scholarly journals Fully hydroxyapatite-coated collared femoral stems in direct anterior versus direct lateral hip arthroplastyFully hydroxyapatite-coated collared femoral stems in direct anterior versus direct lateral hip arthroplasty

2021 ◽  
Vol 64 (2) ◽  
pp. E205-E210
Author(s):  
Sebastian Heaven ◽  
Maxwell Perelgut ◽  
Edward Vasarhelyi ◽  
James Howard ◽  
Matthew Teeter ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Lateral Approach ◽  
Early Recovery ◽  
Total Hip ◽  
Significant Difference ◽  
Femoral Stems ◽  
Direct Lateral Approach

Background: Total hip arthroplasty (THA) via the direct anterior approach has increased in popularity in the last decade, with research supporting enhanced early recovery; however, some investigators have reported increased early revision rates in direct anterior THA. We examined outcomes from a single institution’s experience with a fully hydroxyapatite-coated collared femoral stem implanted via the anterior or the lateral approach. Methods: Patients who had received fully hydroxyapatite-coated collared femoral stems as part of THA surgery performed by 1 of 3 surgeons between January 2012 and September 2017 were identified from our institutional database. We examined revision rates for the 2 approaches and compared them between the 2 groups. We also analyzed outcomes on plain film radiographs obtained immediately postoperatively and at 1 and 2 years. Results: A total of 695 patients received a fully hydroxyapatite-coated collared stem during the study period. Total hip arthroplasty was performed via the direct anterior approach in 281/778 hips (36.1%) and via the direct lateral approach in 497 (63.9%). Nineteen patients (2.5%) underwent subsequent revision surgery; there was no statistically significant difference in the revision rate between the anterior and lateral approaches (2.5% v. 2.4%, p = 0.95). The mean subsidence of the stem at 1 year was 1.68 mm (standard deviation 11.7 mm). No statistically significant differences were observed between the cohorts for any of the radiographic measurements at either follow-up time. Conclusion: We found no significant difference in revision rates between the direct anterior and direct lateral approach. Stem subsidence levels were in keeping with expected values, and no major changes in stem position occurred during the first postoperative year. Surgical approach did not appear to substantially affect biomechanical stem behaviour.

scholarly journals A Comparison of the Incidences of Venous Thromboembolism after Total Hip Arthroplasty between the Direct Anterior Approach and the Direct Lateral Approach, Especially in the Early Period after Introduction of the Direct Anterior Approach

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Tetsuya Kawano ◽  
Hiroaki Kijima ◽  
Shin Yamada ◽  
Natsuo Konishi ◽  
Hitoshi Kubota ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Anticoagulation Therapy ◽  
Direct Anterior Approach ◽  
Lateral Approach ◽  
Surgical Time ◽  
Total Hip ◽  
Direct Lateral Approach

Objective. To compare the incidence of venous thromboembolism (VTE) after total hip arthroplasty (THA) using the direct anterior approach (DAA) with that using the direct lateral approach (DLA). In addition, patient background characteristics and the incidence of VTE were compared between the first half and the latter half of the period after introducing DAA and against DLA. Method. This was a retrospective, multicenter study involving 109 patients (116 hips) who had undergone primary unilateral THA. Thirty-six hips underwent THA using DAA and 80 hips underwent THA using DLA. Patient information including sex, age, and preoperative diagnosis was collected. The incidence of VTE was compared between DAA and DLA. Moreover, the patients who underwent THA using DAA were divided into 2 groups (first half and latter half groups), and sex, age, body mass index (BMI), and surgical time were compared between the 2 groups. Moreover, the incidence of VTE was compared among the 3 groups (first half of DAA, latter half of DAA, and DLA). Results. The incidence of VTE in the DAA group was significantly higher than that in the DLA group p=0.014. The incidence of VTE in the first half group was significantly higher than in the latter half group and the DLA group (p=0.035 and p=0.001, respectively), and there was no difference in the incidence of VTE between the latter half group and the DLA group p=0.923. Surgical time was significantly longer in the first half group than in the latter half group p=0.046. Conclusions. In the first half of the period after introducing the DAA, more VTEs occurred than in the DLA. It may be important to shorten the surgical time in the early stage of introducing the DAA, and aggressive anticoagulation therapy may be required until the surgeon becomes familiar with the procedure.

scholarly journals Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 15 ◽  
Author(s):  
Constant Foissey ◽  
Mathieu Fauvernier ◽  
Cam Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operating Time ◽  
Surgical Techniques ◽  
Direct Anterior Approach ◽  
Clinical Results ◽  
Total Hip ◽  
Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

scholarly journals Decreased Incidence of Periprosthetic Joint Infection in Total Hip Arthroplasty with Use of Topical Vancomycin

