginally higher but non-significant proportion of improper FO restoration in the study group (19 vs. 16 patients, p = 0.60). CONCLUSIONS Obesity, as quantified by BMI, only has a limited impact on the adequate reconstruction of native biomechanical parameters of the hip during DAA-THR. ABL was the only parameter to be significantly decreased in the overweight patients after DAA-THR. Therefore, special care should be taken on proper acetabular reaming and consequent seating of the cup in the obese patient to avoid excessive lateral positioning.
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Affiliation(s)
- Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany (I.S.); (P.M.A.); (M.L.); (K.H.); (A.J.)
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9
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Buchan GBJ, Hecht CJ, Sculco PK, Chen JB, Kamath AF. Improved short-term outcomes for a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system compared to manual technique with fluoroscopic assistance. Arch Orthop Trauma Surg 2024; 144:501-508. [PMID: 37740783 DOI: 10.1007/s00402-023-05061-z] [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: 06/12/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND While robotic-assisted total hip arthroplasty (RA-THA) has been associated with improved accuracy of component placement, the perioperative and early postoperative outcomes of fluoroscopy-based RA-THA systems have yet to be elucidated. METHODS This retrospective cohort analysis included a consecutive series of patients who received manual, fluoroscopy-assisted THA (mTHA) and fluoroscopy-based RA-THA at a single institution. We compared rates of complications within 90 days of surgery, length of hospital stay (LOS), and visual analog scale (VAS) pain scores. RESULTS No differences existed between groups with respect to demographic data or perioperative recovery protocols. The RA-THA cohort had a significantly greater proportion of outpatient surgeries compared to the mTHA cohort (37.4% vs. 3.8%; p < 0.001) and significantly lower LOS (26.0 vs. 39.5 h; p < 0.001). The RA-THA cohort had a smaller 90-day postoperative complication rate compared to the mTHA cohort (0.9% vs. 6.7%; p = 0.029). The RA-THA cohort had significantly lower patient-reported VAS pain scores at 2-week follow-up visits (2.5 vs. 3.3; p = 0.048), but no difference was seen after 6-week follow visits (2.5 vs. 2.8; p = 0.468). CONCLUSION Fluoroscopy-based RA-THA demonstrates low rates of postoperative complications, improved postoperative pain profiles, and shortened LOS when compared to manual, fluoroscopy-assisted THA.
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Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th, New York, NY, 10021, USA
| | - James B Chen
- Mission Orthopaedic Institute, Providence Mission Hospital, Mission Viejo, CA, 92691, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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10
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Tanabe H, Baba T, Ozaki Y, Yanagisawa N, Homma Y, Nagao M, Kaneko K, Ishijima M. Conventional versus lateral fasciotomy for prevention of lateral femoral cutaneous nerve injury in the non-fan-type nerve in total hip arthroplasty with direct anterior approach. Bone Joint J 2023; 105-B:1252-1258. [PMID: 38035608 DOI: 10.1302/0301-620x.105b12.bjj-2023-0375.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims Lateral femoral cutaneous nerve (LFCN) injury is a potential complication after the direct anterior approach for total hip arthroplasty (DAA-THA). The aim of this study was to determine how the location of the fasciotomy in DAA-THA affects LFCN injury. Methods In this trial, 134 patients were randomized into a lateral fasciotomy (n = 67) or a conventional fasciotomy (n = 67) group. This study was a dual-centre, double-blind, prospective randomized controlled two-arm trial with parallel group design and a 1:1 allocation ratio. The primary endpoint was the presence of LFCN injury, which was determined by the presence of numbness, decreased sensation, tingling, jolt-like sensation, or pain over the lateral aspect of the thigh, excluding the surgical scar, using a patient-based questionnaire. The secondary endpoints were patient-reported outcome measures (PROMs) using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS-12). Assessments were obtained three months after surgery. Results The incidence of LFCN injury tended to be lower in the lateral fasciotomy group (p = 0.089). In the lateral fasciotomy group, there were no significant differences in the mean PROM scores between patients with and without LFCN injury (FJS-12: 54.42 (SD 15.77) vs 65.06 (SD 26.14); p = 0.074; JHEQ: 55.21 (SD 12.10) vs 59.72 (SD 16.50); p = 0.288; WOMAC: 82.45 (SD 6.84) vs 84.40 (SD 17.91); p = 0.728). In the conventional fasciotomy group, there were significant differences in FJS-12 and JHEQ between patients with and without LFCN injury (FJS-12: 43.21 (SD 23.08) vs 67.28 (SD 20.47); p < 0.001; JHEQ: 49.52 (SD 13.97) vs 59.59 (SD 15.18); p = 0.012); however, there was no significant difference in WOMAC (76.63 (SD 16.81) vs 84.16 (SD 15.94); p = 0.107). Conclusion The incidence of LFCN injury at three months after THA was comparable between the lateral and conventional fasciotomy groups. Further studies are needed to assess the long-term effects of these approaches.
