Comparison of postoperative effectiveness of less invasive short external rotator sparing approach versus standard posterior approach for total hip arthroplasty

Abstract Background: Most of the studies assessing the corrective posterior total hip arthroplasty (THA) mainly focused on the mini-incision approach. Studies exploring the short external rotator sparing approach are rare. Therefore, this study aimed to compare the effectiveness of standard posterior approach and short external rotator sparing approach.Methods: This prospective observational study included 126 patients who underwent THAin 06/2017-06/2018. Patients were assigned to standard (standard posterior approach) and corrective (short external rotator sparing approach) groups based on the surgical method. Surgical data were recorded postoperatively. Postoperative hip joint recovery was assessed using the times to ambulation and independent stair use, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris score, and Oxford hip score (OHS) at 2 and 8 postoperative weeks. The visual analog scale (VAS) was used for postoperative pain assessment.Results: Postoperative changes of creatine kinase (CK), myoglobin, CRP, and prosthesis position were similar in both groups (P > 0.05). However, intraoperative blood loss (P < 0.001) and postoperative 6-hour drainage volume (P = 0.03), hospital stay, blood transfusion rate, and times to ambulation and independent stair use were significantly reduced in the corrective group. Postoperatively, Oxford and WOMAC scores significantly decreased in both groups. After surgery, the VAS score was more overtly decreased in the corrective group compared with the standard group.Conclusions: This study concluded that the less invasive short external rotator sparing approach for THA caused less damage, reducing perioperative blood loss, shortening functional recovery time, maintaining prosthesis stability, and improving postoperative pain.

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Comparison of postoperative effectiveness of less invasive short external rotator sparing approach versus standard posterior approach for total hip arthroplasty

10.21203/rs.3.rs-68784/v1 ◽

2020 ◽

Author(s):

Tianbao Wang ◽

Yongwei Zhou ◽

Xiaofei Li ◽

Siqi Gao ◽

Qining Yang

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Short External Rotator ◽

Total Hip ◽

Surgical Data ◽

Stair Use ◽

External Rotator ◽

Standard Posterior Approach

Abstract Background Studies assessing corrective posterior total hip arthroplasty (THA) mostly focused on the mini-incision approach, with few exploring the short external rotator sparing approach. This study aimed to compare the effectiveness of standard posterior approach versus short external rotator sparing approach. Methods This prospective observational study included patients treated in the Orthopedics Department of Jinhua Central Hospital in 06/2017-06/2018. Patient grouping was based on the surgical methods. Surgical data were recorded postoperatively. Postoperative hip joint recovery was assessed by the times to ambulation and independent stair use, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Harris score and Oxford hip score (OHS) at 2 and 8 postoperative weeks. The visual analog scale (VAS) was used for postoperative pain assessment. Results Postoperative changes of creatine kinase (CK), myoglobin, CRP, and prosthesis position were similar in both groups. However, intraoperative blood loss and postoperative 6-h drainage volume, hospital stay, and blood transfusion rate were significantly reduced in the corrective (short external rotator sparing) group, as well as times to ambulation and independent stair use. Oxford and WOMAC scores in both groups decreased significantly postoperatively. The VAS score was more overtly decreased postoperatively in the corrective group compared with the standard group. Conclusions The corrective THA causes less damage and reduces perioperative blood loss, shortening functional recovery time, maintaining prosthesis stability and improving pain postoperatively.

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A randomized, double-blind, placebo-controlled trial on the efficacy of tranexamic acid combined with rivaroxaban thromboprophylaxis in reducing blood loss after primary cementless total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b2.bjj-2018-0898.r1 ◽

2019 ◽

Vol 101-B (2) ◽

pp. 207-212 ◽

Cited By ~ 9

Author(s):

A. Clavé ◽

R. Gérard ◽

J. Lacroix ◽

C. Baynat ◽

M. Danguy des Déserts ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Controlled Trial ◽

Thromboembolic Complications ◽

Double Blind ◽

Double Blind Placebo ◽

Total Hip

Aims Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol versus the long protocol. Patients and Methods A multicentre, prospective, randomized, double-blind, placebo-controlled trial was undertaken involving 229 patients undergoing primary cementless THA using a posterior approach, whose extended rivaroxaban thromboprophylaxis started on the day of surgery. There were 98 male and 131 female patients, with a mean age of 65.5 years (32 to 91). The primary outcome, perioperative RBL, was evaluated at 72 hours postoperatively. The efficacy of short- and long-TXA protocols in the reduction of perioperative RBL was compared with a placebo group. Results TXA significantly reduced perioperative blood loss compared with placebo (p < 0.001); the mean differences were 525.3 ml (short-TXA vs placebo) and 550.1 ml (long-TXA vs placebo). No venous or arterial thromboembolic complications were reported. The upper boundary of the 95% confidence interval, when comparing short and long protocols, was below the pre-specified margin of non-inferiority (p = 0.027). Conclusion In patients undergoing primary cementless THA, using a posterior approach, who are treated with rivaroxaban for thromboembolic prophylaxis, short- and long-TXA IV protocols are significantly more effective than placebo in reducing perioperative RBL, without any thromboembolic complications. Non-inferiority of a short- versus a long-TXA protocol in reducing perioperative RBL was supported in a secondary analysis.

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