scholarly journals Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty

2016 ◽  
Vol 27 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Julia Blackburn ◽  
Diana Lim ◽  
Ian Harrowell ◽  
Michael C. Parry ◽  
Ashley W. Blom ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Revision Surgery ◽  
Posterior Approach ◽  
Short Form ◽  
Lateral Approach ◽  
Revision Hip Arthroplasty ◽  
Satisfaction Scale ◽  
Patient Reported ◽  
Revision Tha

Introduction Most total hip arthroplasties (THAs) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery. Methods A retrospective cohort study of 205 patients who underwent revision THA for aseptic loosening. Patients rated their pain from 0-10 and completed the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), WOMAC and Short form-12 questionnaires. Results 205 patients (209 hips) from a cohort of 238 patients (243 hips, 86%) were available for analysis. The mean follow-up was 5 years (SD 1.71). Grouping by approach 20% (43/209) had both primary and revision procedures via a lateral approach, 20% (43/209) had their primary surgery via a lateral approach and their revision surgery via a posterior approach, whilst 60% (123/209) had both procedures via a posterior approach. The WOMAC and OHS were significantly better in patients who had a posterior approach for both primary and revision surgery, compared to those that did not (OHS p = 0.028, WOMAC p = 0.026). We found no significant differences in pain, satisfaction or health-related quality of life between the groups. Discussion Choice of approach for revision hip arthroplasty is influenced by a number of factors, but in clinical situations where either a lateral or posterior approach could be used, the posterior approach appears to be associated with better joint-specific outcomes. Registry data may help further explore the associations between surgical approach and the outcome from revision THA.

scholarly journals Instability in Patients with Lumbar Spine Disease or Fusion Undergoing Posterior Approach vs. Lateral Approach Primary Total Hip Arthroplasty

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Amritdev Parihar ◽  
Evan R. Deckard ◽  
Leonard T. Buller ◽  
R. Michael Meneghini
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Spine Pathology ◽  
Direct Lateral Approach ◽  
Postoperative Dislocation ◽  
Spine Disease

Background and Hypothesis:  Dislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion due to lumbar spine disease or fusion have been reported as high as 20%. Few studies exist that compare dislocation rates in patients with spine pathology undergoing THA via different surgical approaches. The purpose of this study was to compare postoperative dislocation rates in patients with lumbar spine disease or fusion between those undergoing a primary THA using a posterior versus direct lateral surgical approach.    Experimental Design or Project Methods:  With IRB approval, 1,205 primary THAs performed by two surgeons were retrospectively reviewed. One surgeon routinely performs THAs with a posterior approach while the other surgeon routinely uses a direct lateral approach. Chart review from the electronic medical record was conducted to identify patients who have lumbar spine disease or a lumbar spine fusion. Dislocations for patients with and without lumbar spine disease were compared by posterior approach and direct lateral approach.    Results:   767 posterior approach and 431 direct lateral approach THAs were available for analysis.  43.6% of all THAs had lumbar spine pathology (337/767 posterior and 185/431 direct lateral). The overall dislocation rate was 1.26% (15/1195).  The main predictors of dislocation in binary logistic regression were the presence of lumbar spine pathology (OR 5.24, 95% CI: 1.47–18.69, p=0.018) and posterior surgical approach (OR 7.93, 95% CI: 1.04–60.6, p=0.046).  The dislocation rate for direct lateral approach THAs with lumbar spine pathology was significantly lower compared to posterior approach THAs with lumbar spine pathology (0.0% vs 3.6%, p=0.011).    Conclusion and Potential Impact:   Although there were few dislocations, the study results suggest a direct lateral approach for primary THA may be beneficial to reduce postoperative dislocation for patients with limited spinopelvic motion due to lumbar spine pathology. 

