Anterior Total Hip Arthroplasty

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Anterior total hip arthroplasty using a metaphyseal bone-sparing stem: component alignment and early complications

Anterior total hip arthroplasty using a metaphyseal bone-sparing stem: component alignment and early complications

After Institutional Review Board approval, information from all consecutive patients who underwent primary THA at our center by the senior surgeon from 2008 to 2011 was retrieved using an existing patient database. Within this period of time, a total number of 128 primary THA procedures were performed using the DAA. Exclu- sion criteria included cases with inadequate follow-up (<2 months) or where a different implant was used. However, review of these 20 cases that were excluded revealed no complications. A total of 108 primary THAs were identified for final review. The charts of these cases were reviewed to identify patient information including demographics, indications for surgery, and preoperative radiographs (Table 1). Indications for surgery included ad- vanced arthritis recalcitrant to conservative measures in the setting of primary osteoarthritis, posttraumatic arth- ritis, rheumatoid arthritis, avascular necrosis (AVN), fem- oral neck nonunion, and AVN as a sequela of a failed slipped capital femoral epiphysis in one patient. The se- nior author uses the DAA with a short curved stem for all primary THA. While no specific indications for the DAA have clearly been defined, we feel that this approach may especially be more advantageous in larger patients, as the
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A new mini-navigation tool allows accurate component placement during anterior total hip arthroplasty

A new mini-navigation tool allows accurate component placement during anterior total hip arthroplasty

The anterior application of the navigation tool utilizes the same hardware as the lateral application, with slight modifications due to the difference in patient positioning (lateral decubitus versus supine). In lieu of attachment of the pelvic platform to the lateral aspect of the ipsilateral iliac crest as in the lateral application, in the anterior application, the screws supporting the pelvic platform are inserted into the anterior aspect of the iliac crest on either the ipsilateral or contralateral side according to the preference of the sur- geon. As in the lateral application, a small femoral platform is subsequently attached to the greater trochanter (Figure 1). Registration requires the use of the tracker and probe to reg- ister the patient in either the APP or the supine coronal plane. When registering the APP, surgeons use the probe to mark the left and right ASIS and the symphysis pubis, with each location captured by the system camera. When registering the
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Inpatient versus Outpatient Total Hip Arthroplasty

Inpatient versus Outpatient Total Hip Arthroplasty

The purpose of this study was to compare serious adverse events and early postoperative outcomes in patients being discharged either on day 0 (outpatient) or admitted to the hospital overnight (inpatient) following a primary direct anterior total hip arthroplasty (THA). We assessed serious adverse events, cost, patient satisfaction, expectations, functional outcomes, quality of life and pain. In this preliminary analysis of an ongoing randomized control trial, we found no statistically significant differences in serious adverse events, whereas the outpatient group had a significantly shorter length of stay (LOS) in the hospital and was significantly less costly from the perspectives of the hospital and the Ministry of Health (MoH). No other statistically significant differences were found between the two groups for any other outcome measures.
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The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

The limiting factor in treatment outcome in many mechanically compromised hips is the amount of carti- lage damage that has occurred before the surgery [18,19]. Unfortunately early degenerative changes which are revealed at arthroscopy are often not apparent on a regular radiograph [7] and although both MRI and CT scanning are more sensitive, the diagnosis may be basi- cally clinical. Hip arthroscopy can serve as a diagnostic and therapeutic tool in these cases. In our study we excluded patients with no radiographic signs of OA (i.e. Tönnis 0). That might explain the relatively high per- centage of patients (23%) with mild (less than 30% of acetabular anterior wall involvement) that needed a hip replacement, since many small or partial thickness carti- laginous lesions who were omitted from the study settle following debridement and microfracture [20] and others may represent a mild pre arthritic condition.
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Development of a Retractor Holding Device to Reduce the Manpower in Total Hip Arthroplasty through Direct Anterior Approach

Development of a Retractor Holding Device to Reduce the Manpower in Total Hip Arthroplasty through Direct Anterior Approach

In acetabular exposure, the short arm holds the retractor at the anterior edge of the acetabular, and the long arm holds the retractor at obturator foramen (Figure 5, Figure 6). The assistant holds only one retractor at the posterior edge of the acetabulum. In femoral exposure, the short arm holds the retractor at the medial side of the femur (Figure 7). The assistant hold the retractor at greater trochanter to elevate the femur and hold the patient’s leg in adduction and external rotation.

