A comparative study between anterior and posterior approach for bipolar hemiarthroplasty in intracapsular fracture neck of femur

<ul><li>Background: The present study was undertaken to to compare the efficacy of treatment of intracapsular neck of femur fracture operated by anterior and posterior approaches.Methods: A total 100 patients of either sex, aged >65 years with intracapsular neck femur fracture were operated with hemiarthroplasty. The patients were divided into two equal groups and patients were operated alternatively one with anterior approach and the second with posterior approach. Functional outcomes were compared using Harris hip score and range of movements assessed clinically. Hip function and final outcome measures were noted and compared between two groups.Results: The mean age of patients was 63.1±5.3 years in group A and 65.8±5.4 years in group B with female to male ratio was 1.7:1 for group A and 1.8:1 for group B. Operating time for group A and for group B was 65 and 78 minutes respectively. Mean intraoperative blood loss was 120 ml in group A and 150 ml in group B. The most common complication in both the groups were infection and rate in group A was 9.70% and in group B was 13.50%. Posterior approach carried an increased risk of prosthetic dislocation as compared to anterior approach. There was no intraoperative mortality seen in follow up period.Conclusions: Anterior approach for hip hemiarthroplasty in elderly population with intracapsular femoral neck fractures provided significant benefit in early postoperative period when compared to the posterior approach in terms of duration of surgery, intraoperative blood loss, time of recovery, hip dislocation rate.</li></ul>

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Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1506-1 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Pompeo Catania ◽

Daniele Passaretti ◽

Giorgio Montemurro ◽

Simone Ripanti ◽

Stefano Carbone ◽

...

Keyword(s):

Blood Loss ◽

Age Distribution ◽

Harris Hip Score ◽

Consecutive Series ◽

Intraoperative Blood Loss ◽

Pertrochanteric Fractures ◽

Functional Scores ◽

Group A ◽

Group B

Abstract Introduction Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. Materials We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. Results The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65–90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Conclusion Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

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Comparison between the results of bipolar hemiarthroplasty with lateral approach and posterior approach in Sanglah General Hospital in 2018: a case series

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200802 ◽

2020 ◽

Vol 8 (3) ◽

pp. 1180

Author(s):

I. Wayan Subawa ◽

Gede Agung Krisna Yudha ◽

I. Gede Mahardika Putra

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

General Hospital ◽

Outcome Measures ◽

Posterior Approach ◽

Lateral Approach ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Intraoperative Blood Loss ◽

Approach Group

The purpose of this study was to compare the preoperative, intraoperative and postoperative parameters of Bipolar Hemiarthroplasty procedure using lateral approach and posterior approach in Sanglah General Hospital in 2018. Thirty-five patients diagnosed with femoral neck fracture or intertrochanter fracture underwent Bipolar Hemiarthroplasty using either lateral approach or posterior approach at our institution between January 2018 and December 2018. The primary outcome measures were postoperative complication and hip function. The secondary outcome measures were surgical time, transfusion rate, length of hospital stay, intraoperative blood loss and postoperative haemoglobin. There were 14 patients in Lateral Approach group and 21 patients Posterior Approach group included for analysis. There were no significant differences between the two groups regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between Bipolar Hemiarthroplasty with Lateral Approach and Bipolar Hemiarthroplasty with Posterior Approach group in comparison of intraoperative blood loss (p<0.05) and length of stay (p<0.05). The present study concluded that both lateral and posterior approaches are comparable in terms of functional outcomes and complications. However, there is a tendency of longer hospital of length of stay and more of intraoperative blood loss using posterior approach which should be kept in mind when orthopaedic surgeon is performing a bipolar hemiarthroplasty.

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Investigation of The Optimal Surgical Approach to Brucella Lumbar Spondylitis Treatment: A Comparative Study

10.21203/rs.3.rs-62384/v1 ◽

2020 ◽

Author(s):

Chenguang Jia ◽

Jianguo Gao ◽

Zhuo Li ◽

Zhaoliang Dong ◽

Liming Yao ◽

...

