Good long-term outcomes for Direct Anterior Approach Total Hip Arthroplasty in South Africa.
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ABSTRACT:
SUBMITTER: Pietrzak JRT
PROVIDER: S-EPMC7481503 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Subtrochanteric osteotomy of the femur (STO) is a valuable corrective procedure in hip surgeries. However, STO in traditional posterolateral approach usually encounters complications such as postoperative dislocation, bone non-union, and prosthesis failure. Some relevant pathologies and mechanisms have been identified, but there is sparse evidence for verification. The aim of this video in orthopaedic technique is to test our hypothesis of STO in direct anterior approach to total hip arthroplasty in a complicated hip surgery, and to further illustrate the rationality, reproducibility, and superiority of STO in this minimally invasive and enhanced-recovery approach by presenting a standardized and systemic protocol, as well as operational pearls and pitfalls.
| S-EPMC7767779 | biostudies-literature
Project description:High-dislocated hip dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). The DAA has potential advantages including optimizing component positioning, enhanced hip stability, and a more rapid postoperative recovery. We present a surgical technique for DAA total hip arthroplasty for hip dysplasia that includes preoperative planning, soft tissue releases, subtrochanteric osteotomy, component placement, and intraoperative nerve monitoring and imaging. This technique provides detailed technical instructions, specifically including pearls and pitfalls, and complication prevention strategies.
| S-EPMC7303477 | biostudies-literature
Project description:BackgroundCitation analysis is a commonly used method for appraising the impact of academic publications within a particular field of study. A gap exists in the citation analysis literature with regard to the topic of direct anterior approach (DAA) hip arthroplasty. The purpose of this study is to identify the 50 most frequently cited publications related to this topic.MethodsThe Clarivate Analytics Web of Knowledge database was utilized to search for publications relating to DAA hip arthroplasty. The top 50 most cited articles that met inclusion criteria were recorded and reviewed for various metrics.ResultsThe top 50 publications were cited a total of 3521 times, with an average of 86.3 total citations per year between 1980 and 2019. 47 of the 50 articles identified had been published since the year 2000. Cohort designs were the most common study type.ConclusionsThis analysis provides insight into factors that characterize highly cited articles on the specific topic of DAA hip arthroplasty. These factors include higher levels of evidence, recent publication, and origin in the United States. Citations of DAA hip arthroplasty papers appear to be on the rise. The curation and analysis of this set of 50 articles will provide orthopaedic surgery clinicians, researchers, and residency program directors a guide for quickly isolating influential articles on the topic of DAA hip arthroplasty. This may serve as a quick reference for clinical decision-making, foundation for further research, and curriculum on DAA hip arthroplasty.
| S-EPMC7303476 | biostudies-literature
Project description:Addressing acetabular bone defects can be difficult and depends on the amount of bone loss. Augments, either with bone or highly porous metals, are options that still allow the use of a hemispherical cup. Almost all previous research and publication on acetabular augments have focused on revision hip arthroplasty utilizing either a modified lateral or a posterolateral surgical approach. We describe 3 cases of augmenting acetabular bone defects through a direct anterior approach for primary total hip arthroplasty. We achieved proper cup placement, alignment, and augment incorporation while reconstructing complex acetabular deficiencies. All patients had complete pain relief and a satisfactory clinical outcome with stable radiographs at follow-up. With appropriate training, acetabular augmentation can be performed safely and efficiently with excellent clinical results through this approach.
| S-EPMC5859514 | biostudies-literature
Project description:Nerve palsy following total hip arthroplasty (THA) can have a serious effect on a patient`s functional prognosis and on cost-effectiveness, and it is the leading cause of THA-associated medical litigation. However, only a few studies focus on femoral nerve palsy (FNP) following THA with the direct anterior approach (DAA). Moreover, several studies have reported that THA with DAA may result in higher complication rates, particularly during the so-called 'learning-curve period' for the surgeon. This study aimed to identify the incidence of FNP following primary THA with DAA, to determine presumed etiologies through a retrospective investigation of FNP clinical courses following primary THA with DAA and to identify any relationship between the occurrence of FNP following primary THA with DAA and the surgeon's experience of DAA. Since August 2007, DAA for primary THA was introduced in our institution. All 273 consecutive primary THAs with DAA (42 bilateral and 189 unilateral cases) between August 2007 and February 2014 were included in this study. All patients' charts and radiographs were reviewed to identify cases with palsy and to retrieve related factors. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test <3) with or without sensory disturbance over the anteromedial aspect of the thigh. The incidence of FNP following primary THA with DAA was 1.1% (3/273 joints). In all 3 cases, the motor deficit recovered completely within a year. Suspected causes of the palsy in the 3 cases were believed to be improper positioning of the anterior acetabular retractor, excessive leg lengthening, or unknown etiology. There was no significant relationship between palsy and surgeon's experience of DAA. In THA with DAA for patients requiring major leg lengthening, the likelihood of FNP must be considered. To prevent FNP, the anterior acetabular retractor must be placed properly.
