1
|
Supra R, Supra R, Agrawal DK. Surgical Approaches in Total Hip Arthroplasty. JOURNAL OF ORTHOPAEDICS AND SPORTS MEDICINE 2023; 5:232-240. [PMID: 37388321 PMCID: PMC10310317 DOI: 10.26502/josm.511500106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
The Total Hip Arthroplasty (THA) has become one of the most reliable surgical interventions that has improved the quality of life in many patients. THA allows patients to have increased mobility, range of motion, and reduced pain in patients with degenerative hip joints. This surgical procedure has become an effective treatment option for several chronic conditions affecting the hip joint. Although this surgery has been shown to give promising results in patients with hip pathology, selecting the approach for THA is a critical step in pre-operative planning. The best approach for this surgical procedure depends on multiple factors and each present with their own challenges, success rates, and limitations. To further elucidate the advantages and disadvantages associated with different surgical approaches, we critically review each surgical approach along with the different causes of failure of the THA procedure.
Collapse
Affiliation(s)
- Rajiv Supra
- College of Osteopathic Medicine, Touro University, Henderson, Nevada, USA
| | - Rajesh Supra
- Georgetown University School of Medicine, Washington, DC, USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Pomona, California, USA
| |
Collapse
|
2
|
Shen J, Ji W, Shen Y, He S, Lin Y, Ye Z, Wang B. Comparison of the early clinical efficacy of the SuperPath approach versus the modified Hardinge approach in total hip arthroplasty for femoral neck fractures in elderly patients: a randomized controlled trial. J Orthop Surg Res 2023; 18:215. [PMID: 36935491 PMCID: PMC10024840 DOI: 10.1186/s13018-023-03713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/14/2023] [Indexed: 03/21/2023] Open
Abstract
PURPOSE To investigate the clinical efficacy and advantages of the SuperPath approach for total hip arthroplasty in the treatment of femoral neck fractures in the elderly population. METHODS From February 2018 to March 2019, 120 patients were randomly divided into two groups with 60 patients each: the SuperPath group and the conventional group. The results evaluated included the general operation situation, serum markers, blood loss, pain score, hip function and prosthesis location analysis. RESULTS There was no demographic difference between the two groups. Compared with the conventional group, the SuperPath group had a shorter operation time (78.4 vs. 93.0 min, p = 0.000), a smaller incision length (5.8 vs. 12.5 cm, p = 0.000), less intraoperative blood loss (121.5 vs. 178.8 ml, p = 0.000), a shorter hospitalization time (8.0 vs. 10.8 days, p = 0.000) and less drainage volume (77.8 vs. 141.2 ml, p = 0.000). The creatine kinase level in the SuperPath group was significantly lower than that in the conventional group, while there was no difference in the C-reactive protein level and erythrocyte sedimentation rate level. The visual analog scale score was lower one month postoperatively, and the Harris hip score was higher three months postoperatively in the SuperPath group (p < 0.05). There was no difference in the cup abduction angle or anteversion angle of the two groups. CONCLUSION We found better clinical efficacy after using the SuperPath approach with less muscle damage, less postoperative pain and better postoperative function than after using the modified Hardinge approach. Trial registration The randomized clinical trial was retrospectively registered at the Chinese Clinical Trial Registry on 31/12/2020 (ChiCTR-2000041583, http://www.chictr.org.cn/showproj.aspx?proj=57008 ).
Collapse
Affiliation(s)
- Jiquan Shen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Weiping Ji
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China.
| | - Yonghui Shen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Shijie He
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Youbin Lin
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Zhijun Ye
- Department of Orthopaedics, The People's Hospital of Yunhe, Lishui, 323000, Zhejiang, China
| | - Bo Wang
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China.
| |
Collapse
|
3
|
Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation. Clin Biomech (Bristol, Avon) 2022; 92:105555. [PMID: 35026659 DOI: 10.1016/j.clinbiomech.2021.105555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. METHODS All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. FINDINGS Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°-43° of cup inclination, 18°-26° of cup anteversion, 17°-29° of stem anteversion, and 35°-56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. INTERPRETATION Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.
