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OBJECTIVE@#To investigate the effect of different postures on direct anterior approach(DAA) total hip arthroplasty.@*METHODS@#Total of 94 patients who underwent DAA total hip arthroplasty from July 2016 to June 2020 were retrospectively analyzed. They were divided into two groups according to different positions during the operation, including 45 cases in lateral position and 49 cases in supine position (with the aid of stent). The general data such as gender, affected limb, body mass index(BMI), incision length, operation time, intraoperative bleeding volume, drainage volume 24 hours after operation, hemoglobin difference before and after operation, first landing time after operation, postoperative hospitalization time, postoperative complications, visual analogue scale(VAS) at 1 day, 1, 2 weeks, 1, 3 and 6 months after operation, Harris score at 1, 2 weeks, 1, 3 and 6 months after operation were observed and compared between the two groups.@*RESULTS@#Patients in both groups were followed up for 6 to 12 months with an average of (8.31±2.22) months. There was no significant difference between two groups in gender, affected limb, age, height, weight, body mass index(BMI), preoperative VAS score and preoperative Harris score(P>0.05). The incision length, operation time, intraoperative bleeding volume, 24-hour drainage volume, hemoglobin difference before and after operation, first time to the ground and postoperative hospitalization time of patients in supine position (assisted by stent) group were all better than those in lateral position group(P<0.05);There was no significant difference in the number of blood transfusions during and after operation(P=0.550). There was no significant difference in anteversion angle and abduction angle in the supine position(with the aid of stent) group during and after operation (P=0.825, P=0.066);There was significant difference in anteversion angle and abduction angle in the lateral position group during and after operation(P<0.05). VAS of patients in supine position (assisted by stent) group were lower than those in lateral position group at 1 day, 1, 2 weeks and 1 month after operation(P<0.05), and there was no statistical difference between two groups at 3 and 6 months after operation(P>0.05). Harris scores of patients in supine position(assisted by stent) group were higher than those in lateral position group at 1 week, 1 month and 3 months after operation(P<0.05), and there was no significant difference between two groups at 6 months after operation(P>0.05).@*CONCLUSION@#Compared with the lateral position, the supine position DAA total hip arthroplasty has the advantages of small incision, short operation time, less bleeding, early landing time, short hospitalization time, and small intraoperative acetabular cup position judgment error. It has the advantage of fast postoperative recovery, but the recovery of hip joint function is the same after 6 months.
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Humans , Arthroplasty, Replacement, Hip , Retrospective Studies , Antiviral Agents , Treatment Outcome , PostureABSTRACT
Objective:To compare the clinical effects of hip arthroplasty through direct anterior approach (DAA) in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia.Methods:The prospective study method was used to select the patients who needed hip arthroplasty in the Fourth Department of Orthopedics, the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2019. All of them were operated with lateral decubitus DAA. According to the inclusion criteria, they were divided into Kacshin-Beck disease hip osteoarthritis group (group A) and congenital acetabular dysplasia hip osteoarthritis group (group B). Hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score were conducted, and hip abduction angle and flexion angle were measured before surgery, 3, 14 days and 1, 3, and 12 months after surgery.Results:Nineteen and twenty-two patients were included in group A and group B, respectively. All patients successfully completed the surgery. There was no significant difference in Harris score between the two groups before surgery, 3, 14 days, and 1, 12 months after surgery ( P > 0.05). There were no significant differences in WOMAC score, VAS score, hip abduction angle and hip flexion angle between the two groups before surgery and each time point after surgery ( P > 0.05). In the same group, there were significant differences in Harris score, WOMAC score, VAS score, hip abduction angle and hip flexion angle at different time points ( P < 0.001). All postoperative indicators were significantly improved compared with those before surgery. Conclusions:There is no significant difference in the clinical effects of hip arthroplasty through lateral decubitus DAA in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia. This surgical method has good therapeutic effect on both types of hip osteoarthritis.
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@#Introduction: Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods: Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results: There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 – dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion: Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.
