scholarly journals Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study

2013 ◽  
Vol 5 (4) ◽  
pp. 31 ◽  
Author(s):  
Thomas Ilchmann ◽  
Silke Gersbach ◽  
Lukas Zwicky ◽  
Martin Clauss
Keyword(s):  
Minimally Invasive ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Clinical Results ◽  
Lateral Approach ◽  
Minimal Invasive ◽  
Harris Hip Score ◽  
Duration Of Surgery ◽  
One Year ◽  
Continuous Use

A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach.

scholarly journals A prospective randomized peri- and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach

2013 ◽  
Vol 5 (3) ◽  
pp. 19 ◽  
Author(s):  
Stefan Landgraeber ◽  
Henning Quitmann ◽  
Sebastian Güth ◽  
Marcel Haversath ◽  
Wojciech Kowalczyk ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hip Replacement ◽  
Postoperative Outcome ◽  
Lateral Approach ◽  
Harris Hip Score ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Duration Of Surgery ◽  
Minimally Invasive Anterolateral Approach

There is still controversy as to whether minimally invasive total hip arthroplasty enhances the postoperative outcome. The aim of this study was to compare the outcome of patients who underwent total hip replacement through an anterolateral minimally invasive (MIS) or a conventional lateral approach (CON). We performed a randomized, prospective study of 75 patients with primary hip arthritis, who underwent hip replacement through the MIS (n=36) or CON (n=39) approach. The Western Ontario and McMaster Universities Osteoarthritis Index and Harris Hip score (HHS) were evaluated at frequent intervals during the early postoperative follow-up period and then after 3.5 years. Pain sensations were recorded. Serological and radiological analyses were performed. In the MIS group the patients had smaller skin incisions and there was a significantly lower rate of patients with a positive Trendelenburg sign after six weeks postoperatively. After six weeks the HHS was 6.85 points higher in the MIS group (P=0.045). But calculating the mean difference between the baseline and the six weeks HHS we evaluated no significant differences. Blood loss was greater and the duration of surgery was longer in the MIS group. The other parameters, especially after the twelfth week, did not differ significantly. Radiographs showed the inclination of the acetabular component to be significantly higher in the MIS group, but on average it was within the same permitted tolerance range as in the CON group. Both approaches are adequate for hip replacement. Given the data, there appears to be no significant long term advantage to the MIS approach, as described in this study.

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.

EVALUATE INTRAOPERATIVE VARIABLES AND POSTOPERATIVE OUTCOMES OF INTERTROCHANTERIC FRACTURES WITH VULNERABLE/ BROKEN LATERAL WALL MANAGED WITH SHORT AND LONG CEPHALOMEDULLARY NAIL

2021 ◽  
pp. 36-37
Author(s):  
Rahul Kumar ◽  
Wasim Ahmed ◽  
Indrajeet Kumar
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Postoperative Outcomes ◽  
Treatment Modalities ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Duration Of Surgery ◽  
One Year ◽  
Lateral Walls

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral walls managed with short and long cephalomedullary nails. Materials & Methodology: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon's perception of surgery. Functional outcome was evaluated by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck-shaft angle, and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002), and surgeon's perception of surgery (p=0.002) were signicantly more in the LCMN group. The LCMN group had a better functional outcome. HHS for the LCMN group was 89.15±9.53, and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modalities for unstable intertrochanteric fractures with vulnerable/broken lateral walls. In the absence of more extensive study and long-term follow-up, the superiority of one implant over the other cannot be recommended.

Rotational Vertebral Artery Occlusion—Series of 9 Cases

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 1066-1072 ◽  
Author(s):  
Daniel C Lu ◽  
Zsolt Zador ◽  
Praveen V Mummaneni ◽  
Michael T Lawton
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Vertebral Artery ◽  
Anterior Approach ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Cervical Instability ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract BACKGROUND: Rotational vertebral artery syndrome (RVAS) is a rare entity about which previously published studies are mostly limited to individual case reports. OBJECTIVE: To report our decade-long experience with this syndrome in 9 patients with compression ranging from the occiput to C6. METHODS: We utilized a posterior approach for lesions rostral to C4 and an anterior approach for lesions at or caudal to C4. Furthermore, we demonstrated the feasibility and efficacy of a minimally invasive posterior cervical approach. Patient profile, operative indications, surgical approach, operative findings, complications, and long-term follow-up were reviewed and discussed. RESULTS: Average follow-up was 47 months. All procedures provided excellent outcomes by Glasgow Outcome Scale scores. The anterior approach had significantly less blood loss (187.5 mL vs 450 mL, P = .00016) and shorter hospitalization length (2 days vs 4.5 days; P = .0001) compared with the far-lateral approach. There was one complication of cervical instability in the far-lateral approach cohort. As an alternative to the far-lateral surgery, a minimally invasive approach resulted in shorter hospitalization (2 days) and less blood loss (10 mL) while avoiding the complication of cervical instability. CONCLUSION: We demonstrated the safety, efficacy, and durability of 3 surgical approaches for RVAS. Proper examination, preoperative imaging, and surgical planning were necessary for a satisfactory outcome.

scholarly journals Total hip arthroplasty and lumbar spine disorders: Plain co-existence or mutual influence?

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Nils Wirries ◽  
Michael Schwarze ◽  
Dorothea Daentzer ◽  
Michael Skutek
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Mutual Influence ◽  
Negative Impact ◽  
Clinical Signs ◽  
Clinical Results ◽  
Total Hip ◽  
One Year ◽  
Spine Disorders

Lumbar spine disorders (LSD) might influence the outcome after total hip arthroplasty (THA). Despite a known common prevalence of LSD and degenerative hip disorders, this study investigates their mutual influence in case of co-existence with the purpose to advance surgeons planning and patient’s prognosis. Patients with and without LSD were compared before and at the one-year postoperative examination. For clinical evaluation the WOMAC was assessed. The radiological analysis focused on cup anteversion and inclination. The total group included 203 consecutive patients. The overall incidence of LSD was 51.0%. Patients with LSD were on average 4.3 years older and had a 1.8 higher BMI than non-LSD patients (P<0.05). The cup positioning and the clinical results were comparable between both groups before and at the last time of follow up (P>0.05). No hip dislocations nor clinical signs of impingement were seen.We can conclude that there is a high degree of co-existence of LSD and hip disorders. However, a strong negative impact of LSD to clinical or radiologic results could not be confirmed in our study.

scholarly journals Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 15 ◽  
Author(s):  
Constant Foissey ◽  
Mathieu Fauvernier ◽  
Cam Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operating Time ◽  
Surgical Techniques ◽  
Direct Anterior Approach ◽  
Clinical Results ◽  
Total Hip ◽  
Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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