Collapse
|
4
|
Di Maro A, Creaco S, Albini M, Latiff M, Merlo M. Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases. BMC Musculoskelet Disord 2022; 23:101. [PMID: 35101011 PMCID: PMC8802501 DOI: 10.1186/s12891-022-05065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Supercapsular percutaneously assisted total hip (SuperPath) technique is a relatively new minimally invasive approach for total hip arthroplasty (THA). Good clinical outcomes related to its use are reported in the literature. Nonetheless, there are still uncertainties about its validity in terms of radiographic outcomes. Main purpose of the study is to evaluate the effectiveness of the SuperPath in acetabular cup positioning through radiographic evaluation of acetabular inclination angle (IA) and acetabular anteversion (AA) angle within the safe zone described by Lewinnek. The leg length discrepancy (LLD), femoral offset (FO), and acetabular offset (AO) were also measured to ascertain the radiographic effectiveness of SuperPath in the acetabular cup placement. Methods Between January 2016 and December 2019, all SuperPath cases eligible for the study were included. They were operated by three orthopaedic surgeons with long-standing experience in THA via conventional posterolateral approach and who have performed SuperPath training fellowship. The Mann-Whitney U test was used for statistical assessments (p-value < 0.05). Means ± standard deviation (SD) of the radiographic IA and AA were calculated for each year. Results A retrospective analysis of 756 THAs was performed. The average percentage of IA within the Lewinnek’s safe zone was from 80 to 85%, while the average percentage of AA was from 76 to 79%. Both IA and AA showed no statistically significant difference between two consecutive years. Good results, in the ranges of normal values, were also obtained for LLD, FO and AO, with homogeneous outcomes between 1 year and the following one. Conclusion It is possible to achieve good radiographic values of acetabular cup orientation through the SuperPath within the Lewinnek’s safe zone. These results are similar to those reported in the literature by authors using SuperPath. Low rate (0,3%) of hip dislocations were reported. Therefore, the SuperPath technique represents a good alternative THA approach. Nevertheless, there is not a statistically significant improvement in these radiographic parameters over a four-year time. Level of evidence Level IV, retrospective study.
Collapse
Affiliation(s)
- Agostino Di Maro
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy.
| | - Santo Creaco
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy
| | - Mattia Albini
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Fondazione Macchi Varese, ASST Sette Laghi, Viale Borri 57, Varese, Italy
| | - Mahfuz Latiff
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Fondazione Macchi Varese, ASST Sette Laghi, Viale Borri 57, Varese, Italy
| | - Marco Merlo
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy
| |
Collapse
|
5
|
Li L, Zhang Y, Lin YY, Li ZX, Chen L, Chen DS, Fan P. A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach. Orthop Surg 2020; 12:1663-1673. [PMID: 32924261 PMCID: PMC7767786 DOI: 10.1111/os.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the implant orientation, especially the combined anteversion measurements in total hip arthroplasty (THA) using lateral approach, and to compare with implant orientation using posterior-lateral (P-L) approach. The secondary goal was to identify the factors associated with implant orientation. METHODS Five hundred and one patients (545 hips) who underwent primary THA with the modified Hardinge approach between January 2016 and November 2019 by one senior surgeon in our department in a retrospective study were followed up. A survey to inquire about the history of dislocation of the hip after THA was designed and responses were gathered by telephone, WeChat software, and outpatient follow-up. The mean age of the patients was 61.97 ± 11.72 years, and there were 254 males and 247 females. The average follow-up time was 25.2 ± 13.7 months (range, 3.2-49.7 months). Among the patients who were followed up, 97 patients (104 hips) underwent computed tomography (CT) scans from L4 to the tuberosity of the tibia. The implant orientation, including the anteversion and inclination of the cup, anteversion of the stem, combined anteversion, and pelvic tilt were measured based on CT scans of these patients. The results were compared with the implant orientation reported in previous reports measured by CT. Factors that may be associated with implant orientation were investigated, including the patient's age, sex, body mass index (BMI), and diagnosis; size of the cup; diameter of the femoral head component; and pelvic tilt. Data and statistical analyses were performed using SPSS 20.0. RESULTS No cases of dislocation were found in the 501 patients (545 hips) who underwent primary THA during this period. The mean inclination and anteversion of the cups were 38.83° ± 5.04° (24.5°-53.1°) and 9.26° ± 11.19° (-15°-48°), respectively. The mean anteversion of the stem was 13.83° ± 10.7° (-10.2°-42.3°). The combined anteversion was 23.1° ± 13.4° (-7.4°-54.6°). Compared with the reported combined anteversion and anteversion of the cup, the mean anteversion of the cup and combined anteversion using the lateral approach were much lower than the reported values in the literature using the P-L approach. Pelvic tilt was found to be the only independent factor for cup anteversion. Factors including age, sex, BMI, diagnosis, cup size, and diameter of the femoral head component were not associated with implant orientation. CONCLUSION THA using the lateral approach yields smaller cup anteversion and combined anteversion values than using the P-L approach. Pelvic tilt is the only predictor for cup anteversion.
