Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision

Equalization of biomechanical differences is a major goal in total hip arthroplasty (THA). In the current study we compared the accuracy of restoring leg length and offset using imageless navigation with an osseous fixed pin to a femoral pinless device in 97 minimally invasive THAs through an anterolateral approach in the lateral decubitus position. Leg length and offset differences were evaluated on magnification-corrected radiographs by a blinded observer. A postoperative mean difference of -0.9 mm (95% CI -2.8 mm to 1.1 mm, p = 0.38) between pinless navigation and navigation with a fixed pin was observed for leg length and that of -2.4 mm (95% CI -3.9 mm to -0.9 mm, p = 0.002) was observed for offset, respectively. The number of patients with a residual difference below 5 mm after THA was higher if using a fixed pin than in pinless navigation for both leg length (98.2%, 54/55 to 50.0%, 21/42, p < 0.001) and offset (100.0%, 55/55 to 71.4%, 30/42, p < 0.001). Imageless navigation is a feasible method in intraoperative control of leg length and offset in minimally invasive THA. The use of pins fixed to the bone has a higher precision than pinless devices. This trial is registered with DRKS00000739.

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Minimally invasive anterolateral approach versus lateral transmuscular approach for total hip arthroplasty: A systematic review and meta-analysis

The Surgeon ◽

10.1016/j.surge.2021.09.001 ◽

2021 ◽

Author(s):

Tomonori Shigemura ◽

Yasuaki Murata ◽

Yohei Yamamoto ◽

Yuki Shiratani ◽

Hiroyuki Hamano ◽

...

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Anterolateral Approach ◽

Total Hip ◽

Minimally Invasive Anterolateral Approach

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Modified Anterolateral Approach in Minimally Invasive Total Hip Arthroplasty

Hip International ◽

10.5301/hipint.5000218 ◽

2015 ◽

Vol 25 (3) ◽

pp. 245-250 ◽

Cited By ~ 6

Author(s):

Shang-Wen Tsai ◽

Cheng-Fong Chen ◽

Po-Kuei Wu ◽

Tain-Hsiung Chen ◽

Chien-Lin Liu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Anterolateral Approach ◽

Total Hip

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Low rate of early periprosthetic fractures in cementless short-stem total hip arthroplasty using a minimally invasive anterolateral approach

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00583-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Matthias Luger ◽

Günter Hipmair ◽

Clemens Schopper ◽

Bernhard Schauer ◽

Rainer Hochgatterer ◽

...

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Supine Position ◽

Short Stem ◽

Anterolateral Approach ◽

Total Hip ◽

Asa Score ◽

Short Stems

Abstract Purpose Minimally invasive (MIS) approaches in combination with short stems have gained popularity in recent years in total hip arthroplasty (THA). A decreased risk for periprosthetic femoral fractures (PFFs) is reported for cementless short-stem THA, but in contrast to other approaches, the risk factors for PFFs for short-stem THA using MIS anterolateral approach in supine position are not described in literature. Methods A single-center consecutive series of 1052 hips in 982 patients, performed between 2014 and 2019 with a short curved stem and a press fit using an MIS anterolateral approach in supine position, was retrospectively screened for inclusion. Fourteen patients were lost to follow-up. Therefore, 1038 THAs in 968 patients were included. Risk factors for intra- and postoperative PFFs within 90 days were analyzed. We investigated for sex, age, body mass index (BMI), diagnosis, and laterality. Results In total, 18 PFFs (1.7%) occurred. Intraoperative fracture occurred in ten cases ( 0.9%), with another eight cases (0.8%) occurring postoperatively. Increased American Society of Anesthesiologists (ASA) Score was a significant risk factor for PFF (p = 0.026), whereas sex (p = 0.155), age (p = 0.161), BMI (p = 0.996), and laterality (p = 1.000) were not. Seven PFFs (0.7%) required revision arthroplasty. Conclusion Cementless short-stem THA using the MIS anterolateral approach is a procedure with a low number of PFFs within 90 days from index surgery. Fracture rates are comparable to other MIS approaches, and comparable femoral short stems are used. Age, sex, and BMI were not identified as risk factors of PFF, while risk for PFF increased with ASA Score. Level of Evidence Level IV

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German surgeons’ technical preferences for performing total hip arthroplasties: a survey from the National Endoprosthesis Society

International Orthopaedics ◽

10.1007/s00264-021-05188-x ◽

2021 ◽

Author(s):

Ioannis Stratos ◽

Karl-Dieter Heller ◽

Maximilian Rudert

Keyword(s):

Minimally Invasive Surgery ◽

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Invasive Surgery ◽

Online Survey ◽

Fast Track ◽

Anterolateral Approach ◽

Total Hip ◽

Patterns Of Practice

Abstract Purpose The goal of our study was to conduct an online survey that highlights patterns of practice during total hip arthroplasty (THA). Methods The survey was conducted in June and August 2020. Three hundred thirteen members of the German Society for Endoprosthesis participated in the survey. Results The anterolateral approach is by far the most popular approach used for primary total hip arthroplasty, followed by the anterior approach during minimally invasive (55% for the anterolateral and 29% for the anterior) and regular surgery (52% for the anterolateral and 20% for the anterior). Two-thirds of the orthopaedic surgeons do not use drainages during THA. Moreover, 80% of the survey participants routinely apply tranexamic acid during surgery. Surgeons who perform minimally invasive surgery for THA use more frequently fast-track-concepts for post-operative rehabilitation. According to the interviewees, the application of fast-track-concepts leads to reduced periods of hospital stay after THA. Conclusion Our data demonstrate that patterns of practice during THA in Germany are in line with the evidence provided by current literature. This study can be seen as a stimulus to conduct similar surveys in other countries in order to promote minimally invasive surgery for THA.