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

2018 ◽  
Vol 02 (01) ◽  
pp. 054-058
Author(s):  
Kilian Rueckl ◽  
Friedrich Boettner
Keyword(s):  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Posterior Approach ◽  
Posterior Column ◽  
Simple Extension ◽  
Circumflex Artery ◽  
Obturator Externus ◽  
Medial Femoral Circumflex Artery ◽  
Revision Tha ◽  
Acetabular Defects

AbstractReconstruction of acetabular defects in revision total hip arthroplasty (THA) requires excellent exposure. Most extensile approaches to the acetabulum were described in the trauma literature and are not beneficial for revision THA. This article describes a modification of the standard posterior surgical approach to improve visualization of the ischium as required for acetabular defect reconstruction, insertion of standard and custom triflange cages as well as posterior column plating. The current surgical technique utilizes an intermuscular plane between the gemellus inferior muscle and the obturator externus muscle. This intermuscular plane leads the surgeon directly to the ischium and facilitates easy extension toward the insertion of the hamstring muscles without compromising the insertion of the external rotator muscles along the ischium. This article describes a novel surgical approach to the posterior column and ischium under special consideration of the sciatic nerve, superior gluteal vessels, and medial femoral circumflex artery. This simple extension of the standard posterior approach optimizes exposure of the posterior column during revision THA using a posterior approach.

scholarly journals Pain and rehabilitation after total hip arthroplasty are approach dependent: a multisurgeon, single-center, prospective cohort study

2021 ◽  
Author(s):  
Alexander Zimmerer ◽  
Mona Steinhaus ◽  
Erdmann Sickmüller ◽  
Benjamin Ulmar ◽  
Matthias Hauschild ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Walking Distance ◽  
Surgical Approaches ◽  
Inpatient Stay ◽  
Single Center ◽  
The Third

Abstract Purpose The aim of this study was to assess perioperative pain and mobilization after total hip arthroplasty (THA) using three different surgical approaches. Methods This was a multisurgeon, prospective, single-center cohort study. A total of 188 patients who underwent hip arthroplasty (THA) between February 2019 and April 2019 were analyzed according to the surgical approach used (direct anterior, lateral, and posterior approach). Outcome parameters were the daily walking distance during the inpatient stay, the pain level according to the visual analog scale (VAS) at rest and motion during the inpatient stay and at 6-week follow-up and the modified Harris Hips Score (mHHS) preoperatively and at 6 weeks. Results The walking distance within the groups increased significantly during the inpatient stay (p < 0.001). The DAA and posterior approach patients had a significantly longer walking distance than the lateral approach patients on the third postoperative day (DAA vs. lateral, p = 0.02; posterior vs. lateral 3, p = 0.03). DAA and posterior approach patients reported significantly less pain during motion on the third postoperative day and at 6-week follow-up than the lateral approach patients (3 postoperative day: DAA vs. lateral, p = 0.011; posterior vs. lateral, p = 0.04; 6 weeks control: DAA vs. lateral, p = 0.001; Posterior vs. lateral 3, p = 0.005). The mHHS demonstrated significant improvement within each group. However, lateral approach patients reported significantly less improvement than the DAA and posterior approach patients (DAA vs. lateral, p = 0.007; posterior vs. lateral, p = 0.021). Conclusion This study analyzed perioperative pain progression and short-term rehabilitation after THA according to the different surgical approaches. Direct anterior and posterior approaches have shown comparable improvements in pain, walking distance, and mHHS. Whether this effect persists over a longer period of time must be clarified in future studies. Study design Prospective cohort study, level of evidence, 2.

scholarly journals Surgical approach for fracture of distal humerus: Posterior vs lateral

2020 ◽  
Author(s):  
Michela Saracco ◽  
Alessandro Smimmo ◽  
Davide De Marco ◽  
Osvaldo Palmacci ◽  
Giuseppe Malerba ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Radial Nerve ◽  
Posterior Approach ◽  
Age Distribution ◽  
Young Patients ◽  
Lateral Approach ◽  
Humeral Fractures ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Complication Rates

Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.

Effect of marital status on patient-reported outcomes following total hip arthroplasty: a matched analysis with minimum 2-year follow-up

2019 ◽  
pp. 112070001986401
Author(s):  
Ajay C Lall ◽  
Garrett R Schwarzman ◽  
Muriel R Battaglia ◽  
Sarah L Chen ◽  
David R Maldonado ◽  
...  
Keyword(s):  
Marital Status ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Psychosocial Support ◽  
Short Form ◽  
Harris Hip Score ◽  
Never Married ◽  
Total Hip ◽  
Patient Reported