Keyword(s):

Blood Loss ◽

Bone Graft ◽

Surgical Approach ◽

Anterior Approach ◽

Intraoperative Blood Loss ◽

One Stage ◽

Significant Difference ◽

Before And After ◽

Group A ◽

Group B

Abstract Background: The optimal surgical approach in treating lumbar brucellosis (LBS) has not been determined. This study aims to compare the surgical efficacy of anterior approach and combined posterior and anterior approach in treating LBS.Method: A retrospectively cohort study included LBS patients undergoing lumber surgery in the Department of Orthopedics, Department of Orthopedics, Hebei Province from June 2012 to June 2016. According surgical approach, patients were divided into two groups; patients with one-stage anterior approach were classified into group A, and the rest of patients with combined posterior and anterior approach were group B. The operative time, intraoperative blood loss and, hospitalization stay were recorded to compare the surgical risk of two groups. In terms of treatment efficacy, visual analogue scale (VAS), bone graft fusion, erythrocyte sedimentation rate (ESR) and Oswestry disability index (ODI) were assessed and compared before and after surgery.Results: Eight-nine patients with LBS were included into the study. Fifty cases were males, and 39 patients were female. The mean age of this cohort was 61.9 ± 12 years, ranging from 23 to 78 years. Forty-nine patients were divided into group A, undergoing anterior debridement and bone graft fusion. Forty patients underwent posterior fixation combined with anterior approach (group B). The operation time of group A was 30 minutes shorter than that of group B. Group A had less intraoperative blood loss (800 vs. 900 ml; P <0.001). Hospital stay was four days shorter in group A. At the last follow-up, all patients were in good condition with ASIA Level E and ESR returned to normal. The bone fusion rate of Bridwell bone was 89.29% (45/49) and 80.00% (38/40) of group A and group B, respectively. In terms of surgical efficacy, there was no significant difference in VAS score between the two groups before and after operation (P > 0.05). Conclusions: One-stage anterior approach and combine posterior-anterior approach had no significant difference in terms of clinical efficacy. Individualized surgical treatment should be suggested in patients with complicated LBS and ineffective therapeutic treatment. Trial registration: This study has been retrospectively registered in local ethical Institution Review Board(No:[2020]068).

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Assessment of the Learning Curve of Supercapsular Percutaneously Assisted Total Hip Arthroplasty in an Asian Population

BioMed Research International ◽

10.1155/2020/5180458 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Pengfei Lei ◽

Zhan Liao ◽

Jiang Peng ◽

Guang Li ◽

Qian Zhou ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Learning Curves ◽

Harris Hip Score ◽

Intraoperative Blood Loss ◽

Total Hip ◽

Significant Difference ◽

Group A ◽

Group B

The supercapsular percutaneously assisted total hip (SuperPATH) approach is a microinvasive approach that was developed to minimize surgical disruption of soft tissue during routine total hip arthroplasty (THA). This study was aimed at assessing early outcomes and learning curves of the SuperPATH approach in one Chinese hospital’s experience. Early outcomes of the first consecutive 78 SuperPATH cases (80 hips) performed by the same surgeon were evaluated. The patients were divided into 4 groups according to the surgical order. The incision, intraoperative blood loss, hospital stay, Harris hip score, and complication occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates. The operation time and intraoperative blood loss of groups A and B were more than those of groups C and D, and the difference was statistically significant (P<0.05); however, there was no statistically significant difference between the two groups (group A vs. group B, P=0.426; group A vs. group B, P=0.426). There was no statistically significant difference in terms of incision length and hospital stay, and Harris hip score at the last follow-up was increased with statistically significant difference when compared with that preoperatively among the 4 groups. One case of periprosthetic fracture occurred in group A. No other complication, such as joint dislocation, sciatic nerve injury, prosthesis loosening, periprosthetic infection, and deep vein thromboembolism, occurred in the 4 groups. In summary, for surgeons who are familiar with the standard posterolateral approach, they could achieve more familiarity with SuperPATH after 40 cases of surgery.