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Minimally Invasive Surgery Anterolateral Approach in Total Hip Arthroplasty

Navigation and MIS in Orthopedic Surgery ◽

10.1007/978-3-540-36691-1_52 ◽

2007 ◽

pp. 398-404 ◽

Cited By ~ 1

Author(s):

D. S. Garbuz ◽

C. P. Duncan

Keyword(s):

Minimally Invasive Surgery ◽

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Invasive Surgery ◽

Anterolateral Approach ◽

Total Hip

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Low pelvic incidence is a risk factor for intraoperative complications in minimally invasive anterolateral approach for total hip arthroplasty

Hip International ◽

10.1177/1120700020953525 ◽

2020 ◽

pp. 112070002095352

Author(s):

Youngwoo Kim ◽

Aidin Eslam Pour ◽

Jean Yves Lazennec

Keyword(s):

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Pelvic Incidence ◽

Intraoperative Complications ◽

Femoral Fractures ◽

Anterolateral Approach ◽

Femoral Access ◽

Total Hip ◽

Minimally Invasive Anterolateral Approach

Background: Minimally invasive anterolateral approach (ALA) has gained popularity in recent years as better postoperative functional recovery and lower risk of postoperative dislocation are claimed. However, difficulties for femur exposure and intraoperative complications during femoral canal preparation and component placement have been reported. This study analyses the effect of anatomical factors on difficulties for femoral access and intraoperative complications with a modified minimally invasive ALA. Material and methods: 310 consecutive patients who had primary unilateral total hip arthroplasty (THA) by single surgeon using same approach and technique, and being suitable for EOS were included. All patients underwent pre- and postoperative standing and sitting full-body EOS acquisitions and pelvic and femoral parameters were measured. All intra- and postoperative complications for femoral preparation and implantation were assessed. Intraoperative complications included femoral fractures and difficulties for femoral exposure. Results: 10 patients (3.2%) had intraoperative femoral fractures (2 greater trochanter, 8 calcar). Difficult access to the proximal femur was reported for 10 other patients (3.2%). Patients with intraoperative complications presented a significantly lower pelvic incidence (PI) than patients without intraoperative complications (mean PI: 39.4° vs. 56.9°, p < 0.001). Conclusions: The pelvic incidence can be useful to detect anatomically less favourable patients for THA implantation using ALA.

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Comparison of the incidence of venous thromboembolism with minimally invasive total hip arthroplasty: a case control study

10.21203/rs.2.20611/v1 ◽

2020 ◽

Author(s):

Toru Nishiwaki ◽

Akihito Oya ◽

Arihiko Kanaji

Keyword(s):

Venous Thromboembolism ◽

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Hip Arthroplasty ◽

Surgical Approach ◽

Operative Time ◽

Anterolateral Approach ◽

Multidetector Row Computed Tomography ◽

Total Hip ◽

D Dimer

Abstract Background: Venous thromboembolism (VTE) remains a major complication after total hip arthroplasty (THA), irrespective of the surgical approach. This study investigated the incidence of VTE in patients undergoing THA through intermuscular minimally invasive surgical techniques, which included a direct anterior approach (DAA), an anterolateral approach (AL), and anterolateral supine approach (ALS), at a single institution. Methods: One hundred consecutive patients treated with each surgical approach were evaluated. Plasma D-dimer levels 1 month preoperatively and 1 day postoperatively, operative time, and intraoperative blood loss were recorded, and the presence of VTE was evaluated based on multidetector row computed tomography performed the day after surgery. Student’s t-test and Pearson’s chi-square test or one-way analysis of variance were used in statistical analysis. Results: No differences among the groups in terms of age, height, weight, operative time, intraoperative bleeding, and preoperative and postoperative D-dimer levels were observed. The overall incidence of VTE was 21%. The incidences of VTE were 30% in AL, 17% in ALS, and 16% in DAA, representing a significantly higher rate in AL than in ALS and DAA (P=0.025). The incidences of VTE on the operated side were 19% in AL, 13% in ALS, and 12% in DAA, with no statistically significant differences. The incidences of VTE on the non-operated side were 22% in AL, 9% in ALS, and 8% in DAA; these differences were statistically significant (P=0.0045). Conclusions: Results showed that the incidence of VTE was significantly higher in AL than in ALS and DAA, especially for the non-operated side.

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