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Kajos LF, Molics B, Than P, Gőbel G, Elmer D, Pónusz-Kovács D, Csákvári T, Kovács B, Horváth L, Bódis J, Boncz I. Comparative analysis of the quality of life regarding patients who underwent hip replacement in public versus private hospitals in Hungary. Sci Rep 2024; 14:10031. [PMID: 38693216 PMCID: PMC11063203 DOI: 10.1038/s41598-024-60720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
The study aimed to investigate the impact of hip replacement surgery on the quality of life and to compare the outcomes by sociodemographic and surgical data in Hungarian public and private hospitals. Patients were selected at the Department of Orthopaedics (Clinical Centre, University of Pécs) and at the Da Vinci Private Clinic in Pécs. Patients completed the SF-36 and Oxford Hip Score (OHS) questionnaires before the surgery, 6 weeks and 3 months later. We also evaluated socio-demographic data, disease and surgical conditions. The research involved 128 patients, 60 patients in public, 68 patients in private hospital. Despite the different sociodemographic characteristics and surgical outcomes of public and private healthcare patients, both groups had significantly improved the quality of life 3 months after hip replacement surgery measured by OHS and SF-36 physical health scores (p < 0.001). In the mental health score, only the patients of the private health sector showed a significant improvement (p < 0.001). The extent of improvement did not differ between the two healthcare sectors according to the OHS questionnaire (p = 0.985). While the SF-36 physical health score showed a higher improvement for public patients (p = 0.027), the mental health score showed a higher improvement for private patients (p = 0.015).
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Affiliation(s)
- Luca Fanni Kajos
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary.
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary.
- National Laboratory on Human Reproduction, Pécs, 7624, Hungary.
| | - Bálint Molics
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
| | - Péter Than
- Department of Orthopaedics, Clinical Centre, Medical School, University of Pécs, Pécs, 7632, Hungary
| | - Gyula Gőbel
- Da Vinci Private Clinic, Pécs, 7635, Hungary
| | - Diána Elmer
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
- National Laboratory on Human Reproduction, Pécs, 7624, Hungary
| | - Dalma Pónusz-Kovács
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
- National Laboratory on Human Reproduction, Pécs, 7624, Hungary
| | - Tímea Csákvári
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
| | - Bettina Kovács
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
| | - Lilla Horváth
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
| | - József Bódis
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
- National Laboratory on Human Reproduction, Pécs, 7624, Hungary
- Department of Obstetrics and Gynaecology, Clinical Centre, Medical School, University of Pécs, Pécs, 7624, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, 7621, Hungary
- National Laboratory on Human Reproduction, Pécs, 7624, Hungary
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Rhee I, Tirosh O, Ho A, Griffith A, Salehi L, Jensen A, Spiers L, Tran P. The effect of 3 commonly used surgical approaches for total hip arthroplasty on mid- to long-term patient-reported outcome measures. Hip Int 2024; 34:161-167. [PMID: 37743745 DOI: 10.1177/11207000231199342] [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: 09/26/2023]
Abstract
INTRODUCTION The most effective surgical approach for total hip arthroplasty (THA) remains controversial. Comparisons of surgical approach based on patient-reported outcome measures (PROMs) have been limited to short- to mid-term outcomes or the comparison of only 2 approaches. The aim of this study was to compare PROMs for the 3 main approaches for THA with up to 10 years follow-up. METHODS A total of 906 patients who underwent primary THA at a single hospital between 2009 and 2020 through an anterior (312), lateral (211) or posterior (383) approach were evaluated using the Oxford Hip Score (OHS), EuroQoL-5-Dimension (EQ-5D-5L) and visual analogue scale/verbal rating scale for pain (VAS/VRS). PROMs were prospectively collected before surgery and routinely at 6 weeks, 6 months and 1, 2, 5 and 10 years after surgery. RESULTS There was no significant difference in demographics or comorbidities between the 3 groups. All 3 approaches resulted in a significant improvement in overall PROMs after THA, and plateaued after 6 months postoperatively, with no difference between the approaches (OHS, p < 0.01;EQ-5D-5L Index, p < 0.01;VAS/VRS, p < 0.01). The EQ-5D-5L mobility dimension showed that the lateral approach resulted in 20% more patients reporting problems with mobility than the posterior and anterior approaches at the 6-week, 6-month, 2-year and 10-year follow-up. CONCLUSIONS This study shows that all 3 common THA approaches substantially and similarly improve the OHS, EQ-5D-5L Index and VRS between 6 months and 10 years postoperatively. However, patient-reported mobility was poorer after a lateral approach and continued to be so at long-term follow-up.