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Early Outcomes of Obese Patients Undergoing Total Hip Arthroplasty: Comparison of Anterior to Posterior Approach

Early Outcomes of Obese Patients Undergoing Total Hip Arthroplasty: Comparison of Anterior to Posterior Approach

The obesity crisis combined with the aging population in the United States has caused a significant increase in the prevalence of hip arthritis in recent years and has led to an increased incidence of total hip arthroplasty. Surgical complication rates are known to be higher in the obese patient population and guidelines are being considered as to which patients have a risk profile that allows them to be acceptable candidates for surgical intervention [1, 2]. The risk of various peri-operative complications in obese patients includes infection, wound healing issues, peri-prosthetic mal-alignment or fracture, medical complications, and thromboembolic events [2-6]. There are a limited number of studies in the literature that provide specific data on the actual complication rates for total hip replacement surgery in obese patients [7-9], and fewer that specifically evaluate the different complication rates associated with the surgical approach used in obese patients [10-13].
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Collared Vs. Collarless Total Hip Arthroplasty In Both Direct Anterior And Direct Lateral Approach Surgery: A Prospective Cohort Comparison Study

Collared Vs. Collarless Total Hip Arthroplasty In Both Direct Anterior And Direct Lateral Approach Surgery: A Prospective Cohort Comparison Study

With a globally aging population, the burden of age-related hip pathology on healthcare systems is set to grow in line with recently observed trends(1). While this results in an increasing demand for Total Hip Arthroplasty worldwide(2), advances in component technology and evolving surgical techniques are expanding the indications for THA to include increasingly younger patients with symptomatic hip pathology. This paradigm shift in the field of hip arthroplasty is driving surgeons to devise and refine techniques that meet the increasing demands of the modern hip arthroplasty patient – decreased pain, shorter hospital stays and shorter times to return to work or other physical activity. Although Anterior hip arthroplasty has been well-described in the literature as meeting each of these requirements respectively (3,4,5) there is research to suggest that, in doing so, it also carries a higher risk of early revision when compared to alternative, more traditional surgical approaches(6). While the learning curve of the Direct Anterior approach has been documented in detail(7) and is often considered to be a factor when determining risk of early revision, another important question is raised – is our implant technology meeting the same demands that our surgical techniques are striving toward? The majority of early failures in Anterior hip arthroplasty occur on the femoral side(8), and recent literature has demonstrated that fully hydroxyapatite-coated bone impaction stems outperform flat-tapered stems in the early post-operative period(8). However, although there has been cadaveric study suggesting collared stems are able to
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Case Report Anterior dislocation of the hip sustained for 32 years and a venous reflux disorder treated with a total hip arthroplasty: a case report

Case Report Anterior dislocation of the hip sustained for 32 years and a venous reflux disorder treated with a total hip arthroplasty: a case report

Six months after the operation, the patient reported that the pain and fullness had resolved. He was no longer limping. Motion of the left hip was restored to 100°-0°-10° range of flexion and extension, 10°-0°-10° range of abduction and adduction, and 10°-0°-10° range of internal and external rotation (Figure 7A-E). The four-character test and Tomas sign were negative. The Harris score increased to 72. The lengths from the anterior superior iliac spine to the tip of the tibial malleolus were 94 cm bilaterally. The CRP level was 5.24 mg/L and the ESR was 3 mm/h, all of which had returned to normal. Radiography showed that the implants were in situ and in good alignment (Figure 8). Color Doppler ultrasound did not detect the old thrombosis in the left ventral vein. The left dorsal pedal artery pulse was stronger than pre-operatively.
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The role of dedicated instrumentation in total hip arthroplasty

The role of dedicated instrumentation in total hip arthroplasty

In the postero-lateral approach, an angled flanged retractor is placed on the anterior wall of the acetabulum to retract the proximal femur anteriorly and to hold back the anterior–inferior capsule with the flanged portion pointing caudal (Fig. 2). A single point retractor is placed under the transverse acetabular ligament to provide inferior acetab- ular exposure. In the lateral mini-approach, a double point retractor is placed on posterior acetabular wall retracting both the capsule and the femur posteriorly, while a curved single point retractor is positioned on the anterior wall to hold the glutei muscles (Fig. 3). The retractors have light holders and can be fitted with a fiber optic light source that shines directly into the wound.
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Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis

Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis

The direct anterior approach (DAA) is an alternative surgical approach for THA. The DAA is less commonly used, although it is gaining popularity in recent years [7]. Advocates of the DAA suggested that the DAA is an intermuscular and internervous approach with less muscle and soft-tissue dissection [8]. Conversely, sur- geons who favor the LA cite advantages of extensile exposure with low rates of postoperative instability [9]. Several randomized controlled trials (RCTs) have com- pared the DAA to the lateral approach for THA. Many of these studies contained relatively small samples and demonstrated inconsistent outcomes [7]. This uncer- tainty leaves the determination of which surgical ap- proach to adopt to the preference of the surgeons. Mjaaland et al. [10] reported that the DAA caused less pain but higher postoperative levels of creatine kinase.
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A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty

A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty

Results: At final follow-up, the XSFMA functional index scores were 10.3 (anterior) and 15.08 (lateral) while the bother index summed up to a score of 15.8 (anterior) and 21.66 (lateral) respectively, thus only differing significantly for the functional index ( p = 0.040 and p = 0.056). The SF-36 physical component score (PCS) was 47.49 (anterior) and 42.91 (lateral) while the mental component score (MCS) summed up to 55.0 (anterior) and 56.23 (lateral) with a significant difference evident for the PCS ( p = 0.017; p = 0.714). Patients undergoing THA through a DAA undertook a mean of 6402 cycles per day while those who had undergone THA through a transgluteal approach undertook a mean of 5340 cycles per day ( p = 0.012). Furthermore, the obtained outcome for the T25-FW with 18.4 s (anterior) and 19.75 s (lateral) and the maximum walking distance (5932 m and 5125 m) differed significantly ( p = 0.046 and p = 0.045). The average HHS showed no significant difference equaling 92.4 points in the anterior group and 91.43 in the lateral group ( p = 0.477). The radiographic analysis revealed an average cup inclination of 38.6° (anterior) and 40. 28° (lateral) without signs of migration.
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Direct anterior approach for total hip arthroplasty with a novel mobile traction table  a prospective cohort study

Direct anterior approach for total hip arthroplasty with a novel mobile traction table a prospective cohort study

visualization and fluoroscopy. The leather boot is designed to fit the foot and ankle snugly with a double locking ban- dage mechanism to avoid slipping off the foot. From the superior anterior iliac spine, Heuter’s interval between the tensor fascia lata and sartorius muscle is palpated. The skin incision runs along the mid-line of the tensor fascia lata. This line links the anterior superior iliac spine and the lateral femoral condyle and is more than one finger’s breadth from Heuter’s interval, avoiding injury of the lat- eral femoral cutaneous nerve. The incision begins 3 cm proximal from the tip of the greater trochanter and 9 cm distal to the trochanter (12 cm long in total). With fluor- oscopy, a vertical line passing though the tip of the greater trochanter is identified and the pelvic tilt is adjusted by symmetry of the obturator foramina, centering the coccyx with the symphysis.
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A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

Two reviewers (Zhao Wang and Jing-zhao Hou) inde- pendently extract the following information: first author name and publication year, country, patients’ general characteristic (no. of patients, age, proportion of female patients, BMI), outcomes, study, and follow-up duration. The primary outcomes were Harris hip score at 2 weeks, 6 weeks, 12 weeks and 1 year, VAS at 24 h, 48 h, and 72 h; incision length, operation time, postoperative blood loss, length of hospital stay, and complications (in- traoperative fracture, postoperative dislocation, hetero- topic ossification (HO), and groin pain).
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Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta analysis

Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta analysis

found a disparity in terms of gait analysis between the two groups, and DAA group showed faster recovery, and Kiss reported that Wesseling study gait analysis per- formed a year after operation revealed significantly greater improvement in gait in ALA close to normal gait and resulted in better functional outcome than in DAA group [16, 17, 21]. In our meta-analysis, the peak hip flexion within 3 months was significantly greater in the DAA group than in the ALA group. However, in the remaining studies, there was no difference in the results of gait analysis between the two groups, although a few data showed differences. However, caution is needed when interpreting the results of gait analysis in the above studies. Gait utilizes all the joints and muscles from the pelvis to the ankle, and therefore challenges as- sociated with gait can be detected directly in the hip joint, although it can be observed in the form of com- pensation movement in the hip or other joints. The au- thors also believed that these differences were due to various forms of damage to the abductor, resulting in the difference between the two approaches.
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Periprosthetic femoral fractures following total hip and total knee arthroplasty