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OBJECTIVE@#To investigate the application value of liquid crystal digital display goniometer in total hip arthroplasty.@*METHODS@#From January 2018 to December 2019, 83 patients underwent primary total hip arthroplasty, including 28 males and 55 females, aged 42 to 81 (70.4±7.9) years. There were 63 cases of femoral neck fracture and 20 cases of avascular necrosis of femoral head. All patients used liquid crystal digital goniometer to control the anteversion of acetabular cup prosthesis during operation, and CT scanning was used to measure the anteversion of acetabular cup after operation. The two methods were compared to understand the accuracy of using liquid crystal digital goniometer.@*RESULTS@#Postoperative CT measurement showed that the acetabular anteversion of all patients was in the safe area advocated by Lewinnek. The anteversion angle of acetabular cup measured by liquid crystal digital goniometer was 14.20(12.80 to 15.40)°, and the anteversion angle of acetabular cup measured by postoperative CT scan was 14.20 (13.40 to 15.50)°. There was no significant difference between the two (@*CONCLUSION@#It is an accurate and reliable method to control the anteversion of acetabular cup with liquid crystal digital display angle instrument, which has a good auxiliary reference value.
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Female , Humans , Male , Acetabulum/surgery , Arthroplasty, Replacement, Hip , Hip Prosthesis , Liquid Crystals , Retrospective StudiesABSTRACT
BACKGROUND: Total hip arthroplasty can significantly alleviate pain in patients with end-stage hip disease and improve the joint function. Different surgical approaches have their own advantages and disadvantages. As a popular approach, direct anterior approach is to expose the hip joint through the fascia lata muscle and the sartorius muscle gap, which is in line with the concept of minimally invasive surgery, and has the advantages of small damage to soft tissue and quick recovery after arthroplasty. However, it has a certain learning curve, which requires the surgeons to have certain experience. OBJECTIVE: To compare the perception of the elderly with unilateral femoral head fracture undergoing total hip arthroplasty through direct anterior approach and anterolateral approach. METHODS: Forty-two patients (42 hips) with unilateral femoral head fracture in Orthopedic Center, Xinjiang Uygur Autonomous Region People’s Hospital from January 2017 to June 2018 were enrolled, and all patients underwent total hip arthroplasty. The patients were randomized into two groups, including 21 patients (21 hips) in anterolateral approach group and 21 patients (21 hips) in direct anterior approach group. The patients signed the informed consents and the study was approved by the Hospital Ethics Committee. The incision length, operation time and blood loss were recorded. The Harris hip joint score, and Oxford Hip scores at 1 week, 1 and 3 months postoperatively were compared. The prosthesis location and complications were observed. RESULTS AND CONCLUSION: (1) The hospitalization time in the direct anterior approach group was significantly shorter than that in the anterolateral approach group (P 0.05). (4) The Harris hip and Oxford Hip scores at 1 week after surgery in the direct anterior approach group were significantly higher than those in anterolateral approach group (P 0.05). (5) One case in the direct anterior approach group and two cases in the anterolateral approach group appeared with bursitis surrounding with the incision and pain, which disappeared after local sealing. One patient in the direct anterior approach group developed subcutaneous hematoma, and healed at postoperative 3 weeks. One case in the direct anterior approach suffered from inner thigh skin numbness. (6) These results indicate that at early postoperative period, patients in anterolateral approach group are feeling better than those in direct anterior approach group. Although direct anterior approach has the advantages of small incision, less pain at the early postoperative period and fast recovery, it has a certain learning curve, with a longer operation time and more blood loss.