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Affiliation(s)
- Hiroki Tanabe
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | | | - Yasuhiro Homma
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Masashi Nagao
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
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Stadler C, Schauer B, Brabec K, Schopper C, Gotterbarm T, Luger M. A neck-sparing short stem shows significantly lower blood loss in total hip arthroplasty compared to a neck-resecting short stem. Sci Rep 2023; 13:19695. [PMID: 37951980 PMCID: PMC10640618 DOI: 10.1038/s41598-023-47008-9] [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: 03/23/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Short stems are associated with a significantly lower blood loss (BL) compared to straight stems in total hip arthroplasty (THA). Different types of stems differ in design, fixation and level of femoral neck osteotomy. Therefore, we sought to evaluate the difference regarding the perioperative BL between two short stems with different designs in direct anterior approach (DAA). A total of 187 THA performed by a single surgeon were analysed. 107 patients received a neck-resecting (Group A) and 80 patients a neck-sparing short stem (Group B). Blood counts of the day before surgery and of two days after surgery were evaluated. Total blood volume and BL were calculated. Additionally, duration of surgery was analysed. The perioperative BL was significantly lower in Group B (451.4 ± 188.4 ml) compared to Group A (546.6 ± 232.7 ml; p = 0.002). The postoperative haematocrit (31.6 ± 3.7% vs. 30.4 ± 4.4%; p = 0.049) and haemoglobin-level (11.0 ± 1.3 g/dL vs. 10.4 ± 1.5 g/dL; p = 0.002) were significantly higher in Group B. Duration of surgery was significantly shorter in Group B (62.0 ± 11.4 min vs. 72.6 ± 21.8 min; p < 0.001). The use of a neck-sparing short stem leads to a significantly decreased BL compared to a neck-resecting short stem in DAA THA. A less extensively conducted capsular release necessary for optimal femoral exposition might lead to a lower perioperative BL and shorter durations of surgery.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Katja Brabec
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
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12
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von Hertzberg-Boelch S, Mueller L, Stratos I, Arnholdt J, Holzapfel B, Rudert M. Which patient-specific parameters correlate with operation time for total hip arthroplasty? - A retrospective analysis of the direct anterior approach. INTERNATIONAL ORTHOPAEDICS 2023; 47:1975-1979. [PMID: 37269401 PMCID: PMC10345041 DOI: 10.1007/s00264-023-05841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/14/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE The current study aims to identify patient-specific factors that correlate with operation time for total hip arthroplasty (THA) performed via the direct anterior approach (DAA). METHODS In this retrospective study, patient-specific factors were tabulated from the charts and measured from preoperative templating radiographs. These factors were correlated with operation time by bivariate analysis. Significant factors were used for stepwise multiple regression analysis. RESULTS Nine hundred-sixty procedures were included. BMI (R = 0.283), the distance from the superior iliac spine to the greater trochanter (DAA Plane) (R = - 0.154), patients age (R = 0.152) and the abdominal fat flap (R = 0.134) showed the strongest correlations (p < 0.005) with operation time. The multiple regression model including BMI, Kellgren and Lawrence Score, Age, DAA Plane and the Canal to Calcar ratio had the best predictive accuracy (corrected R2 = 0.122). CONCLUSIONS Patient-specific factors that make the entry into the femur difficult correlate significantly with operation time of THA via the DAA.
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Affiliation(s)
- Sebastian von Hertzberg-Boelch
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany.