Introduction: Mental health and patient expectation have been identified as key predictors of recovery following THA; however, there is limited literature examining the effects of social support and marital status on patient-reported outcomes (PROs). Methods: Data were prospectively collected and retrospectively reviewed for patients who underwent THA between July 2008 and January 2016. Patients were included if they underwent primary THA during this period and if they had documented preoperative marital status of married, divorced, or never married. Married patients were group matched to non-married patients (divorced or never married) with similar sex, age, body mass index (BMI), gender distribution, and frequency of surgical approach. Results: There were 414 married patients and 98 non-married patients who were eligible and had minimum 2-year follow-up. Mean PROs were significantly worse in the non-married group than the married group for the following measures: modified Harris Hip Score ( p = 0.002), Harris Hip Score ( p = 0.002), Forgotten Joint Score ( p = 0.04), and the physical portions of the Veterans RAND ( p = 0.025) and Short Form ( p = 0.02) surveys. Conclusions: Our study demonstrated inferior absolute PRO scores at latest follow-up for patients who were non-married compared to married following THA. These results show that while total hip replacement may still yield clinical benefit in all patients, non-married patients may ultimately achieve an inferior functional status, and expectations should be adjusted accordingly. Physicians should assess levels of psychosocial support in their patients prior to undergoing hip arthroplasty in order to optimise results.

scholarly journals Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach

2017 ◽  
Vol 88 (3) ◽  
pp. 239-247 ◽  
Author(s):  
Signe Rosenlund ◽  
Leif Broeng ◽  
Anders Holsgaard-Larsen ◽  
Carsten Jensen ◽  
Søren Overgaard
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Patient Reported Outcome ◽  
Total Hip ◽  
Patient Reported ◽  
Lateral And Posterior Approach

Surgical approach significantly affects the complication rates associated with total hip arthroplasty

2019 ◽  
Vol 101-B (6) ◽  
pp. 646-651 ◽  
Author(s):  
V. K. Aggarwal ◽  
A. Elbuluk ◽  
J. Dundon ◽  
C. Herrero ◽  
C. Hernandez ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Periprosthetic Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Deep Infection ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Wound Drainage

Aims A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications. Patients and Methods The electronic medical records of all patients who underwent primary elective THA at a single large-volume arthroplasty centre, between 2011 and 2016, with at least two years of follow-up, were reviewed. After exclusion, 3574 consecutive patients were included in the study. There were 1571 men (44.0%) and 2003 women (56.0%). Their mean age and body mass index (BMI) was 63.0 years (sd 11.8) and 29.1 kg/m2 (sd 6.1), respectively. Data gathered included the age of the patient, BMI, the American Society of Anesthesiologists (ASA) score, estimated blood loss (EBL), length of stay (LOS), operating time, the presence of intra- or postoperative complications, type of complication, and the surgical approach. The approaches used during the study were posterior, anterior, direct lateral, anterolateral, and the northern approach. The complications that were recorded included prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture. Finally, the need for re-operation was recorded. Means were compared using analysis of variance (ANOVA) and Student’s t-tests where appropriate and proportions were compared using the chi-squared test. Results A total of 248 patients had 263 complications related to the surgery, with an incidence of 6.94%. The anterior approach had the highest incidence of complications (8.5% (113/1329)) and the posterior approach had the lowest, at 5.85% (97/1657; p = 0.006). Most complications were due to deep infection (22.8%), periprosthetic fracture (22.4%), and prolonged wound drainage (21.3%). The rate of dislocation was 0.84% (14/1657) with the posterior approach and 1.28% (17/1329) with the anterior approach (p = 0.32). Conclusion Overall, THA has a relatively low complication rate. However, the surgical approach plays a role in the incidence of complications. We found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate. Periprosthetic fracture and surgical site infection contributed most to the early complication rates. Cite this article: Bone Joint J 2019;101-B:646–651

scholarly journals Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
James Lachman ◽  
Jania A. Ramos ◽  
Samuel Adams ◽  
Mark Easley ◽  
James DeOrio
Keyword(s):  
Revision Surgery ◽  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Study Patient ◽  
Foot And Ankle ◽  
Metal Component ◽  
Component Failure ◽  
Ankle Arthroplasty ◽  
Patient Reported