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BACKGROUND: The posterolateral approach is the most commonly used surgical approach for total hip arthroplasty. In recent years, total hip replacement by direct anterior approach has been applied in clinic gradually, and has achieved good treatment outcomes. OBJECTIVE: To compare the clinical efficacy of the direct anterior approach in supine position and the posterolateral approach in supine position for total hip arthroplasty. METHODS: Ninety patients undergoing unilateral primary total hip arthroplasty at Baoding Municipal First Center Hospital from April 2015 to April 2019 were included, including 35 males and 55 females, aged 35-70 years. The patients were divided into direct anterior approach group (n=45) and posterolateral approach group (n=45) by the random number table method. Postoperative follow-up was used to evaluate the Harris hip scores, Visual Analogue Scale scores, initial fixation mass of prosthesis and safe range of the cup. The study was approved by the Ethics Committee of Baoding Municipal First Center Hospital. RESULTS AND CONCLUSION: (1) Ninety patients were followed up for 3-51 months, with an average 14 months. There were 2 cases of intraoperative great trochanteric fracture, 1 case of femoral lateral cutaneous nerve injury, 4 cases of femoral nerve injury, and 20 cases of tensor fascia lata injury. No such complications occurred in the posterolateral approach group. (2) The direct anterior approach group showed significant superior outcomes compared with the posterolateral approach group in the Harris hip scores and Visual Analogue Scale scores at 1 month after surgery (P 0.05). (3) In the direct anterior approach group, the femoral prosthesis of 44 hips was in neutral position, and 1 hip was in varus position. The initial fixation quality of all prosthesis was excellent. In the posterolateral approach group, the femoral prosthesis of 43 hips was in neutral position, 2 hips were in varus position and all prosthesis initial fixation quality was excellent. No significant difference was found between two groups (P > 0.05). (4) The ratio of acetabular cups in the safety range of Lewinnek in the direct anterior approach group was higher than that in the posterolateral approach group (100%, 82%, P < 0.05). (5) These results imply that compared with the posterolateral approach, direct anterior approach in supine position for total hip arthroplasty can significantly reduce postoperative pain, promote postoperative early rapid recovery, obtain more accurate angle of the acetabular prosthesis, and be more conducive to the equalization of both lower limbs. It is a safe and reliable approach. However, direct anterior approach has certain technical difficulty and needs a learning curve. And there are some complications different from other approaches.
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BACKGROUND: With the trend of minimally invasive and “rapid rehabilitation” in modern surgery, direct anterior approach is preferred by orthopedic surgeon in recent years. OBJECTIVE: To review the direct anterior approach’s history, surgical indications, patients’ selection, surgical methods, common complications, surgery advantages and learning curves, to provide ideas for the rapid rehabilitation of hip arthroplasty. METHODS: PubMed, Wanfang database, and CNKI were retrieved for articles addressing total hip arthroplasty through direct anterior approach published from 1956 to 2020. Key words were minimally invasive, direct anterior approach, total hip arthroplasty, enhanced recovery after surgery, complication, learning curve” in Chinese and English. Finally, 67 articles met the criteria for review. RESULTS AND CONCLUSION: (1) The direct anterior approach is an ideal minimally invasive surgical path because of it walks in the fascia gap and it is a truly neuromuscular interface with no damage to important muscles and nerve blood vessels. (2) Direct anterior approach has advantages of quicker recovery, less postoperative pain, short hospital stay and high patient satisfaction. However, because most doctors in our country have changed their surgical approach to direct anterior approach, direct anterior approach still has shortages, such as long learning curve and high rate of early complications.