Periprosthetic femoral fractures following total hip and total knee arthroplasty

found reduced torsional and bending strength in ten human femurs with full-thickness anterior cortical notches when compared with those without[39]. However, these findings have not been replicated in clinical studies. Ritter et al found no increased incidence in those with femoral notching in a study of over 1000 TKAs[40]. Gujarathi et al similarly found no association in their radiographic analysis of 200 TKAs followed up for a mean of nine years[41]. If there is a causal relationship between femoral notching and PFFs, a much larger study would be required to provide adequate power[28]. Poor operative technique, including component malpositioning, malalignment and excessive resection, is also associated with increased risk of fracture[28].
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Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

In our hospital, we introduced DAA according to Matta [14] as routine in 2009 for primary elective total hip replacement [15]. Three years after introduction we observed a clustering of early infections caused either by gram-negative bacilli or by multiple microorganisms (polymicrobial). Thus, we asked the question as to whether there is (i) an increased risk of infection for DAA, and (ii) whether the spectrum of microorganisms differs between patients with DAA and those with the lateral transgluteal approach (LAT), being routine at our hospital until 2009.

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In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials

In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials

on the effects of primary THA with an AA versus PA. We used combination searches that included therapy-specific keywords such as THA and total hip arthroplasty and sur- gical approach-specific keywords such as anterior, direct, posterior, posterolateral, and Smith-Peterson with publica- tion type denoted as Randomized Controlled Trial or MeSH Term denoted as Prospective Studies. Additionally, manual searches were conducted using the Directory of Open Access Journals (DOAJ), Google Scholar, and the reference lists of included papers and relevant meta-analyses. No date or language restrictions were applied to the searches. Articles published in non-English journals were translated into Eng- lish. The final search was conducted on June 30, 2017.
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Comparison of outcome measures and complication rates following three different approaches for primary total hip arthroplasty: a pragmatic randomised controlled trial

Comparison of outcome measures and complication rates following three different approaches for primary total hip arthroplasty: a pragmatic randomised controlled trial

This approach to the hip joint was initially described by Hueter [13, 14] and later popularised by Smith-Petersen [15]. It utilises the anatomic internervous plane between the superior gluteal nerve laterally and femoral nerve medially and has recently been popularised for total hip replacement [16], but its first reported use for total hip replacement dates back to 1947 in France, by Judet and colleagues [17]. Studies have suggested higher rates of dislocation in patients who underwent a posterior approach for their total hip arthroplasty [18]. The neuro- vascular plane for the anterior approach is between the superior gluteal nerve and the femoral nerve. In some reports, patients who have undergone an anterior approach for total hip arthroplasty have shorter hospital stays than those who have undergone a posterior approach, and this is thought to be due to the muscle- sparing aspect of the approach [19, 20]. Compared with the posterior approach, the anterior approach involves less exposure of the femur for medullary reaming, and this may pose problems with regards to femoral compo- nent positioning and femoral shaft complications [21]. Methods
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The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty

The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty

The introduction of new approaches and instruments can be expected to temporarily be associated with com- plications, such as neurovascular injury and component malposition. It is important to have information about the risk for various complications and predisposing factors. This study is based on non-selected, consecutive, primary unilateral total hip replacements. The very reason to use this approach is the possibility to minimize surgical soft tissue injury and to maintain normal muscle function and stability of the hip [1,7,9-13]. The approach is internervous and does not include the release of muscles or tendons. In the literature there is little evi- dence for a higher complication rate with the direct anterior approach compared to lateral approaches. It is however of interest to demonstrate and discuss the hard- ships involved when the technique is adopted by a team of surgeons with mixed experience.
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Peak Active Hip Flexion Following Navigated Total Hip Arthroplasty.

Peak Active Hip Flexion Following Navigated Total Hip Arthroplasty.

Three months post-THA patients underwent 3D biomechanical analysis using a 10 camera motion analysis system (Vicon Motion Systems, Oxford, UK), sampling at 100 HZ. The Full Body Plug-in Gait marker set (Vicon Motion Systems, Oxford, UK) was applied to all subjects, with two additional markers placed half-way between the anterior superior iliac spine and posterior superior iliac spine on the left and right side of the pelvis. The thigh and tibia markers were placed on stalks. All remaining markers were placed per the Plug-in marker set standard. Patients performed a standing active hip flexion movement in the capture volume, using the support of two height-adjusted walking sticks for support (Figure 1). Patients were then asked to sit down upon, and then rise from, a stool which was height adjusted to the level of the knee joint line(Figure 2). The sitting task was repeated three times, and biomechanical data from the three trials averaged. Data processing and biomechanical outputs were performed in Vicon Nexus (ver. 2.8).
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