Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

2018 ◽  
Vol 02 (01) ◽  
pp. 054-058
Author(s):  
Kilian Rueckl ◽  
Friedrich Boettner
Keyword(s):  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Posterior Column ◽  
Simple Extension ◽  
Circumflex Artery ◽  
Obturator Externus ◽  
Medial Femoral Circumflex Artery ◽  
Revision Tha ◽  
Acetabular Defects

AbstractReconstruction of acetabular defects in revision total hip arthroplasty (THA) requires excellent exposure. Most extensile approaches to the acetabulum were described in the trauma literature and are not beneficial for revision THA. This article describes a modification of the standard posterior surgical approach to improve visualization of the ischium as required for acetabular defect reconstruction, insertion of standard and custom triflange cages as well as posterior column plating. The current surgical technique utilizes an intermuscular plane between the gemellus inferior muscle and the obturator externus muscle. This intermuscular plane leads the surgeon directly to the ischium and facilitates easy extension toward the insertion of the hamstring muscles without compromising the insertion of the external rotator muscles along the ischium. This article describes a novel surgical approach to the posterior column and ischium under special consideration of the sciatic nerve, superior gluteal vessels, and medial femoral circumflex artery. This simple extension of the standard posterior approach optimizes exposure of the posterior column during revision THA using a posterior approach.

scholarly journals Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty

2016 ◽  
Vol 27 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Julia Blackburn ◽  
Diana Lim ◽  
Ian Harrowell ◽  
Michael C. Parry ◽  
Ashley W. Blom ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Revision Surgery ◽  
Posterior Approach ◽  
Short Form ◽  
Lateral Approach ◽  
Revision Hip Arthroplasty ◽  
Satisfaction Scale ◽  
Patient Reported ◽  
Revision Tha

Introduction Most total hip arthroplasties (THAs) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery. Methods A retrospective cohort study of 205 patients who underwent revision THA for aseptic loosening. Patients rated their pain from 0-10 and completed the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), WOMAC and Short form-12 questionnaires. Results 205 patients (209 hips) from a cohort of 238 patients (243 hips, 86%) were available for analysis. The mean follow-up was 5 years (SD 1.71). Grouping by approach 20% (43/209) had both primary and revision procedures via a lateral approach, 20% (43/209) had their primary surgery via a lateral approach and their revision surgery via a posterior approach, whilst 60% (123/209) had both procedures via a posterior approach. The WOMAC and OHS were significantly better in patients who had a posterior approach for both primary and revision surgery, compared to those that did not (OHS p = 0.028, WOMAC p = 0.026). We found no significant differences in pain, satisfaction or health-related quality of life between the groups. Discussion Choice of approach for revision hip arthroplasty is influenced by a number of factors, but in clinical situations where either a lateral or posterior approach could be used, the posterior approach appears to be associated with better joint-specific outcomes. Registry data may help further explore the associations between surgical approach and the outcome from revision THA.

scholarly journals Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hou-Tsung Chen ◽  
Cheng-Ta Wu ◽  
Tsan-Wen Huang ◽  
Hsin-Nung Shih ◽  
Jun-Wen Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Type Ii ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Press Fit ◽  
Cementless Cup ◽  
Revision Tha ◽  
Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

scholarly journals Instability in Patients with Lumbar Spine Disease or Fusion Undergoing Posterior Approach vs. Lateral Approach Primary Total Hip Arthroplasty

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Amritdev Parihar ◽  
Evan R. Deckard ◽  
Leonard T. Buller ◽  
R. Michael Meneghini
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Spine Pathology ◽  
Direct Lateral Approach ◽  
Postoperative Dislocation ◽  
Spine Disease

Background and Hypothesis:  Dislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion due to lumbar spine disease or fusion have been reported as high as 20%. Few studies exist that compare dislocation rates in patients with spine pathology undergoing THA via different surgical approaches. The purpose of this study was to compare postoperative dislocation rates in patients with lumbar spine disease or fusion between those undergoing a primary THA using a posterior versus direct lateral surgical approach.    Experimental Design or Project Methods:  With IRB approval, 1,205 primary THAs performed by two surgeons were retrospectively reviewed. One surgeon routinely performs THAs with a posterior approach while the other surgeon routinely uses a direct lateral approach. Chart review from the electronic medical record was conducted to identify patients who have lumbar spine disease or a lumbar spine fusion. Dislocations for patients with and without lumbar spine disease were compared by posterior approach and direct lateral approach.    Results:   767 posterior approach and 431 direct lateral approach THAs were available for analysis.  43.6% of all THAs had lumbar spine pathology (337/767 posterior and 185/431 direct lateral). The overall dislocation rate was 1.26% (15/1195).  The main predictors of dislocation in binary logistic regression were the presence of lumbar spine pathology (OR 5.24, 95% CI: 1.47–18.69, p=0.018) and posterior surgical approach (OR 7.93, 95% CI: 1.04–60.6, p=0.046).  The dislocation rate for direct lateral approach THAs with lumbar spine pathology was significantly lower compared to posterior approach THAs with lumbar spine pathology (0.0% vs 3.6%, p=0.011).    Conclusion and Potential Impact:   Although there were few dislocations, the study results suggest a direct lateral approach for primary THA may be beneficial to reduce postoperative dislocation for patients with limited spinopelvic motion due to lumbar spine pathology. 