- LVR Klinik für Orthopädie Viersen, Viersen, Germany.
| | - Laura Mueller
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany
| | - Joerg Arnholdt
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Munich, Germany
| | - Boris Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Munich, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Julius-Maximilian University, Würzburg, Germany
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13
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Wilson JM, Hadley ML, Ledford CK, Bingham JS, Taunton MJ. The Fate of the Patient With Superficial Dehiscence Following Direct Anterior Total Hip Arthroplasty. J Arthroplasty 2023; 38:S420-S425. [PMID: 37105323 DOI: 10.1016/j.arth.2023.04.044] [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: 11/28/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Direct anterior approach (DAA) total hip arthroplasty (THA) has been associated with higher rates of superficial incisional dehiscence. However, limited data are available regarding the outcomes following initial treatment of this complication. This study aimed to evaluate patient risk factors, reoperations, and revisions in those who developed superficial wound dehiscence following DAA THA. METHODS We identified 3,687 patients who underwent a primary DAA THA between 2010 and 2019 from our enterprise total joint registry. Of these, 98 (2.7%) patients developed a superficial wound dehiscence requiring intervention [irrigation and debridement (n = 42) or wound care with or without antibiotics (n = 56)]. Dehiscence was noted at a median of 27 (range, 2-105) days. These patients were compared to patients who did not have a superficial wound complication (n = 3,589). Landmark survivorship analysis was performed to account for immortal time bias with a 45-day landmark time. RESULTS Patients who had superficial wound dehiscence compared to those who did not, were more often women (64 versus 53%, P = .02) and had increased mean body mass index (33 versus 29, P < .001). There was no difference in 4-year survivorship free from any revision between cohorts (97 versus 98%, respectively, P = .14). There were 2 (2.0%) revisions in the superficial dehiscence group: 1 for periprosthetic joint infection and 1 for aseptic femoral loosening. CONCLUSION Superficial wound dehiscence following DAA THA was associated with higher body mass index and was more common in women. Fortunately, with proper index management, the risk of revision THA and periprosthetic joint infection was not increased for these patients.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Hadley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cameron K Ledford
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
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Homma Y, Baba T, Watari T, Hayashi K, Kobayashi H, Matsumoto M, Banno S, Ozaki Y, Ochi H, Jinnai Y, Ishii S, Tanabe H, Shirogane Y, Zhuang X, Yuasa T, Kaneko K, Ishijima M. Recent advances in the direct anterior approach to total hip arthroplasty: a surgeon's perspective. Expert Rev Med Devices 2023; 20:1079-1086. [PMID: 37942898 DOI: 10.1080/17434440.2023.2280986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique. AREAS COVERED In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application. EXPERT OPINIONS The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Mikio Matsumoto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Sammy Banno
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuta Jinnai
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Seiya Ishii
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Tanabe
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Xu Zhuang
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takahito Yuasa
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
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15
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Makhdom AM, Hozack WJ. Direct anterior versus direct lateral hip approach in total hip arthroplasty with the same perioperative protocols one year post fellowship training. J Orthop Surg Res 2023; 18:216. [PMID: 36935481 PMCID: PMC10026497 DOI: 10.1186/s13018-023-03716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/15/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Variable results have been reported regarding the clinical outcomes in Total hip arthroplasty (THA) based on the surgical approach. The aim of this study is to compare the clinical outcomes between Direct anterior (DA) and direct lateral (DL) approaches in THA when performed immediately after fellowship training. METHODS During the 1st year of practice, all consecutive patients who underwent THA via DA and DL hip approaches were retrospectively investigated. Patients'demographics, diagnosis, American society of Anesthesiology (ASA) score, route of anesthesia, length of hospital stay (LOS), leg length discrepancy (LLD), radiographic parameters, operative time, number of opioids refills postoperatively, and complications were collected and compared between the two groups. The short form of Hip Disability and Osteoarthritis Outcome score, Joint Replacement (HOOS, JR) was prospectively collected pre and postoperatively. The minimum follow-up period was 2 years. RESULTS Forty patients in DA group and 38 patients in DL group were included. No statistically significant difference was found between the two groups in terms of demographics, diagnosis, ASA scores, route of anesthesia at the time of THA, postoperative radiographic parameters, LOS, LLD, opioid refills and HOOS scores (p > 0.05). Patients in the DA group had shorter operative time (83 ± 17 min) when compared to the DL group (93 ± 24 min) (p = 0.03). No major complications were found except for one early deep infection patient in DL group. CONCLUSION Both DA and DL approaches resulted in satisfactory outcomes in THA when performed by a fellowship trained surgeon.