| S-EPMC6527207 | biostudies-literature
Project description: Not available
| S-EPMC10907387 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described.Case presentationA 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation.ConclusionWe address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication.
| S-EPMC10288717 | biostudies-literature
Project description:BackgroundLimited literature exists concerning the femoral cement mantle quality that can be achieved through an anterior approach in total hip arthroplasty (THA). We radiologically evaluated the quality and thickness of the femoral cement mantle in patients undergoing THA utilizing the direct anterior approach (DAA).MethodsImmediate postoperative anteroposterior and lateral radiographs of 116 consecutive patients who underwent hybrid or fully cemented THA using the DAA and cemented Quadra-C stem (Medacta, International, SA, Switzerland) were assessed by 2 arthroplasty surgeons blinded to the study. Surgical indications were hip osteoarthritis or subcapital hip fracture. The cement mantle and stem alignment were evaluated using the Barrack classification and Khalily methods, respectively. After calibration of radiographs, the thinnest part of the cement mantle per Gruen zone was recorded. Parameters were compared between obese and nonobese patients.ResultsAgreement between raters was substantial for the cement quality in anteroposterior (k = 0.707, P ≤ .001) and moderate for lateral radiographs (k = 0.574, P ≤ 001). The cement mantle was graded A in 39.25%, B in 53.0%, and C in 7.75% of anteroposterior radiographs and similarly for lateral radiographs (40.1% A, 51.75% B, 9.5% C). 93% of stems had neutral alignment. The mean thinnest cement mantle (P = .237) and incidence of inadequate cement mantle (<2 mm) per zone (P = .431) were comparable between Gruen zones. The cement mantle quality (P = .174) and inadequacy (P > .05) and stem alignment (P = .652) were comparable between obese and nonobese patients.ConclusionsDAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.
| S-EPMC7502567 | biostudies-literature
Project description:This report describes a patient with ankylosing spondylitis (AS) who underwent total hip arthroplasty (THA) by the direct anterior approach and sustained a L4-5 extension fracture dislocation with neural deficits. A magnetic resonance imaging revealed an epidural hematoma at the site of the fracture causing critical stenosis. The patient was taken to the operating room for a L3-S1 posterior decompression with L2-pelvis posterior spinal fusion. AS and diffuse idiopathic skeletal hyperostosis create a stiff spine that predisposes to fractures because of the larger moment arms experienced than normal spines. The arthroplasty surgeon performing THA should be aware and take precautions to reduce stress on the spine.
| S-EPMC5712024 | biostudies-literature
Project description:BackgroundIn total hip arthroplasty (THA), component position is critical to avoid instability and improve longevity. Appropriate combined femoral and acetabular component anteversion is important for improved THA stability and increased impingement-free range of motion. In direct anterior THA (DA-THA), concern has been expressed regarding the accuracy of femoral component positioning. This study seeks to quantify acetabular, femoral, and combined component orientation relative to the accepted "safe zones" in patients who have undergone DA-THA.MethodsTwenty-nine patients who had THA performed via direct anterior approach had postoperative computerized tomography scans done to assess femoral anteversion. Stem rotational alignment was measured relative to the transepicondylar axis (TEA) and the posterior condylar axis (PCA) of the femur at the knee. Acetabular abduction and version were recorded on anteroposterior pelvis radiographs.ResultsThe mean stem anteversion was 17.5° (standard deviation = 10.8°) from the TEA and 21.7° (standard deviation = 11.3°) from the PCA. Ten of 30 cups were appropriately anteverted; however, all the cups had appropriate abduction. Combined version when using the TEA resulted in 79% (23/29) of patients within the "safe zone" of 25°-50°. Pearson correlation coefficients were high for both stem anteversion from the TEA (R = 0.96) and PCA (R = 0.98); however, interobserver reliability for combined component anteversion was greater for the TEA (kappa, 0.83 vs 0.65).ConclusionsCombined anteversion within the "safe zone" was achieved 79% of the time with DA-THA. Interestingly, most of the "excessive" combined anteversion appears to be related to increased anteversion of the acetabular component with only 10 patients within the acetabular cup "safe zone" of 5°-25°.
| S-EPMC7451890 | biostudies-literature