Surgical approach significantly affects the complication rates associated with total hip arthroplasty

2019 ◽  
Vol 101-B (6) ◽  
pp. 646-651 ◽  
Author(s):  
V. K. Aggarwal ◽  
A. Elbuluk ◽  
J. Dundon ◽  
C. Herrero ◽  
C. Hernandez ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Periprosthetic Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Deep Infection ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Wound Drainage

Aims A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications. Patients and Methods The electronic medical records of all patients who underwent primary elective THA at a single large-volume arthroplasty centre, between 2011 and 2016, with at least two years of follow-up, were reviewed. After exclusion, 3574 consecutive patients were included in the study. There were 1571 men (44.0%) and 2003 women (56.0%). Their mean age and body mass index (BMI) was 63.0 years (sd 11.8) and 29.1 kg/m2 (sd 6.1), respectively. Data gathered included the age of the patient, BMI, the American Society of Anesthesiologists (ASA) score, estimated blood loss (EBL), length of stay (LOS), operating time, the presence of intra- or postoperative complications, type of complication, and the surgical approach. The approaches used during the study were posterior, anterior, direct lateral, anterolateral, and the northern approach. The complications that were recorded included prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture. Finally, the need for re-operation was recorded. Means were compared using analysis of variance (ANOVA) and Student’s t-tests where appropriate and proportions were compared using the chi-squared test. Results A total of 248 patients had 263 complications related to the surgery, with an incidence of 6.94%. The anterior approach had the highest incidence of complications (8.5% (113/1329)) and the posterior approach had the lowest, at 5.85% (97/1657; p = 0.006). Most complications were due to deep infection (22.8%), periprosthetic fracture (22.4%), and prolonged wound drainage (21.3%). The rate of dislocation was 0.84% (14/1657) with the posterior approach and 1.28% (17/1329) with the anterior approach (p = 0.32). Conclusion Overall, THA has a relatively low complication rate. However, the surgical approach plays a role in the incidence of complications. We found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate. Periprosthetic fracture and surgical site infection contributed most to the early complication rates. Cite this article: Bone Joint J 2019;101-B:646–651

Revision for Recurrent Dislocation of Total Hip Replacement

2009 ◽  
Vol 19 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Mark Rogers ◽  
Ashley W. Blom ◽  
Andrew Barnett ◽  
Alexia Karantana ◽  
Gordon C. Bannister
Keyword(s):  
Total Hip Replacement ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Recurrent Dislocation ◽  
Anterior Dislocation ◽  
Operative Strategy ◽  
Total Hip ◽  
Transgluteal Approach ◽  
Revision Tha

Background and purpose Dislocation is one of the commonest complications of total hip arthroplasty with an incidence of between 0.5 and 9.2%. Despite this, little is known of the outcome of treatment strategies for dislocation. The aim of this study was to establish the optimal strategy for the operative management of recurrent dislocation following THA taking account of the surgical approach employed in the replacement that became unstable and the direction of the instability that followed. Methods We reviewed 70 patients who underwent revision surgery for recurrent dislocation after total hip arthroplasty (THA), 38 through the transgluteal (Hardinge) and 32 through the posterior approach. 52 of these followed primary and 18 followed revision THA for reasons other than instability. We recorded the surgical approach, the direction of dislocation and the operative strategy employed for each case. Results We achieved stability in 75% of patients who dislocated after primary and 50% after revision THA. 77% of dislocations performed initially through the transgluteal approach were anterior and 88% through the posterior approach were posterior. Following the transgluteal approach, we stabilised anterior dislocation in 54% of cases. Following the posterior approach we stabilised posterior dislocation in 79%. The most successful operative strategy overall was cup augmentation which conferred stability in 90% of cases. Interpretation Instability after primary total hip replacement is easier to treat (75% chance of success) than after revision total hip replacement (50% chance of success). Although previous studies have shown that the posterior approach has a slightly higher risk of dislocation, this study has shown that achieving stability after a posterior dislocation is more likely than after an anterior dislocation. The outcome of revision for instability depends on the surgical approach used initially, and the direction of dislocation.

scholarly journals Preventing postoperative prosthetic joint dislocation by repairing obturator externus in total hip arthroplasty performed via the posterior approach