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
David A Crawford ◽  
Keith R Berend ◽  
Joanne B Adams ◽  
Adolph V Lombardi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Anterior Approach ◽  
Joint Infection ◽  
Lateral Approach ◽  
Control Group ◽  
Total Hip ◽  
Joint Infections ◽  
Direct Lateral Approach

Background: Periprosthetic joint infections following total hip arthroplasty (THA) can cause significant patient morbidity and carry with them a substantial cost burden to the healthcare system.  The purpose of this study was to assess whether the addition of topical vancomycin decreased the incidence of superficial and deep infections after primary total hip arthroplasty?    Methods: We performed a retrospective analysis of patients who underwent primary THA with (1070 hips) and without (815 hips) the use of topical vancomycin.  Records were reviewed to determine incidence of PJI. Infections were categorized as deep or superficial. Medical comorbidity data was evaluated for known risk factors including diabetes, rheumatoid arthritis, and BMI. Records were further reviewed to determine surgical approach used and bacterial cause of PJI.    Results: The overall incidence of infection in the control group was 1.47% (12 hips) and significantly decreased to 0.47% (5 hips) with the addition of topical vancomycin (p=0.022). Deep infections also decreased from 0.86% (7 hips) in the control group to 0.09% (1 hip) in the vancomycin group (p=0.011).  There was no difference in BMI or percent of patients with diabetes between groups.       In all patients, regardless of vancomycin use, the incidence of infection in the direct lateral approach was higher (2.04%, 9 hips) than the anterior approach (0.055%, 8 hips)  (p=0.004). Conclusions:  We found a lower incidence of periprosthetic joint infection after THA with the addition of topical vancomycin. We also found a decreased incidence of infection in patients who had surgery through an anterior approach compared with those who had a direct lateral approach.

scholarly journals Transfusion rates with intravenous tranexamic acid in total hip arthroplasty performed using the direct anterior approach

2018 ◽  
Vol 29 (5) ◽  
pp. 511-515 ◽  
Author(s):  
Matthew D Free ◽  
David H Owen ◽  
Edward Pascoe ◽  
Penny Allen ◽  
Luke Yang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Lateral Approach ◽  
Reduce Blood Loss ◽  
Total Hip ◽  
Transfusion Requirements

Introduction: Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing total hip arthroplasty (THA). Most studies have focused on TXA in THA performed using a posterior approach (PA) or lateral approach. The aim of this study was to analyse the efficacy of TXA in patients undergoing THA using the direct anterior approach (DAA). Patients and methods: Using our institutional database, a retrospective analysis was conducted on consecutive primary THA performed for osteoarthritis to determine transfusion rates in patients undergoing THA with the DAA with and without TXA. Results: 146 consecutive THA were performed using DAA: 83 (56.8%) patients had TXA and 63 (43.2%) did not have TXA. Among patients who had TXA, 1 patient required a blood transfusion compared to 7 patients among those who did not have TXA (1.2% vs. 11.12%, p = 0.02). The relative risk of 0.11 (95% confidence interval 0.01–0.86) indicates an 89% reduction in the risk of requiring blood transfusion with TXA administration compared to no TXA. Conclusion: TXA is effective in reducing blood transfusion requirements for patients undergoing DAA THA.

scholarly journals Does total hip arthroplasty via the direct anterior approach using dual mobility increase leg length discrepancy compared with single mobility?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Seiya Ishii ◽  
Yasuhiro Homma ◽  
Tomonori Baba ◽  
Yuta Jinnai ◽  
Xu Zhuang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Dual Mobility ◽  
Total Hip ◽  
Length Discrepancy ◽  
Significant Difference

Abstract Background Total hip arthroplasty (THA) via the direct anterior approach (DAA) using dual mobility cup (DMC) is considered to effectively prevent postoperative dislocation. However, the dislocation and reduction procedure using a trial implant during the surgery is difficult because of high soft tissue tension. Thereby, leg length discrepancy (LLD) is difficult to assess when using DM via the DAA. Purpose To compare the LLD between cases using conventional SM and those using DMC in THA via the DAA with fluoroscopy. Patients and methods We retrospectively investigated 34 hips treated with DMC (DMC-DAA group) and 31 hips treated with SM (SM-DAA group). The LLD was defined as the difference in the distance from the teardrop to the medial-most point of the lesser trochanter between the operative and nonoperative sides at immediate postoperative X-ray. Results The mean LLD in the DMC-DAA group and SM-DAA group was 0.68 ± 7.7 mm and 0.80 ± 5.5, respectively, with no significant difference. The absolute value of the LLD in the DMC-DAA group and SM-DAA group was 6.3 ± 4.4 mm and 5.9 ± 5.5, respectively, with no significant difference. Conclusion Despite the difficulty in assessment of the LLD during THA via the DAA using DMC, this technique does not increase the LLD compared with the use of SM. Level of evidence III, matched case-control study.

