Does surgical approach affect early outcomes following primary total hip replacement in obese patients?

2019 ◽  
pp. 112070001988264
Author(s):  
John Zhang ◽  
Michael C Wyatt ◽  
Chris M Frampton ◽  
Geoffrey Anderson
Keyword(s):  
Multivariate Analysis ◽  
Femoral Head ◽  
Total Hip Replacement ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Total Hip

Aim: The aim of this study was to assess whether obese patients undergoing primary total hip replacement (THR) via a posterior approach had superior revision rates and Oxford Hip Scores (OHS) compared to those via a lateral approach. Patients and methods: This is a retrospective cohort study using prospective data from the New Zealand Joint Registry applying STROBE and RECORD guidelines. Patients undergoing THR since 2010 were stratified by body mass index (BMI) into obese (BMI 30–39 kg/m2), and morbidly obese (BMI ⩾40 kg/m2) groups. All-cause revision rates, and 6-month OHS post-surgery were compared between groups. Multivariate analysis was performed. Results: 12,109 unilateral THRs in obese patients were identified. The mean follow-up was 2.8 years (range 0.01–6.95 years). Univariate analysis in the BMI ⩾ 40 group showed the posterior approach had a significantly lower all-cause revision rate (0.99/100 observed component years (ocys); 95% CI, 0.65–1.44/100 ocys) than the lateral approach (1.71/100 ocys (95% CI, 0.98–2.77/100 ocys), p < 0.05). There was no significant difference in dislocation rates between the surgical approaches. OHS was statistically higher in the posterior approach group in BMI 30–39 patients ( p < 0.001) but not clinically significant. Multivariate analysis showed femoral head size significantly influenced all-cause revision rates and mitigated against the increased risk associated with the surgical approach. Conclusion: The choice of surgical approach in obese patients conveys no advantage in overall revision rates in the short-term. Choosing an appropriate size of femoral head may be of greater importance than choice of surgical approach for obese patients in primary THR.

SHALL IT BE BETTER, AS AN APPROACH FOR THR, POSTERIORLY OR LATERALLY; A CLINICO-FUNCTIONAL AND GAIT ANALYTICAL OUTCOME ANALYSIS, IN A PROSPECTIVE STUDY, IN THE SOUTH-INDIAN POPULATION.

2021 ◽  
pp. 71-75
Author(s):  
Arun Kumar C ◽  
Ganashree S ◽  
Arivoli S ◽  
Aswath C A ◽  
Rakesh Kumar B ◽  
...  
Keyword(s):  
Prospective Study ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Harris Hip Score ◽  
South Indian Population ◽  
Total Hip ◽  
South Indian

Introduction: Hip resurfacing arthroplasty (HRA) or Total hip replacement (THR), as it is popularly called, attempts to mollify these basic clinical problems, in patients with a hip arthritic problem, which may be of a sequela to age-related degeneration, osteonecrosis, systemic disorder like Rheumatoid arthritis (RA) or Ankylosing spondylosis (AS) or as a result of trauma and or an old infection. The basic pathology, is an unfavourable and abrading hip diarthrodial joint. The endeavour of the study was, to establish the efcacy of the Posterior vs Lateral approach for THA/THR, by studying their outcomes in primary THR. This prospective study was undertaken at Che Materials And Methods: ttinad Hospital and Research Institute (CARE), Kelambakkam, Chengalpattu district, Tamilnadu, In the Department of Orthopaedics from Jan 2017 to Dec 2020 (48 months). The Functional outcome of hip surgery was measured using the Harris Hip Score, Oxford hip score and the WOMAC. Rivermead visual gait analysis (RVGA) method was used post-operatively to assess the gait. The Biomechanical outcomes of Abductor Gait Component, were individually assessed by EMG studies. The Harris Hip Score, The Oxford Hip S Results: core and WOMAC score, when the lateral approach was compared to the posterior approach pre-op and post-op in the 12 months minimum follow-up period, the laterally approached group faired better. The VAS score was equivocal. The comprehensive RVGA assessment also showed marginally better results for the laterally approached group as was the case with the Trendelenburg test score. The EMG studies for the Gluteus Maximus, Medius and the lateral rotators of hip also favoured the outcomes for the laterally approach hips. The supremacy of the Lateral Approach, ove Conclusion: r Posterior Approach, cannot be adjudged in a short-term follow-up study. It is thus opined that the Lateral Approach may be statistically and data wise superior, but the patient satisfaction, which is a major factor, is almost the same in both the approach groups. The follow-up needs to be atleast for a decade for us to be able to come to any meaningful conclusion. With regards to surgery like the Total hip replacement, which have a longevity factor exceeding 10 years, studies have to be followed up for periods in excess of 10 years.

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.

Total hip replacement through a posterior approach using a 22 mm diameter femoral head

2014 ◽  
Vol 96-B (9) ◽  
pp. 1202-1206 ◽  
Author(s):  
V. Kumar ◽  
S. Sharma ◽  
J. James ◽  
J. P. Hodgkinson ◽  
M. V. Hemmady
Keyword(s):  
Femoral Head ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Total Hip

Total hip replacement in morbidly obese patients with osteoarthritis

2010 ◽  
Vol 92-B (8) ◽  
pp. 1066-1071 ◽  
Author(s):  
Y. H. Chee ◽  
K. H. Teoh ◽  
B. M. Sabnis ◽  
J. A. Ballantyne ◽  
I. J. Brenkel
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Total Hip

Total Hip Replacement after Failed Femoral Head and Neck Excision in Two Dogs and Two Cats

2012 ◽  
Vol 41 (1) ◽  
pp. 136-142 ◽  
Author(s):  
Noel Fitzpatrick ◽  
Laura Pratola ◽  
Russell Yeadon ◽  
Christos Nikolaou ◽  
Michael Hamilton ◽  
...  
Keyword(s):  
Femoral Head ◽  
Head And Neck ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Total Hip

Outcomes and complications of total hip replacement in super-obese patients

2013 ◽  
Vol 95-B (6) ◽  
pp. 758-763 ◽  
Author(s):  
R. Rajgopal ◽  
R. Martin ◽  
J. L. Howard ◽  
L. Somerville ◽  
S. J. MacDonald ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Obese Patients ◽  
Super Obese ◽  
Total Hip

A Proximal Referencing System for the Charnley Low Friction Arthroplasty

2002 ◽  
Vol 12 (3) ◽  
pp. 303-307
Author(s):  
M.D.A. Fletcher ◽  
J.C.J. Webb ◽  
T. Maung
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
Soft Tissue Balance ◽  
Low Friction ◽  
Total Hip

Dislocation is a serious complication of total hip arthroplasty occurring in up to 9% of cases. Recurrent dislocation accounts for 4% of revisions in the Swedish Hip Arthroplasty Study. Soft tissue balancing is one of the factors, independent of the surgical approach used, that is involved in producing a stable total hip replacement. We describe a proximal referencing system for use with the Charnley low friction arthrosplasty (LFA), which optimises this factor. The dislocation rate, using this method, is 0.3% (in 333 cases performed by a single surgeon over a 5 year period). This system should prove valuable to orthopaedic surgeons in training, ensuring they achieve correct soft tissue balance in total hip arthroplasty.

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