Category: Ankle Arthritis Introduction/Purpose: Metal component failure in total ankle arthroplasty(TAA) is difficult to treat. Traditionally, to an arthrodesis has been advocated. Revision TAA surgery has become more and more common with availability of revision implants and refinement of bone conserving primary implants. It this study, patient reported results and clinical outcomes are analyzed for patients undergoing revision total ankle arthroplasty. Methods: We retrospectively reviewed prospectively collected data on 45 patients (cases) with a mean age of 63.7 +/-10.2 years who developed loosening or collapse of either major metal component in the primary total ankle arthroplasty. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. Prospectively collected patient reported outcomes measures including the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score, Visual Analog Scale (VAS), Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and the Foot and Ankle Outcomes Score (FAOS) questionnaires were collected. Clinical data was collected through thorough review of the electronic medical record to identify clinical failure defined as explant and second revision or conversion to arthrodesis or amputation. Results: The causes of failure of primary TAA in this study were aseptic loosening of both components (40%), talar component subsidence/loosening (37.7%), tibial loosening (8.8%), coronal talar subluxation (8.8%) and talar malrotation (2.2%). Twenty-four patients (53.3%) underwent revision of all components, nineteen (42.2%) just the talar and polyethylene components, and two (4.4%) the tibial and polyethylene components. The average time to revision was 5.56 years +/- 5.71 with a follow-up of 3.02 years +/- 1.25 after revision. Ten (22.2%) revision arthroplasties required further surgery; five required conversion to arthrodesis and five required second revision TAA. VAS scores, SF36 scores, SMFA scores, AOFAS Hindfoot scores, and FAOS all improved after revision surgery but took 2 years to reach scores comparable to 1 year after primary TAA. Conclusion: Clinical and patient reported results of revision ankle arthroplasty after metal component failure were comparable to those after primary ankle arthroplasty. In our series, 22.2% of revision TAAs required a second revision TAA or arthrodesis surgery. Various prosthesis performed similarly when used in revision scenarios. Patients recovered faster from primary ankle arthroplasty when compared to revision ankle arthroplasty but all scores were comparable by the two-year follow-up visit after revision arthroplasty surgery.

A conservative approach to dislocation following total hip arthroplasty: a review of 8606 hips

2020 ◽  
pp. 112070002095906
Author(s):  
Luke Ogonda ◽  
Roslyn S Cassidy ◽  
David E Beverland
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Posterior Approach ◽  
Cost Savings ◽  
Conservative Approach ◽  
Significant Cost ◽  
Total Hip ◽  
Primary Surgery ◽  
Acetabular Side

Patients and methods: We present the data on 8606 total hip arthroplasty (THA) procedures carried out in 7818 patients through a posterior approach between 1998 and 2017. Results: 218 hips (2.5%) suffered at least 1 dislocation with dislocation rates declining from 6.2% from 1998 to 2002 to 1.5% from 2003 to 2017. Overall, 92 hips (1.06%) required revision surgery but of these, only 5 (0.06%) had a full revision of both components with the remaining 87 requiring intervention only on the acetabular side. None have had a pseudo-arthrosis; none were left dislocated and all remain stable to date. Conclusions: In patients who have a second dislocation within 3 months of their primary surgery we recommend a spica or long leg cylinder cast to reduce the need for revision surgery. We propose an algorithm to manage instability with less aggressive operative treatment in this often-elderly patient population with the potential for less physiological insult and significant cost savings.

Conversion of a Long Distally Fixed Uncemented Revision Femoral Stem to a Proximally Fixed Implant following Fatigue Fracture

2011 ◽  
Vol 21 (6) ◽  
pp. 766-769 ◽  
Author(s):  
Peter S. Young ◽  
Rory G. Middleton ◽  
Ian D. Learmonth ◽  
Tahawwar Hasnat A. Minhas
Keyword(s):  
Fatigue Fracture ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Revision Hip Arthroplasty ◽  
Hip Revision ◽  
Clear Cut ◽  
Younger Patient ◽  
Primary Hip Arthroplasty

There has been increasing focus on bone conservation through proximal fixation in primary hip arthroplasty. However, the debate regarding fixation in revision arthroplasty and which factors influence implant choice remains less clear-cut. We report a case involving fatigue fracture of a long, distally well-fixed, uncemented revision stem. This was revised to a proximally fixed implant. This case highlights a number of issues when considering the choice of implant in hip revision surgery and raises the issue of bone conservation in revision surgery. We would suggest that in both primary and revision hip arthroplasty meticulous pre-operative consideration of the choice of implant should be undertaken, especially in the younger patient with higher expectations and functional demands.

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