scholarly journals The bikini incision anterior cemented total hip arthroplasty: Assessment of radiological and clinical outcomes

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 3
Author(s):  
Ikram Nizam ◽  
Avinash Alva ◽  
Sophia Gogos
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Operating Table ◽  
Total Hip ◽  
Femoral Stems ◽  
Standard Operating

Introduction: There has been an increased interest in minimally invasive direct anterior approach total hip arthroplasty (THA) to provide greater patient satisfaction, improve pain relief, and reduce the duration of hospitalisation. A direct anterior approach hybrid cemented THA, utilising a bikini line incision, can be technically challenging. We aimed to undertake radiological analysis of femoral stem cementation, clinical outcomes, and component survivorship. Methods: Over a 5-year period, 215 primary elective bikini anterior THA conducted by a single surgeon were included. All procedures were performed using a cemented collarless polished stem. The operation was performed on a standard operating table. Patients undergoing posterior approach, revision procedures, and fractured neck of femurs were excluded. Post-operative radiographs were analysed for femoral cementation quality using the Barrack grading system. Harris hip scores (HHS) were determined at 6 weeks, 12 weeks, annually thereafter and the difference in HHS was noted. Results: In total, 215 anterior bikini THA (R = 101, L = 114) were performed in 199 patients (M = 89, F = 110) with a mean age of 77 and mean follow up of 2.9 years (range = 0.5–5). Radiographic analysis of femoral cementation showed 189 femoral stems (88%) were either Barrack A or B cementation grade, suggesting optimal cementation. Lucency in the cement-bone interface occurred mainly in Gruen Zone 1 (43%) and Zone 13(46.9%). At the most recent follow-up (mean 2.9 years), component survivorship was at 99.54% (stem). Significant improvement was noted in Harris hip scores at final follow-up (from 54 preoperatively to 92.7 at 2.9 years postoperatively). Conclusion: Our results suggest that a bikini incision direct anterior approach for total hip arthroplasty can be safely employed to perform cemented femoral stems on a standard operating table.

scholarly journals The external obturator footprint as a landmark in total hip arthroplasty through a direct anterior approach: a CT-based analysis

2018 ◽  
Vol 29 (1) ◽  
pp. 96-101 ◽  
Author(s):  
Hannes A Rüdiger ◽  
Benjamin Fritz ◽  
Franco M Impellizzeri ◽  
Michael Leunig ◽  
Christian W Pfirrmann ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Ct Scans ◽  
Anatomical Landmarks ◽  
Greater Trochanter ◽  
Total Hip ◽  
Significant Difference ◽  
Anatomical Axis

Background: Anatomical landmarks for templating of total hip arthroplasty (THA) that are visible both during surgery and on radiographs are rare. If surgery is performed through a direct anterior approach the external obturator tendon (EO) is consistently visible. To use this point as a reference the exact position and dimensions of the footprint need to be known. Aim: To determine the location and dimension of the EO footprint on pelvic radiographs by correlating the EO anatomy in CT scans with conventional radiographs. Methods: CT scans and radiographs of 200 patients were analysed. The EO tendon was identified on CT scans; the height of its footprint, and its distance to the tip of the greater trochanter and to the anatomical axis of the femur was measured. The accuracy and inter-rater reliability in the identification of the EO footprint was determined. Results: The EO tendon was visible on all CT scans and it’s footprint was identifiable on all corresponding radiographs. It’s cranio-caudal dimension was 6.4 ± 1.4 mm. It’s distance to the tip of the greater trochanter was 16.0 ± 3.1 mm. The EO footprint was located 5.2 ± 3.7 mm lateral to the femoral anatomical axis. There was no significant difference regarding the accuracy of EO footprint localisation on radiographs among the 2 readers. Conclusion: The EO footprint on the greater trochanter is consistently visible on CT scans and radiographs. As the variability of the footprint dimension is small, this structure may serve as a useful landmark in THA, particularly when performed through a direct anterior approach.

scholarly journals Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 54 ◽  
Author(s):  
Yu Ozaki ◽  
Tomonori Baba ◽  
Yasuhiro Homma ◽  
Hironori Ochi ◽  
Taiji Watari ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Patient Reported Outcomes ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Significant Difference ◽  
Patient Reported

Introduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL). Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS). Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01). Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA.

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