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Affiliation(s)
- Isaac Rhee
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Oren Tirosh
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Victoria University, St. Albans, VIC, Australia
| | - Andy Ho
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Andrew Griffith
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Lily Salehi
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Amalie Jensen
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Libby Spiers
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Victoria University, St. Albans, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
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Kim AG, Rizk AA, Chiu AM, Zuke W, Acuña AJ, Kamath AF. No clinically significant differences in patient-reported outcome measures across total hip arthroplasty approaches. Hip Int 2024; 34:21-32. [PMID: 37260099 DOI: 10.1177/11207000231178722] [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: 06/02/2023]
Abstract
INTRODUCTION As recent studies demonstrate an ongoing debate surrounding outcomes and complications with respect to different total hip arthroplasty (THA) approaches, patient-reported outcome measures (PROMs) may provide valuable information for clinician and patient decision-making. Therefore, our systematic review aimed to assess how surgical approach influences patient-reported outcomes. METHODS 5 online databases were queried for all studies published between January 1, 1997 and March 4, 2022 that reported on PROMs across various surgical approaches to THA. Studies reporting on PROMs in primary THA patients segregated by surgical approach were included. Articles reporting on revision THA, hip resurfacing, and arthroscopy were excluded. Mantel-Haenszel (M-H) models were utilised to calculate the pooled mean difference (MDs) and 95% confidence interval (CIs). RESULTS No differences between the DAA and other approaches were observed when evaluating HOOS (MD -0.28; 95% CI, -1.98-1.41; p = 0.74), HHS (MD 2.38; 95% CI, -0.27-5.03; p = 0.08), OHS (MD 1.35; 95% CI, -2.00-4.71; p = 0.43), FJS-12 (MD 5.88; 95% CI, -0.36-12.12; p = 0.06), VAS-pain (MD -0.32; 95% CI, -0.68-0.04; p = 0.08), and WOMAC-pain (MD -0.73; 95% CI, -3.85-2.39; p = 0.65) scores. WOMAC (MD 2.47; 95% CI, 0.54-4.40; p = 0.01) and EQ-5D Index (MD 0.03; 95% CI, 0.01-0.06; p = 0.002) scores were found to significantly favour the DAA cohort over the other approaches. Only the EQ-5D index score remained significant following sensitivity analysis. CONCLUSIONS Superiority of any 1 approach could not be concluded based on the mixed findings of the present analysis. Although our pooled analysis found no significant differences in outcomes except for those measured by the EQ-5D index, a few additional metrics, notably the WOMAC, HHS, FJS-12, and VAS-pain scores, leaned in favour of the DAA.
