Hip replacement by a minimal anterior approach.
Ontology highlight
ABSTRACT:
SUBMITTER: Paillard P
PROVIDER: S-EPMC2267519 | biostudies-other | 2007 Aug
REPOSITORIES: biostudies-other
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Project description:BackgroundThis study sought to determine the accuracy in placing the acetabular component, estimation of leg length, offset, radiation time and dose, and operative time using a handheld navigation device compared to conventional anterior total hip arthroplasty (THA). It also examined the learning curve of the handheld navigation device.MethodsData were prospectively collected for a consecutive series of 159 THAs; 99 THAs with handheld navigation and 60 conventional THAs. Thresholds of <5°, ≥5° to <10°, and ≥10° for acetabular inclination and version and thresholds of <5 mm, ≥5 mm to <10 mm, and ≥10 mm for leg-length and combined offset discrepancy were used to assess accuracy. Fluoroscopy time and exposure, operative time, and complications were compared. Learning curve was determined using operative time. Statistical analysis was performed for the different accuracy thresholds with P values set a <0.05 for significance.ResultsThe handheld navigation device demonstrated a mean accuracy of 3.2° and 1.8° for version and inclination, respectively. The handheld navigation group had significantly fewer outliers in version (P < .001), inclination (P < .001), leg-length discrepancy (P < .001), and offset discrepancy (P < .001). Fluoroscopic dose and time (P < .001) were lower in the handheld navigation cohort. The learning curve for handheld navigation was 31-35 cases. The mean operative time after the learning curve was similar to that in the conventional fluoroscopy group (P = .113).ConclusionsHandheld navigation technology provided more accurate results while mitigating radiation exposure to the surgeon and patient. There were fewer outliers in the handheld navigation group. After the learning curve, all metrics improved in accuracy, and operative time was similar to that of the conventional technique.
| S-EPMC9399378 | biostudies-literature
Project description:Conversion of prior proximal femoral fracture fixation to hip arthroplasty is a fairly common and successful procedure, necessitated by various modes of failure. The procedure is well described utilizing a posterior or anterolateral surgical approach. The anterior approach for total hip arthroplasty has gained in popularity. The approach allows for supine positioning and facilitates live fluoroscopic imaging. We present possible advantages and disadvantages, as well as the surgical technique, of conversion to total hip arthroplasty via the direct anterior approach.
| S-EPMC6920725 | biostudies-literature
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:BackgroundWhen performing a total hip arthroplasty via the direct anterior approach (DAA), many orthopedic surgeons utilize an orthopedic traction table. This technique requires an expensive table, time for positioning, staff to operate the table, and time-consuming transitions when preparing the femur. Some surgeons advocate for an "off-table" technique to avoid these difficulties. In this paper, we compare operating room efficiency between on-table and off-table techniques.Material and methodsWe retrospectively reviewed patients undergoing total hip arthroplasty by a single surgeon across the transition from on-table to off-table DAA technique. Three cohorts were defined; the last 40 on-table hips, the first 40 off-table hips, followed by the second 40 hips. Timestamps from the operative record were recorded to calculate setup, surgical, takedown, and total room time. Implant fixation, patient demographic data, comorbidities, and complications were recorded.ResultsFrom cohort 1 to 2, there was a 7-minute (14.44%, P = .0002) improvement in setup time but no change in total room time. From cohort 2 to 3, there was an additional 7-minute (15.47%, P < .0001) improvement in setup time, 32-minute (25.88%, P < .0001) improvement in surgical time, and 40-minute (21.96%, P < .0001) improvement in total room time yielding cumulative changes from cohort 1 to 3 of 15 minutes (27.68%, P < .0001), 28 minutes (23.11%, P < .0001), and 43 minutes (23.37%, P < .0001), respectively. There was no correlation between height, weight, or body mass index and time at any interval.ConclusionConversion to an off-table DAA technique offers an improvement in operating room efficiency. This is seen in setup, operative, and total room time. Implementation could allow for an additional case each day.
| S-EPMC9121069 | biostudies-literature
Project description:Although the anterior approach for total hip arthroplasty has gained increasing utilization, some studies have suggested a higher risk of femoral complications, as well as difficulty with femoral exposure. Techniques of soft tissue releases have been described to offer better femoral exposure, and to help mitigate complications. The purpose of the study is to describe an algorithmic soft tissue femoral release in direct anterior approach total hip arthroplasty and to assess the clinical outcomes of patients upon which this algorithm of femoral soft tissue releases was utilized. Clinical outcomes with the Harris Hip Score, reoperation rates, component survivorship, and complications were analyzed.
| S-EPMC6921189 | 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: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:BackgroundSupercapsular Percutaneously Assisted total hip arthroplasty (SuperPATH approach) is a relatively new minimal invasive approach which has been associated with encouraging postoperative outcomes. The aim of this study is to compare the minimal invasive (MIS) SuperPATHapproach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data.Material and methodsForty eight (48) consecutive patients undergone primary total hip arthroplasty (THA) by the same surgeon (GD), were enrolled in our study. From this study population, the modified Hardinge approach was performed in 23 patients and the SuperPATH approach was performed in 25 patients. Soft tissue impairment was studied based on three representative markers, C-reactive-protein (CRP) and two enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH). We measured these markers 10 min after surgery, on 1st and 2nd postoperative day. The levels of the perceived pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS) score which was registered 6 h, 12 h, 1 day and 2 days postoperatively. The functional and clinical evaluation of the patients was achieved with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9) and neuropathic pain questionnaire (DN-4) 6 months and 1 year postoperatively. The rest of the collected data included patient's age, gender, body mass index (BMI), other comorbitities, the American Society of Anesthiologists score (ASA), Charlson Index score, the pre-operative diagnosis, implant positioning through radiographic evaluation, the type of anesthesia, the days of hospitalization, the operating time, incision length, blood loss and blood transfusion requirements and complication rates.ResultsSuperPATH approach was related with statistically considerable lower levels of CRP at 10 min (p = 0,001) and at 24 h (p = 0,047) postoperatively, as well as lower LDH levels in all time points postoperatively. It was also associated with shorter incision length (p < 0.001), longer operating time (p < 0.001), higher mean cup inclination p < 0.001, decreased postoperative pain levels the first 6 and 12 h (p < 0.001) and relatively better clinical and functional results 6 months after surgery, but not at 12 months.ConclusionOur study revealed some advantages in favor of the SuperPATH approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is required in order to further elucidate its efficacy.
| S-EPMC7476237 | biostudies-literature