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OBJECTIVE@#To investigate the short-term clinical effect of direct anterior approach (DAA) in total hip arthroplasty(THA).@*METHODS@#From January 2018 to September 2018, the data of 30 patients(33 hips) who underwent the first THA using the side lying DAA completed by the same operation team were followed up and evaluated. There were 19 males and 11 females;the age was 58 to 80 (69.0±5.4) years old;the visual analogue scale (VAS) of pain was used, Harris scoring system, operation time, intraoperative blood loss, related complications and hip radiographs were evaluated in clinical and imaging aspects.@*RESULTS@#Thirty patients (33 hips) were followed up for 12 to 20(14.3±3.7) months, operation time (66.0±7.2) min and intraoperativehemorrhage (156±32) ml. The position of acetabulum prosthesis was examined by imaging:anteversion angle (18.6±3.6)° and abduction angle (41.2±4.8)° respectively. The VAS score was improved from 7 to 9(8.1±1.4) before operation to 1 to 3(1.9±0.7) at 1 month after operation. Harris score of hip joint improved significantly, from 28 to 46(35.4±5.2) before operation to 76 to 92 (88.6±4.5) at 1 month after operation, 74 to 93 (85.6±6.9) at 6 months after operation, and 79 to 95 (90.7±8.1) at 12 months after operation, the difference was statistically significant(<0.05). Complications occurred in 3 cases of fracture of the proximal femur, including 1 case of hip sprain fracture due to careless walking one month after operation. Considering that incomplete fracture may have occurred during the operation, 1 case of avulsion fracture of anterior inferior iliac spine, no deep infection, no dislocation. There were 1 case of injury of lateral femoral cutaneous nerve and 2 cases of injury of tensor fascia lata, among which 1 case was complete incision of the edge of the hook.@*CONCLUSION@#The primary THA with DAA in lateral position has a good short;term clinical effect, can meet the needs of patients' rapid recovery, and is a safe and effective surgical approach.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Antiviral Agents , Arthroplasty, Replacement, Hip , Hepatitis C, Chronic , Hip Joint , Hip Prosthesis , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE@#To systematically evaluate the clinical efficacy of high-quality direct anterior approach (DAA) and other approaches for the treatment of elderly patients with femoral neck fracture.@*METHODS@#Literatures published in English or Chinese about the direct anterior approach and other approaches for hemiarthroplasty in femoral neck fracture were searched on Cochrane Library, PubMed, EMBASE, Web of science, Wanfang, CNKI databases from their establishment to May 2019. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The quality of RCT were evaluated by Cochrane Risk of Bias Assessment Tool, and non-RCT were evaluated by the NOS scale. Meta-analysis was performed using the RevMan 5.3 software.@*RESULTS@#A total of 9 articles were included with 901 cases, in which 429 cases used DAA, and 472 used other approaches. DAA had a significantly lower dislocation rate compared to subgroup of posterior and posterolateral approach [=0.19, 95%CI (0.06, 0.61), =0.005]. No significant differences were found between DAA group and subgroup of direct lateral and anterolateral approach[=1.08, 95%CI(0.20, 5.76), =0.93]. Also there were no relevant differences between the DAA group and control in infection rate[=1.07, 95%CI(0.47, 2.43), =0.88], perioperative fracture rate[=0.95, 95%CI(0.36, 2.50), =0.92], re operation rate[=0.76, 95%CI(0.30, 1.89), =0.55], overall complication rate [=0.88, 95%CI (0.63, 1.22), =0.44], mortality [=1.33, 95%CI (0.84, 2.11), =0.23], operative time[MD=1.43, 95%CI(-5.85, 8.71), =0.70].@*CONCLUSION@#The current evidenceindicates that the DAA was associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty. There was no significant difference in dislocation rate with the lateral and anterolateral approach.
Subject(s)
Aged , Humans , Antiviral Agents , Arthroplasty, Replacement, Hip , Femoral Neck Fractures , General Surgery , Hemiarthroplasty , Hepatitis C, Chronic , Reoperation , Treatment OutcomeABSTRACT
PURPOSE: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. MATERIALS AND METHODS: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. RESULTS: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). CONCLUSION: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.
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Humans , Acetabulum , Arthroplasty, Replacement, Hip , Femur , Hemorrhage , Hip , Hip Joint , Leg , Methods , Muscle Strength , Operating Tables , Retrospective StudiesABSTRACT
BACKGROUND:Direct anterior approach has been reported to be associated with a risk of reaming the anterior column of the acetabulum,but there is little evidence supporting this opinion.OBJECTIVE:To reveal differences in the bone stock of the anterior and posterior columns between the direct anterior approach and the posterolateral approach in total hip arthroplasty by CT measurement.METHODS:Sixty cases of primary total hip arthroplasty through direct anterior approach (n=30) or posterolateral approach (n=30) at Fuzhou Second Hospital of Xiamen University from October 2015 to December 2017 were enrolled.The cross-sectional area of the anterior and posterior column of the acetabulum,the height of the anterior and posterior column,acetabular diameter,and anteversion were measured by CT.All researchers had 5-10 years of clinical experience,and the surgeons were associate chief physicians or above.The trial has been approved by the Ethics Committee of Fuzhou Second Hospital of Xiamen University on June 1,2017.All patients signed the written informed consents.RESULTS AND CONCLUSION:(1) The postoperative cross-sectional area of the anterior and posterior column of the acetabulum,and the height of the anterior and posterior column in the two groups were less than those at baseline (P ＜ 0.05),the acetabular diameter was larger than that at baseline (P ＜ 0.01),and the anteversion showed no significant difference (P ＞ 0.05).The area of the anterior column in the direct anterior approach group was higher than that in the posterolateral approach group (P ＜ 0.05),and other parameters were insignificantly different between two groups (P ＞ 0.05).(2) in summary,compared with posterolateral approach in total hip arthroplasty,direct anterior approach leads to increased area of the anterior column,and made no effect on other parameters.Thereafter,direct anterior approach is not a risk factor for eccentric reaming the anterior column of acetabulum,and the conclusion needs to be confirmed by multicenter,prospective randomized controlled trials.