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Affiliation(s)
- Asim M Makhdom
- Department of Orthopaedic Surgery, King Abdulaziz University, 7441 Al Mortada Street, Jeddah, 22252, Saudi Arabia.
| | - William J Hozack
- Adult Reconstruction, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street Floor 5, Philadelphia, PA, 19107, USA
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Liu H, Yao X, Kong W, Zhang L, Si J, Ding X, Zheng Y, Zhao Y. Cochlear Reimplantation Rate and Cause: a 22-Year, Single-Center Experience, and a Meta-Analysis and Systematic Review. Ear Hear 2023; 44:43-52. [PMID: 35973054 PMCID: PMC9848219 DOI: 10.1097/aud.0000000000001266] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In terms of cochlear reimplantation, there is no consensus on the definition, range, or calculation formulation for the reimplantation rate. This study aims to put forward a relatively standardized and more explicit definition based on a literature review, calculate the rate of cochlear reimplantation, and examine the classification and distribution of the reimplantation causes. DESIGN A systematic review and retrospective study. A relatively clearer definition was used in this study: cochlear reimplantation is the implantation of new electrodes to reconstruct the auditory path, necessitated by the failure or abandonment of the initial implant. Seven English and Chinese databases were systematically searched for studies published before July 23, 2021 regarding patients who accepted cochlear reimplantation. Two researchers independently applied the inclusion and exclusion criteria to select studies and complete data extraction. As the effect size, the reimplantation rate was extracted and synthesized using a random-effects model, and subgroup and sensitivity analyses were performed to reduce heterogeneity. In addition, a retrospective study analyzed data on cochlear reimplantation in a tertiary hospital from April 1999 to August 2021. Kaplan-Meier survival analysis and the log-rank test were adopted to analyze the survival times of cochlear implants and compare them among different subgroups. RESULTS A total of 144 articles were included, with 85,851 initial cochlear implantations and 4276 cochlear reimplantations. The pooled rate of cochlear reimplantation was 4.7% [95% CI (4.2% to 5.1%)] in 1989 to 2021, 6.8% [95% CI (4.5% to 9.2%)] before 2000, and 3.2% [95% CI (2.7% to 3.7%)] after 2000 ( P =0.003). Device failures accounted for the largest proportion of reimplantation (67.6% [95% CI (64.0% to 71.3%)], followed by medical reasons (28.9% [95% CI (25.7% to 32.0%)]). From April 1999 to August 2021, 1775 cochlear implants were performed in West China Hospital (1718 initial implantations and 57 reimplantations; reimplantation rate 3.3%). In total, 45 reimplantations (78.9%) were caused by device failure, 10 (17.5%) due to medical reasons, and 2 (3.5%) from unknown reasons. There was no difference in the survival time of implants between adults and children ( P = 0.558), while there existed a significant difference between patients receiving implants from different manufacturers ( P < 0.001). CONCLUSIONS The cochlear reimplantation rate was relatively high, and more attention should be paid to formulating a standard definition, calculation formula, and effect assessment of cochlear reimplantation. It is necessary to establish a sound mechanism for long-term follow-up and rigorously conduct longitudinal cohort studies.