Collapse
Affiliation(s)
- Li Li
- Zhejiang Provincial Key Laboratory of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yu Zhang
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yuan-Yuan Lin
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Zhen-Xing Li
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Liang Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Dao-Sen Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Pei Fan
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| |
Collapse
|
6
|
Teeter MG, Lanting BA, Naudie DD, McCalden RW, Howard JL, MacDonald SJ. Highly crosslinked polyethylene wear rates and acetabular component orientation: a minimum ten-year follow-up. Bone Joint J 2018; 100-B:891-897. [PMID: 29954202 DOI: 10.1302/0301-620x.100b7.bjj-2017-1457.r3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims The aim of this study was to determine whether there is a difference in the rate of wear between acetabular components positioned within and outside the 'safe zones' of anteversion and inclination angle. Patients and Methods We reviewed 100 hips in 94 patients who had undergone primary total hip arthroplasty (THA) at least ten years previously. Patients all had the same type of acetabular component with a bearing couple which consisted of a 28 mm cobalt-chromium head on a highly crosslinked polyethylene (HXLPE) liner. A supine radiostereometric analysis (RSA) examination was carried out which acquired anteroposterior (AP) and lateral paired images. Acetabular component anteversion and inclination angles were measured as well as total femoral head penetration, which was divided by the length of implantation to determine the rate of polyethylene wear. Results The mean anteversion angle was 19.4° (-15.2° to 48°, sd 11.4°), the mean inclination angle 43.4° (27.3° to 60.5°, sd 6.6°), and the mean wear rate 0.055 mm/year (sd 0.060). Exactly half of the hips were positioned inside the 'safe zone'. There was no difference (median difference, 0.012 mm/year; p = 0.091) in the rate of wear between acetabular components located within or outside the 'safe zone'. When compared to acetabular components located inside the 'safe zone', the wear rate was no different for acetabular components that only achieved the target anteversion angle (median difference, 0.012 mm/year; p = 0.138), target inclination angle (median difference, 0.013 mm/year; p = 0.354), or neither target (median difference, 0.012 mm/year; p = 0.322). Conclusion Placing the acetabular component within or outside the 'safe zone' did not alter the wear rate of HXLPE at long-term follow-up to a level that risked osteolysis. HXLPE appears to be a forgiving bearing material in terms of articular surface wear, but care must still be taken to position the acetabular component correctly so that the implant is stable. Cite this article: Bone Joint J 2018;100-B:891-7.
Collapse
Affiliation(s)
- M G Teeter
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - B A Lanting
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - D D Naudie
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - R W McCalden
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - J L Howard
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - S J MacDonald
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
7
|
Teeter MG, Goyal P, Yuan X, Howard JL, Lanting BA. Change in Acetabular Cup Orientation From Supine to Standing Position and Its Effect on Wear of Highly Crosslinked Polyethylene. J Arthroplasty 2018; 33:263-267. [PMID: 28917617 DOI: 10.1016/j.arth.2017.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/19/2017] [Accepted: 08/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to measure acetabular cup position and wear of the highly crosslinked polyethylene liner in the supine and standing position for patients at a minimum of 10 years after the operation. METHODS A total of 38 patients were recruited at a mean of 12.5 years after the operation. All patients received a single acetabular cup design with a highly crosslinked liner and a 28-mm cobalt-chromium femoral head. Patients underwent supine and standing radiostereometric examinations in which the X-ray sources and detectors were positioned to obtain an anterior-posterior and cross-table lateral radiograph. Acetabular cup position and the three-dimensional wear rate were measured from the radiographs, and outcome scores were recorded for each patient. RESULTS Anteversion significantly increased (P < .0001) a mean of 12° from supine (15.1° ± 10.4°) to standing (27.2° ± 10.5°) position. Inclination also significantly increased (P = .001) a mean of 2° from supine (44.4° ± 6.8°) to standing (46.3° ± 7.7°) position. There was no difference (P = .093) in wear rate between supine (0.067 ± 0.070 mm/y) and standing (0.073 ± 0.074 mm/y) positions. There were no correlations between cup orientation and wear rate in either position. CONCLUSION Highly crosslinked polyethylene is a forgiving bearing material. Although adherence to the traditional acetabular position target zone is recommended, ensuring hip stability and consideration of the patient's functional position are also important objectives to consider for the acetabular position.
Collapse
Affiliation(s)
- Matthew G Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada; Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Prateek Goyal
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|