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Methods: A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups ( P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared.
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Objective: To evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases. Methods: A retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively. Results: All the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores ( t=45.274, P=0.000; t=36.586, P=0.000; t=32.486, P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score ( t=21.314, P=0.000). Conclusion: Arthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.
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Objective:To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes.Methods: A series of 100 consecutive,unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed.There were 50 male patients and 50 female patients.The average patient age was 51 years,and the average body mass index was 24.69 kg/m2.The preoperative diagnosis included avascular necrosis of femoral head,hip osteoarthritis,osteoarthritis se-condary to acetabular dysplasia,sequelae of hip old infection,ankylosing spondylitis,rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture.There were 7 hips which had surgical history prior to the index hip arthroplasty,including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach,2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach,and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual).All were uncemented hips.The stems used in this study included 67 Triloc stems (DePuy company,USA),45 Corail stems (DePuy company,USA),2 Accolade stems (Stryker company,USA),1 Synergy stem (Smith-Nephew company,USA) and 1 Polarstem (Smith-Nephew company,USA).Results: The average follow up period was 8.5 months,the average incision scar length was 10 cm,and the average postoperative Harris score was 93.62.There was 95％ postoperative leg length discrepancy within 3 mm.The average cup inclination angle was 38.7°with 94.8％ in the range of 30° to 50°.The average cup anteversion angle was 14.3° with 94.2％ within the target range of 5° to 25°.The were 15 (12.9％) operative complications,including two femoral perforations (changing stem from Triloc to Corail),three calcar fractures (treated with cerclage wires),four greater trochanter fractures (2 were treated wire tension band,and 2 nondisplaced fractures untreated),one deep infection (debridement and retaining of the prothesis),one superficial infection (debridement),one hematoma and three wound healing complications (debridement).All the complications were successfully treated without any sequelae at the end of the latest follow-up.There was no postoperative dislocation.There was no major nerve and vascular injuries.There were 35 cases (30.2％) reporting symptoms of lateral femoral cutaneous nerve palsy.Conclusion: Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation,which is helpful for early rapid postoperative recovery.
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Objective:To evaluate the result of operation and gait analysis at the early stage after direct anterior approach (DAA) in total hip arthroplasty (THA).Methods: In this study,20 patients who suffered from necrosis of femoral head or developmental dysplasia of the hip were scheduled to undergo THA.The basic information and visual analogue scale (VAS) score,Harris score before and after surgery were recorded.All of the patients finished the gait analysis before the surgery and 6 weeks and 12 weeks after the surgery,the data were compared with those of normal adult people.Results: Their hospital stay after the operation was 3.3 d,the VAS score after the operation was no more than 4 points,the positions of prosthesis were satisfactory,and there was no dislocation.The gait analysis results contained step speed,stride,the range of motion (ROM) of hip and knee.The step speed before the surgery (preoperation,Pre) was 0.64 m/s,6 weeks after the surgery (6W) was 0.77 m/s,12 weeks after the surgery (12W) was 1.07 m/s,and the control group was 1.19 m/s.The stride at Pre,6W,12W,and control group were 43.15 steps/min,51.42 steps/min,55.52 steps/min,and 57.15 steps/min,respectively.The ROM of hip joint at Pre,6W,12W,and control group were 31.00°,39.62°,40.40°,and 45.67°,respectively.The ROM of knee joint at Pre,6W,12W,and control group were 50.52°,59.28°,67.29°,and 70.42°,respectively.The results of the gait analysis showed that the gait recovery after the direct anterior total hip arthroplasty was very fast and at the 12th week after surgery the gait of the patients was close to the normal adult people.Conclusion: The direct anterior approach is one of the choosable approach of the THA,and this kind of surgery has a better recovery of gait after the operation,and at the end of 12 weeks after the surgery the gait is very close to the normal adult people.But we also need more studies to prove this conclusion.