Arthroplasty ◽  
2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Hideki Fujii ◽  
Takuya Otani ◽  
Yasuhiko Kawaguchi ◽  
Tetsuo Hayama ◽  
Toshiomi Abe ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Soft Tissues ◽  
Joint Dislocation ◽  
Total Hip ◽  
Obturator Externus ◽  
Prosthetic Joint ◽  
Repair Group

Abstract Background In total hip arthroplasty performed via the posterior approach, repairing the posterior soft tissues is a conventional method for preventing postoperative prosthetic joint dislocation. The aim of this study was to verify whether obturator externus repair played the main role and what was the mechanism of the repair preventing the dislocation. Methods Included were 188 patients who underwent primary cementless total hip arthroplasty via the posterior approach. The patients were divided into a repair group (n = 94) and a non-repair group (n = 94). Patients of repair group received additional obturator externus repair while patients of non-repair group did not. The range of motion of hip joint was assessed before and after operation. Data were compared between the two groups. A p value < 0.05 was considered statistically significant. Results Before operation and under anesthesia, with regard to internal rotation of hip joint, the mean values of repair and non-repair groups were 24° ± 16/28° ± 15 (p = 0.2933). The mean values of the groups were 13° ± 8/15° ± 9 immediately after repair (p = 0.5672). Range of internal rotation 1 year after operation were 15° ± 8/19° ± 9 (p = 0.0139). Specifically, the values in repair group were lower than those in non-repair group. During a 5-year period of postoperative follow-up, hip joint dislocation occurred in one patient of non-repair group. No dislocation was observed in repair group. Conclusion When THA is performed via the posterior approach, repairing the obturator externus may decrease the risk of postoperative prosthetic joint dislocation by reinforcing the posterior soft tissues of the hip joint. Level of evidence Therapeutic study, Level IVa.

scholarly journals The Incidence of Dislocation (Utilizing a Neck Sparing Stem) in Community Based Practices with the Posterior Approach

2015 ◽  
Vol 5 (2) ◽  
Author(s):  
Edward J. McPherson ◽  
Bradley K. Vaughn ◽  
Louis Keppler ◽  
Declan Brazil ◽  
Timothy McTighe
Keyword(s):  
Risk Factors ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Stem Length ◽  
Joint Mechanics ◽  
Total Hip ◽  
Patient Profile ◽  
Acetabular Components

Purpose. To evaluate early and mid-term risk factors and dislocation rates in the posterior surgical approach in three separate community private practices using a short curved neck-sparing total hip stem design.Material and Methods.The three senior authors performed 338 short curved neck-sparing stem designs since April 2010 to June 2014.  Various cementless acetabular components were used for all three surgical centers based on preoperative and intraoperative risk factors. All cases were reviewed retrospectively for incidence of dislocation after surgery.Version and inclination of the acetabular component and version of the femoral component were assed intra-operatively prior to final implantation. Various risk factors were reviewed including surgical approach, cup position, combined cup and stem positioning, and femoral head size.There have been significant papers in the past ten years that have recommended large head diameters to reduce the chances of head/neck mechanical impingement. Since the neck-sparing designs have a potentially increased risk of mechanical impingement head diameters were restricted to 32 mm or larger. In the smaller patient profile if a 32 mm head size could not be reached a dual-mobility style implant was chosen or stem choice was changed to a conventional style design.Results.Historically the posterior approach has had higher reports of dislocations as compared to direct anterior, anterolateral or straight lateral approach in conventional cemented and cementless implant designs. Older neck-sparing designs of conventional stem length by Freeman, Townley and Whiteside have not reported any increased dislocation problems but these stems have been associated with modified acetabular component designs, including the short curved neck sparing design of Pipino back in the 1980s.Incidence of dislocation in our series utilizing a short curved neck-sparing stem with more traditional hemispherical cementless acetabular components was 3 or 0.88%.Conclusion.Neck sparing stem designs do save significantly more bone and require less soft tissue dissection as compared to conventional cementless stem designs. Mechanical risk factors are increased with the use of short curved neck-sparing stem designs. Careful pre-operative and intra-operative evaluation does reduce the risk factors resulting in low and in some cases lower than previous published rates with conventional style stems.Short curved neck sparing stems do provide safe and reliable reproduction of the joint mechanics in routine primary total hip arthroplasty in both short and mid term results.Key Words: hip, arthroplasty, posterior approach, dislocation, neck sparing, and risk factors

Femoral Stem Tip Orientation and Surgical Approach in Total Hip Arthroplasty

2007 ◽  
Vol 17 (4) ◽  
pp. 212-217 ◽  
Author(s):  
P.D. Vaughan ◽  
P.J. Singh ◽  
R. Teare ◽  
R. Kucheria ◽  
G.C. Singer
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Sagittal Plane ◽  
Femoral Stem ◽  
Entry Point ◽  
Total Hip ◽  
Significant Difference ◽  
Tip Position

Introduction A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation. Methods We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane. Results: There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01). Discussion Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.

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