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Affiliation(s)
- Andrew G Kim
- Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Adam A Rizk
- Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Austin M Chiu
- Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Zuke
- Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alexander J Acuña
- Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Atul F Kamath
- Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Lalevée M, Martinez L, Rey B, Beldame J, Matsoukis J, Poirier T, Brunel H, Van Driessche S, Noé N, Billuart F. Gait analysis after total hip arthroplasty by direct minimally invasive anterolateral approach: A controlled study. Orthop Traumatol Surg Res 2023; 109:103521. [PMID: 36539033 DOI: 10.1016/j.otsr.2022.103521] [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: 12/15/2021] [Revised: 07/13/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Clinical and functional improvement after minimally invasive total hip arthroplasty (THA) has become increasingly controversial. The minimally invasive anterolateral approach (MIALA) allows rapid recovery resulting in a reduced need for rehabilitation. Alterations in muscle and static balance have previously been demonstrated. Results in the context of quantified gait analysis (QGA) and MIALA compared to an asymptomatic population remain unknown beyond one year postoperatively. Thus, the main objective of this controlled study was to compare the spatiotemporal parameters of gait, obtained using a QGA, beyond one year postoperatively in subjects operated on for THA by MIALA, with a group of asymptomatic subjects of the same age. The secondary objectives of the study were to compare the other QGA and EMG data acquired in operated subjects with asymptomatic subjects. HYPOTHESIS We hypothesized that QGA and EMG parameters would not normalize beyond one year postoperatively. PATIENTS AND METHODS Thirty-one subjects were recruited, including 16 patients (68 years old; IQR: 65-70) who underwent MIALA, at 15.5 months postoperatively (IQR: 13-17) and 15 asymptomatic subjects (62 years old; IQR: 61-71). Subjects underwent QGA and maximal isometric muscle force tests on the gluteus medius, gluteus maximus, Tensor Fascia Lata (TFL) and Sartorius muscles. Spatiotemporal gait parameters were the primary endpoint. The other QGA parameters: kinetics (characteristic values of vertical ground reaction forces, peak hip moments) and kinematics (hip joint amplitudes and pelvic mobility in the frontal and sagittal plane) constituted the secondary criteria. RESULTS Five subjects were excluded for unrestored offset. Walking speed was lower in operated patients (1.03m/s versus 1.18m/s, p=0.005). Maximal isometric muscle force moments were lower in patients operated on for the gluteus maximus and medius as well as the TFL (p<0.005). The vertical ground reaction forces were lower for the operated patients for the loading phase (FzFCmax, p=0.001), the single stance phase (FzSPmin, p=5.05.10-2) and the swing phase (FzTOmax, p=0.0002). The moments were lower in the sagittal plane for the operated patients (0.6N.m for the operated versus 1.1N.m for the asymptomatic, p=0.02). The pelvic amplitudes in the sagittal plane were lower for operated patients (3.3° versus 7.2°, p=0.05). DISCUSSION Our hypothesis appears to be validated. Gait deficits persisted beyond one year postoperatively after THA with MIALA. A decrease in walking speed, maximal isometric muscle force of the gluteus medius and gluteus maximus and TFL was observed, as well as a decrease in propulsive force and peak hip moment. Functionally, these results could signify muscle damage following surgery, requiring rehabilitation for improved muscle function. LEVEL OF PROOF III: Non-randomized controlled trial.
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Affiliation(s)
- Matthieu Lalevée
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France
| | - Lucas Martinez
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de Recherche ERPHAN, UR 20201, UVSQ, France
| | - Benjamin Rey
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, Groupe Hospitalier du Havre, BP24, 76083, Le Havre cedex, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Stéphane Van Driessche
