scholarly journals Total Hip Arthroplasty Through the Direct Anterior Approach With and Without the Use of a Traction Table; a Matched-control, Retrospective, Single Surgeon Study

2020 ◽  
Author(s):  
DIANE WERNLY ◽  
Julien Wegrzyn ◽  
Geoffroi Lallemand ◽  
Jaad Mahlouly ◽  
Christophe Tissot ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Leg Length ◽  
Total Hip ◽  
Operative Complications ◽  
Post Operative Complications

Abstract BackgroundHip surgeons performing total hip arthroplasty (THA) through the direct anterior approach (DAA) commonly use a traction table to facilitate exposure. Even though performing THA through DAA without traction table could be technically more demanding, this technique offers the advantage of intraoperative leg length comparison. Therefore, this study aimed to compare clinical outcomes, complication rates, component positioning and leg length discrepancy (LLD) after THA through the DAA performed with or without a traction table.MethodsA single-surgeon continuous series of 75 patients who underwent DAA THA performed with a traction table were matched for gender, age and BMI with 75 patients who underwent DAA THA performed without a traction table (male:62, female:88, with an average age of 68 y.o). Clinical and radiological outcomes, intra- and post-operative complications and LLD were retrospectively assessed.ResultsNo statistically significant difference was detected in surgical time, hospital stay, Harris Hip Score (HHS), complication rates, and implant positioning between the two groups. Leg length restoration was significantly more accurate in the group performed without a traction table (2.4 ± 2 mm vs. 3.7 ± 3.1 mm, respectively; p value ≤ 0.05). No LLD > 10 mm was reported in the group performed without traction table, whereas two cases (2.7 %) were reported in those performed with traction table.ConclusionPerforming THA through DAA without a traction table was associated with a significantly more accurate leg length restoration without significantly increase in the rates of intra- and post-operative complications.

scholarly journals Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Stephen J Nelson ◽  
Murillo Adrados ◽  
Raj J Gala ◽  
Erik J Geiger ◽  
Matthew L Webb ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Operating Table ◽  
Leg Length ◽  
Neck Length ◽  
Anterior Capsule ◽  
Total Hip

BackgroundAchieving correct leg and femoral neck lengths remains a challenge during total hip arthroplasty (THA).  Several methods for intraoperative evaluation and restoration of leg length have been proposed, and each has inaccuracies and shortcomings.  Both the supine positioning of a patient on the operating table during the direct anterior approach (DAA) THA and the preservation of the anterior capsule tissue  are simple, readily available, and cost-effective strategies that can lend themselves well as potential solutions to this problem.TechniqueThe joint replacement is performed through a longitudinal incision (capsulotomy) of the anterior hip joint capsule, and release of the capsular insertion from the femoral intertrochanteric line. As trial components of the prosthesis are placed, the position of the released distal capsule in relationship to its original insertion line is an excellent guide to leg length gained, lost, or left unchanged.MethodsThe radiographs of 80 consecutive primary THAs were reviewed which utilized anterior capsule preservation and direct capsular measurement as a means of assessing change in leg/femoral neck length. Preoperatively, the operative legs were 2.81 +/- 8.5 mm (SD) shorter than the nonoperative leg (range: 17.7 mm longer to 34.1 mm shorter).  Postoperatively, the operative legs were 1.05 +/- 5.64 mm (SD) longer than the nonoperative leg (range: 14.9 mm longer to 13.7 mm shorter).ConclusionThe preservation and re-assessment of the native anterior hip capsule in relationship to its point of release on the femur is a simple and effective means of determining leg/femoral neck length during DAA THA.

Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial

2021 ◽  
Vol 103-B (2) ◽  
pp. 321-328
Author(s):  
Frans-Jozef Vandeputte ◽  
Jens Vanbiervliet ◽  
Cigdem Sarac ◽  
Ronald Driesen ◽  
Kristoff Corten
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Anterior Capsule ◽  
Total Hip ◽  
Implant Positioning ◽  
Sf 36 ◽  
One Year

Aims Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). Methods In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. Results At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). Conclusion No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321–328.

scholarly journals Minimizing complications in bikini incision direct anterior approach total hip arthroplasty: A single surgeon series of 865 cases

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Avinash Alva ◽  
Ikram Nizam ◽  
Sophia Gogos
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Womac Score ◽  
Complication Rates ◽  
Term Survival ◽  
Total Hip ◽  
Implant Survivorship

Abstract Purpose The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure. Methods We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA’s over a period of 6 years (mean = 3.9yrs from 0.9 to 6.8 years). Results The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40–58) preoperatively to 3.5(range 0–8.8) and similarly, HHS scores improved from 53(range 40–56) to 92.5(range 63–100) at final follow-up (mean = 3.9 yrs) when compared to preoperative scores. Conclusions These results suggest that bikini incision DAA technique can be safely utilised to perform 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.

The Learning Curve for the Direct Anterior Approach for Total Hip Arthroplasty: A Single Surgeon's First 500 Cases

2017 ◽  
Vol 27 (5) ◽  
pp. 483-488 ◽  
Author(s):  
James M. Hartford ◽  
Michael J. Bellino
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Fracture Rate ◽  
Leg Length ◽  
Total Hip ◽  
Major Complications

Background Concerns arise over the early complications encountered during the learning curve for the direct anterior approach for total hip arthroplasty. The purpose of this study is to examine the learning experience of a single surgeon in adapting this approach. Methods The 1st 500 primary total hip arthroplasties are reviewed. The patients were evaluated out to 3 months. Rates of major complications, reoperations, periprosthetic fractures, heterotopic ossification, leg length discrepancies and lateral femoral cutaneous nerve deficits were identified for each of 100 patients. Results The major complication rate decreased from 5% to 2% throughout the series. Reoperation rates fluctuated from 2% in the 1st 100 cases to 3% in the 4th 100 cases to 1% in the 5th 100 cases. The periprosthetic fracture rate decreased from 9% to 2%. Conclusions The incidence of heterotopic ossification declines throughout the series and is attributed to changes in irrigation technique and quantity. The incidence of major complications decreases with increasing experience. The most dramatic improvements occur after the 1st group of 100 cases.

scholarly journals Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Gongyin Zhao ◽  
Ruixia Zhu ◽  
Shijie Jiang ◽  
Nanwei Xu ◽  
Hongwei Bao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Anterior Capsule ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. Results LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. Trial registration ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

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.

Does the thigh circumference affect the positioning of the acetabular component when using the direct anterior approach in total hip arthroplasty?

2019 ◽  
Vol 101-B (5) ◽  
pp. 529-535 ◽  
Author(s):  
C. A. Jacobs ◽  
E. T. Kusema ◽  
B. J. Keeney ◽  
W. E. Moschetti
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Thigh Circumference ◽  
Total Hip ◽  
Length Discrepancy

Aims The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. Patients and Methods We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the acetabular component, radiological leg-length discrepancy, and femoral offset. The radiological outcomes were considered as continuous and binary outcome variables based on Lewinnek’s ‘safe zone’. Results Similar trends were seen in all three thigh circumference groups. In multivariable analyses, patients in the largest 20 cm thigh circumference quartile (59 cm to 78 cm) had inclination angles that were a mean of 5.96° larger (95% confidence interval (CI) 2.99° to 8.93°; p < 0.001) and anteversion angles that were a mean of 2.92° larger (95% CI 0.47° to 5.37°; p = 0.020) than the smallest quartile. No significant differences were noted in leg-length discrepancy or offset. Conclusion There was an associated increase in inclination and anteversion as thigh circumference increased, with no change in the risk of malpositioning the components. THA can be performed using the DAA in patients with large thigh circumference without the risk of malpositioning the acetabular component. Cite this article: Bone Joint J 2019;101-B:529–535.

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