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Assessment of the Learning Curve of Supercapsular Percutaneously-assisted Total Hip Arthroplasty in an Asian Population

10.21203/rs.3.rs-28305/v1 ◽

2020 ◽

Author(s):

Pengfei Lei ◽

Zhan Liao ◽

Jiang Peng ◽

Guang Li ◽

Qian Zhou ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Learning Curves ◽

Harris Hip Score ◽

Intraoperative Blood Loss ◽

Total Hip ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: The supercapsularpercutaneously-assisted total hip (SuperPATH) approach is a micro-invasive approach that was developed to minimize surgical disruption of soft-tissue during routine total hip arthroplasty (THA). This study aimed to assess early outcomes and learning curves of the SuperPATHapproachin one Chinese hospital’s experience.Methods: Early outcomes of the first consecutive 78SuperPATH cases (80 hips) performed by same surgeon were evaluated. The patients were divided into 4 groups according to the surgical order. The incision, intraoperative blood loss, hospital stay, Harris hip score and complications occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates.Results:The operation time and intraoperative blood loss of group A and B was more than that of group C and D, and the difference was statistically significant (P<0.05), however there was no statistically significant difference between the two groups (group A vs. group B, P=0.426; group A vs. group B, P=0.426).There was no statistically significant difference in terms of incision length and hospital stay and Harris hip score at the last follow-up was increased with statistically significant difference when compared with that of preoperative among the 4 groups. One case of periprosthetic fracture occurred in group A. No other complication, such as joint dislocation, sciatic nerve injury, prosthesis loosening, periprosthetic infection and deep vein thromboembolism, occurred in 4 groups.Conclusion:In summary, for surgeons who familiar with the standard posterolateral approach, they could achieve more familiar with SuperPATH after 40 case of surgery.

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Surgery for thoracolumbar junction (T12-L1) tuberculosis a multicentre, retrospective study

10.21203/rs.2.13914/v1 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Blood Loss ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

Surgical Techniques ◽

Operation Time ◽

Thoracolumbar Junction ◽

Group A ◽

The Mean ◽

Group B ◽

Approach Group

Abstract Purpose A multicentre, retrospective study was conducted to evaluate the safety and efficacy of different surgical techniques for thoracolumbar junction (T12-L1) tuberculosis. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 257) from January 2005 to January 2015 were collected and reviewed. A total of 45 patients were operated on by an anterior approach (Group A), 52 by a combined anterior and posterior approach (Group B) and 160 by a posterior approach (Group C). Anti-tuberculosis therapy was performed both before and after surgery. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Results All three surgical approaches achieved bone fusion, pain relief and neurological recovery. The mean loss of correction in group A at last follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time and blood loss in group B were greater than in groups A and C. Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only approach is superior to the anterior-only approach in the correction of kyphosis and maintenance of spinal stability. The posterior-only approach is recommended because it achieves the same efficacy as the anterior-only or combined approach but with shorter operation times, less trauma and less blood loss. Keywords Spinal tuberculosis; Thoracolumbar junction; Three approaches.

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Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-3399487 ◽

2019 ◽

Vol 10 (04) ◽

pp. 631-640 ◽

Cited By ~ 1

Author(s):

Vanitha Rajagopalan ◽

Rajendra Singh Chouhan ◽

Mihir Prakash Pandia ◽

Ritesh Lamsal ◽

Girija Prasad Rath

Keyword(s):

Brain Tumor ◽

Blood Loss ◽

Blood Volume ◽

Perioperative Complications ◽

Tumor Surgery ◽

Intraoperative Blood Loss ◽

Brain Tumor Surgery ◽

Group A ◽

Group B ◽

Group D

Abstract Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p = 0.008), tumor size >5 cm (p < 0.001), high-grade glioma (p = 0.004), meningioma (p < 0.001), mass effect (p = 0.002), midline shift (p = 0.014), highly vascular tumors documented on preoperative imaging (p < 0.001), extended craniotomy approach (p = 0.002), intraoperative colloids use >1,000 mL (p < 0.001), intraoperative brain bulge (p = 0.03), intraoperative appearance as highly vascular tumor (p < 0.001), and duration of surgery >300 minutes (p < 0.001). Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.