- Polyclinique Sainte-Marguerite, 5, avenue de la Font Sainte-Marguerite, 89000 Auxerre, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de Recherche ERPHAN, UR 20201, UVSQ, France; Université de Paris-Saclay, UFR Simone Veil-Santé, 2, avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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Pearce AN, Sieber FE, Wang NY, Stambough JB, Stronach BM, Mears SC. Leg Length Discrepancy After Hip Fracture Repair is Associated With Reduced Gait Speed. Geriatr Orthop Surg Rehabil 2023; 14:21514593231186724. [PMID: 37435442 PMCID: PMC10331100 DOI: 10.1177/21514593231186724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction A negative correlation exists between functional outcomes and leg length discrepancy (LLD) following hip fracture repair. We have assessed the effects of LLD following hip fracture repair in elderly patients on 3-meter walking time, standing time, activities of daily living (ADL), and instrumental activities of daily living (IADL). Methods One hundred sixty-nine patients enrolled in the STRIDE trial were identified with femoral neck, intertrochanteric, and subtrochanteric fractures that were treated with partial hip replacement, total hip replacement, cannulated screws, or intramedullary nail. Baseline patient characteristics recorded included age, sex, body mass index Charlson comorbidity index (CCI) score. ADL, IADL, grip strength, sit-to-stand time, 3-meter walking time and return to ambulation status were measured at 1 year after surgery. LLD was measured on final follow-up radiographs by either the sliding screw telescoping distance or the difference from a trans-ischial line to the lesser trochanters, and was analyzed as a continuous variable using regression analysis. Results Eighty eight patients (52%) had LLD <5 mm, 55 (33%) between 5-10 mm and 26 subjects (15%) >10 mm. Age, sex, BMI, Charlson score, and ambulation status had no significant impact on LLD occurrence. Type of procedure and fracture type did not correlate with severity of LLD. Having a larger LLD was not found to have a significant impact on post-operative ADL (P = .60), IADL (P = .08), sit-to-stand time (P = .90), grip strength (P = .14) and return to former ambulation status (P = .60), but did have a statistically significant impact on 3-meter walking time (P = .006). Discussion LLD after hip fracture was associated with reduced gait speed but did not affect many parameters associated with recovery. Continued efforts to restore leg length after hip fracture repair are likely to be beneficial.
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Affiliation(s)
- Alexa N. Pearce
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Frederick E. Sieber
- Department of Anesthesiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Departments of Medicine, Biostatistics, and Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, and Institute for Clinical and Translational Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin M. Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Passano B, Simcox T, Singh V, Anil U, Schwarzkopf R, Davidovitch RI. Does Surgical Approach to the Hip Play a Role in Same-Day Discharge Outcomes? J Arthroplasty 2023:S0883-5403(22)01132-9. [PMID: 36608836 DOI: 10.1016/j.arth.2022.12.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Different approaches for total hip arthroplasty (THA) may offer advantages in regard to achieving same-day-discharge (SDD) success. METHODS We retrospectively identified patients aged ≥ 18 years who underwent elective primary THA from 2015 to 2020 who were formally enrolled in a single institution's SDD program. A total of 1,127 and 207 patients underwent THA via direct anterior approach and posterior approach, respectively, were included. Cohorts were assigned based on approach. The primary outcome was failure-to-launch, defined as hospital stay extending past 1 midnight. Secondary outcomes included Forgotten Joint Score-12, Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, 90-day readmission and revision rate, and surgical time. Patient-reported outcomes were collected at 3 and 12 months. RESULTS After controlling for demographic differences, posterior approach patients had higher rates of failure-to-launch (12.1% versus 5.9%, P = .002) and longer surgical times (99 versus 80 minutes; P < .001) compared to direct anterior approach patients. The cohorts had similar readmission (1.7% versus 1.4%; P = .64) and revision rates (1% versus 1%; P = .88). The magnitude of improvement in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores from preoperative to 12 months was similar between cohorts (35.3 versus 34.5; P = .42). The differences in outcome scores between cohorts at each time point were not considered clinically significant. CONCLUSION Our analysis suggests that patient selection and surgical approach may be important for achieving SDD. Surgical approach did not significantly impact readmission or revision rates nor did it have a meaningful impact on patient-reported outcomes in the first year after surgery.
