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

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.

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

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.

The “Sign of Horns” deformity following the Thompson’s approach to the proximal radius—A rare case report and literature review

The Thompson’s approach is used as the standard posterior approach by many surgeons. Although posterior interosseous nerve palsy following the Thompson’s approach has been reported by several authors, isolated paralysis of the extensor digitorum communis (EDC) is a rare occurrence. We report to you a case of isolated paralysis of EDC following the Thompson’s approach in a 14-year-old boy who recovered completely on the 5th postoperative day. Each of the approaches to the proximal radius poses a risk of damage to the posterior interosseous nerve and its branches because of traction. Damage may occur during exposure or implant insertion. Any surgery around the supinator and the radial tunnel region is dangerous because of complex anatomy, lack of intermuscular planes and varying distribution of the radial nerve. Avoiding excessive posterior or ulnar retraction of the EDC and improper dissection can avoid the “sign of horns” deformity following the Thompson’s approach.

Intrapelvic Dislocation of a Femoral Trial Head During Primary Total Hip Arthroplasty Requiring Laparotomy for Retrieval

Background and Purpose: Total hip arthroplasty (THA) is a safe and reliable surgical procedure. However, THA also has intra- and postoperative complications. A dreaded and frustrating intraoperative complication during total hip arthroplasty is dislocation of the femoral trial head from the neck into the pelvis. Methods: Here, we report on the case of a 71-year old female patient with osteoarthritis of the left hip. Total hip arthroplasty was performed in a lateral position through a standard posterior approach. During intraoperative trial reduction, the femoral trial head dissociated from the taper and dislocated into the psoas compartment. Several unsuccessful attempts, including an additional ventral approach, were made to immediately retrieve the femoral trial head. Results and interpretation: Postoperative a Computerized Tomography (CT) was performed to locate the trial head, a secondary explorative laparotomy was undertaken to retrieve it. The retrieval of the femoral trial head should be performed in a planned second surgical procedure to avoid possible complications during the manipulation necessary for retrieval.