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Patient-reported results of simultaneous direct anterior approach and posterolateral approach total hip arthroplasties performed in the same patients

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00611-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhi Yang ◽

Shuo Feng ◽

Kai-Jin Guo ◽

Guo-Chun Zha

Keyword(s):

Blood Loss ◽

Anterior Approach ◽

Operative Time ◽

Direct Anterior Approach ◽

Hip Pain ◽

Posterolateral Approach ◽

Harris Hip Score ◽

Intraoperative Blood Loss ◽

Total Hip ◽

Patient Reported

Abstract Background Several studies have compared clinical results of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA); however, the effect of the surgical approach on outcome of THA remains controversial. Most of these studies used two distinct groups of patients, and THAs were performed by different surgeons, using different designs of prosthesis. These confounding factors may limit the strength of the conclusions. The purpose of this prospective, simultaneous bilateral randomized study was to investigate whether patients would perceive the difference between the direct anterior approach (DAA) and the posterolateral approach (PLA) after THA. Materials and methods Among 20 patients scheduled to undergo same-day bilateral THA between October 2017 and August 2019, one hip was randomly assigned to DAA and the other to PLA. Patient-reported outcome measures [Hip disability and Osteoarthritis Outcome Score (HOOS), patients’ hip pain on mobilization] and physician-assessed measures [Harris Hip Score (HHS), operative time, intraoperative blood loss, cup abduction, cup anteversion, stem orientation, and incidence of complications (intraoperative fracture, nerve damage, incisional problem, or postoperative dislocation)] were compared. Results All patients were followed up for 12 months. Hip pain was significantly less with DAA-THA compared with PLA-THA at postoperative 1, 3, and 7 days (p < 0.05). There was no clinical difference between DAA-THA and PLA-THA in terms of the VAS, HOOS, or HSS at 6 weeks and 3, 6, and 12 months postoperatively (p > 0.05). DAA-THA had a longer operative time and shorter length of incision compared with PLA-THA. There was no statistical difference between DAA-THA and PLA-THA in terms of intraoperative blood loss, cup abduction, cup anteversion, stem orientation, and perioperative complications (p > 0.05). Conclusions This study demonstrates that DAA-THA and PLA-THA could provide comparable HHS and HOOS at all follow-ups. Compared with PLA-THA, DAA-THA is associated with less hip pain within postoperative 7 days and shorter incision length, but longer operative time. Level of evidence Level I, therapeutic study. Trial registration Chinese Clinical Trail Registry, ChiCTR1800019816. Registered 30 November 2018—retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=30863

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Comparison of Conventional Fenestration Discectomy Versus Percutaneous Transforaminal Endoscopic Discectomy for Treating Lumbar Disc Herniation

10.21203/rs.3.rs-20662/v1 ◽

2020 ◽

Author(s):

Quanyi Li ◽

yongchun zhou

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Intraoperative Blood Loss ◽

Endoscopic Discectomy ◽

Percutaneous Transforaminal Endoscopic Discectomy ◽

Group A ◽

Group B

Abstract Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) versus percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH from January 2012 to December 2017 were retrospectively analysed. IFD was performed on the 605 patients in Group A, while PTED was performed on the 505 patients in Group B. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for pain, and modified Macnab criteria were adopted to evaluate the outcomes. Moreover, the surgery durations, intraoperative blood loss, postoperative off-bed activities, and postoperative lengths of hospital stay for the two groups were observed. Results: The follow-up period ranged from 24 months to 60 months, with an average duration of 43 months. As the excellent and good outcome rate was 93.5% in Group A and 92.6% in Group B, there were no significant differences in efficacy between the two groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest durations and postoperative lengths of hospital stay than did Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and PTED had similar levels of efficacy in treating LDH, transforaminal endoscopic discectomy exhibited several advantages, such as less trauma, less bleeding, and a shorter length of hospital stay, and it can be considered an ideal surgical option for treating LDH.Save and Continue

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Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193931 ◽

2019 ◽

Vol 7 (9) ◽

pp. 3475

Author(s):

Wayan Suryanto Dusak ◽

Herryanto Agustriadi Simanjuntak ◽

I Gusti Ngurah Paramartha Wijaya Putra

Keyword(s):

Blood Loss ◽

Postoperative Complication ◽

Harris Hip Score ◽

Secondary Outcome ◽

Surgical Trauma ◽

Transfusion Rate ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Surgical Time

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.

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