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Affiliation(s)
- Brandon Passano
- Department of Orthopedic Surgery, NYU Long Island, Mineola, New York
| | - Trevor Simcox
- Department of Orthopedic Surgery, NYU Long Island, Mineola, New York
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York; Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Roy I Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Billuart F, Lalevée M, Brunel H, Van Driessche S, Beldame J, Matsoukis J. MRI assessment of minimally invasive anterolateral approaches in total hip arthroplasty. Orthop Traumatol Surg Res 2022; 108:103356. [PMID: 35724839 DOI: 10.1016/j.otsr.2022.103356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) on a minimally invasive anterolateral (MIAL) approach frequently leads to gluteus minimus and gluteus medius lesions, and sometimes to tensor fasciae latae (TFL) denervation. We therefore developed compensatory strategies, which we assessed on pre- and post-operative MRI: 1) to assess gluteus minimus and gluteus medius fatty infiltration (FI), 2) to assess TFL FI, and 3) to assess FI in the other periarticular muscles. HYPOTHESIS The modified MIAL approach reduces the rate of gluteus minimus and gluteus medius lesion. MATERIALS AND METHODS A continuous prospective single-surgeon series of THA using a MIAL approach included 25 patients. Femoral implantation was performed with the hip in extension so as to distance the proximal femur from the gluteals, avoiding muscle trauma. The superior gluteal nerve branch in the space between the gluteus medius and TFL, running toward the TFL, was systematically released and protected. MRI was performed preoperatively and at 3 months and 1 year post-surgery. FI was analyzed according to the Goutallier classification in all periarticular muscles. RESULTS One patient lacked preoperative MRI and was excluded, leaving 24 patients, for 72 MRIs. In 10/24 patients (41.7%) the gluteus minimus and in 8/24 patients (33.3%) the anterior third of the gluteus medius showed ≥2 grade increase in FI between preoperative and 1-year MRI, with significant increases in both at 3 months (p<0.001) and 1 year (p<0.001). At least a 2 grade increase in FI at 1 year was seen in 1 patient (4.2%) in the TFL, in 2 (8.3%) in the piriformis, and in 1 (4.2%) in the obturator internus. There were no significant differences in FI between preoperative, 3-month or 1-year MRI in any other periarticular muscles. CONCLUSION Femoral implantation in hip extension did not reduce the rate of gluteal lesions, which remained frequent. In contrast, release of the superior gluteal nerve branch could be effective in conserving TFL innervation. Some rare lesions of the proximal part of the pelvi-trochanteric muscles were also observed. LEVEL OF EVIDENCE IV, Prospective case series.
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Affiliation(s)
- 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
| | - Matthieu Lalevée
- Centre hospitalier universitaire de Rouen, service de chirurgie orthopédique et traumatologique, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | | | - Julien Beldame
- Institut clinique du Pied-Paris, Ramsay santé, clinique blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
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Kijima H, Tateda K, Yamada S, Nagoya S, Fujii M, Kosukegawa I, Kawano T, Miyakoshi N, Yamashita T, Shimada Y. Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:11795441211031340. [PMID: 34345193 PMCID: PMC8280835 DOI: 10.1177/11795441211031340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
Purpose: Muscle-sparing approaches for total hip replacement (THR) involve learning
curves. This study aimed to clarify changes in invasiveness and infection
rate with changes in approach. Methods: One surgeon changed the approach of THR from Dall’s approach (Dall) to
anterolateral modified Watson-Jones approach (OCM). Another changed from
Dall to a direct anterior approach (DAA). Another 3 surgeons changed from
posterolateral approach (PL) to OCM. Subjects were 150 cases, comprising the
last 25 cases with conventional approaches and the first 25 cases with new
approaches (Dall to OCM: 25 + 25; Dall to DAA: 25 + 25; PL to OCM: 25 + 25
cases). Differences in operative time, bleeding volume, hospital stay,
haemoglobin (Hb), white blood cell count, lymphocyte count, creatine kinase
(CK) and C-reactive protein (CRP) were investigated. Results: In the change from Dall to OCM, only hospital stay decreased. In the change
from Dall to DAA, hospital stay and CRP decreased, but bleeding volume
increased. In the change from PL to OCM, operative time, CRP and CK
decreased, but Hb also decreased. Cases with lymphocyte count <1000/μL or
lymphocytes comprising <10% of total white blood cells at around day 4
after surgery were defined as latent infection cases. In these cases,
operative time was longer, Hb was lower and CK was higher. Conclusion: Introducing muscle-sparing approaches improved many markers of invasiveness,
but some items deteriorated. In the early stages of introducing a new
approach, choosing cases without obesity and without high muscle volume may
reduce the risk of infection.
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Affiliation(s)
- Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenji Tateda
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shin Yamada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoshi Nagoya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masashi Fujii
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ima Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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