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Affiliation(s)
- Haotian Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
- These authors are co-first authors who have contributed equally to this work
| | - Xinyi Yao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
- These authors are co-first authors who have contributed equally to this work
| | - Weili Kong
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Lin Zhang
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jingyuan Si
- Department of Otolaryngology-Head and Neck Surgery, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Xiuyong Ding
- Department of Otolaryngology-Head and Neck Surgery, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Yun Zheng
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
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17
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Maccagnano G, Maruccia F, Rauseo M, Noia G, Coviello M, Laneve A, Quitadamo AP, Trivellin G, Malavolta M, Pesce V. Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease. J Clin Med 2022; 11:jcm11164785. [PMID: 36013024 PMCID: PMC9410486 DOI: 10.3390/jcm11164785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Francesco Maruccia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michela Rauseo
- Department of Anesthesia and Intensive Care, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giovanni Noia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michele Coviello
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico. Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico. Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Andrea Laneve
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Alessandro Pio Quitadamo
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giacomo Trivellin
- Hip and Trauma Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Michele Malavolta
- Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Vito Pesce
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
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Kawanishi K, Fukuda D, Niwa H, Okuno T, Miyashita T, Kitagawa T, Kudo S. Relationship between Tissue Gliding of the Lateral Thigh and Gait Parameters after Trochanteric Fractures. SENSORS 2022; 22:s22103842. [PMID: 35632253 PMCID: PMC9144969 DOI: 10.3390/s22103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022]
Abstract
Trochanteric fractures lead to severe functional deficits and gait disorders compared to femoral neck fractures. This study aims to investigate gait parameters related to gliding between tissues (gliding) after trochanteric fracture (TF) surgery. This study implemented a cross-sectional design and was conducted amongst patients who underwent TF surgery (n = 94) approximately three weeks post-trochanteric fracture surgery. The following parameters were evaluated: (1) gliding between tissues; (2) lateral femoral pain during loading; (3) maximum gait speed; (4) stride time variability and step time asymmetry as measures of gait cycle variability; (5) double stance ratio and single stance ratio for assessment of stance phase, (6) jerk; and (7) Locomotor rehabilitation index as a measure of force changes during gait. The gliding coefficient was significantly correlated with lateral femoral pain (r = 0.517), jerk root mean square (r = −0.433), and initial contact-loading response jerk (r = −0.459). The jerk of the force change value during gait was also effective in understanding the characteristics of the gait in the initial contact-loading response in patients with trochanteric fractures. Additionally, gliding is related not only to impairments such as pain but also to disabilities such as those affecting gait.
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Affiliation(s)
- Kengo Kawanishi
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan; (K.K.); (T.K.)
- Department of Rehabilitation, Kano General Hospital, Osaka 531-0041, Japan; (H.N.); (T.O.)
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
| | - Daisuke Fukuda
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
- Department of Rehabilitation, Higashi Osaka Hospital, Osaka 536-0005, Japan
| | - Hiroyuki Niwa
- Department of Rehabilitation, Kano General Hospital, Osaka 531-0041, Japan; (H.N.); (T.O.)
| | - Taisuke Okuno
- Department of Rehabilitation, Kano General Hospital, Osaka 531-0041, Japan; (H.N.); (T.O.)
| | - Toshinori Miyashita
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
- PMP Inc., Osaka 580-0025, Japan
| | - Takashi Kitagawa
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan; (K.K.); (T.K.)
- Department of Rehabilitation, Higashi Osaka Hospital, Osaka 536-0005, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan; (K.K.); (T.K.)
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
- Correspondence: ; Tel.: +81-6-6616-6911
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Rivera F, Comba LC, Bardelli A. Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review. World J Orthop 2022; 13:388-399. [PMID: 35582154 PMCID: PMC9048494 DOI: 10.5312/wjo.v13.i4.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/31/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers.
AIM To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate.
METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.
RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.
CONCLUSION DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.
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Affiliation(s)
- Fabrizio Rivera
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
| | - Luca C Comba
- Department of Orthopedic Trauma, Università degli Studi di Torino, Torino 10124, Italy
| | - Alessandro Bardelli
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
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How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed a systematic review by searching the PubMed database for hip aseptic loosening. We included meta-analysis, randomized controlled trials, reviews, and systematic reviews in the last 10 years, which provided information on techniques that can prevent aseptic loosening in total hip arthroplasty. From a total of 3205 articles identified, 69 articles (2%) met the inclusion criteria, leading to a total of 36 recommendations. A lot of research has been conducted in terms of septic loosening in the last decade. Currently, we have various techniques by which we can reduce the rate of aseptic loosening. Nevertheless, further randomized clinical trials are needed to expand the recommendations for aseptic loosening prevention.
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