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Objective:To compare the efficacy and safety between direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty.Methods: This study evaluated postoperative results of 92 consecutive total hip arthroplasties performed by a single surgeon;44 from the DAA,and 48 from PA.The age,body mass index,operation time,blood loss,hospital stay,positioning of the artificial hip,postoperative Harris score and postoperative complications were recorded and analyzed.Results: Both the average age of the patients separately (58.0±11.9) years in DAA group and (61.0±10.4) years in PA group and the body mass index (25.1±3.7) in DAA group and (24.7±3.3) in PA group,showed no significant difference between the two groups.The DAA group had significantly reduced the hospital stay (3.8±1.7) days vs.(4.9±2.3) days for the PA group (P0.05).The amount of blood loss: in group DAA (238.0±55.3) mL,and in group PA (387.0±61.2) mL (P0.05).Complications were encountered in the two groups.There were two intraoperative complications (4.4％),1 great trochanter fracture and 1 lateral cutaneous nerve injury in DAA group.No dislocation was observed in DAA group.One dislocations and 1 groin pain were recorded in PA group.No prosthesis loosening,deep vein thrombosis,sciatic nerve injury and other complications occurred in the two groups.Conclusion: Total hip arthroplasty using the anterior approach allows for superior recovery and better stability.
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Objective:To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA).Methods: We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital.A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study.There were 17 males and 5 females,and the median age was 48 years(range: 34-67 years).All the surgery was done by DAA method by two senior surgeons.The clinic characters,early surgery treatment results and complications were analyzed.Results: We used the cementless stems in all the cases.The average operating time was (167±23) min;the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL;the wound drainage in average was (111±73) mL Most of the patients could move out of the bed by themselves on the first day after operation,5 patients could walk without crutches on the first operating day,and 13 patients could squat on the third days after operation.The patients were discharged averagely 4 days after operation.We followed up all the patients for averagely 16 months (range: 8-24 months).There was no loosening or failure case in the latest follow up.In the study,2 patients had great trochanter fracture,2 patients had thigh pain,4 patients had lateral femoral cutaneous nerve palsy,and 3 patients had muscle damage.The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01).Conclusion: The DAA THA can achieve faster recovery and flexible hip joint after operation.However it is a kind of surgery with high technique demanding.Carefully selected patients,and skilled technique,can help the surgeon avoid the early complications.It is associated with high complication rate in the learning curve for bilateral DAA THA.
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Objective:To compare the clinical effects of direct anterior approach (DAA) and posterolateral piriformis-sparing approach (Mis-PLA) for minimally invasive surgery of total hip arthroplasty.Methods: The patients who had total hip arthroplasty from March 2015 to February 2016 were randomly divided into 2 groups: DAA group and Mis-PLA group.In the study,43 patients (45 hips) were performed with total hip replacement via the direct anterior approach (DAA group).As comparison,39 patients (42 hips) were performed with total hip replacement via the posterolateral piriformis-sparing approach (Mis-PLAgroup) at the same period.DAA group:27 male patients (27 hips),and 16 female patients (18 hips),with an average age of (57.4±7.3) years,preoperative Harris score (41.4±8.7),body mass index(BMI)(24.3±2.2) kg/m2;Mis-PLA group: 25 male patients (26 hips),14 female patients (16 hips),with an average age of (59.2±7.3) years,preoperative Harris score (39.6±8.4),BMI (24.7±2.5) kg/m2.The length of incision,operation time,blood loss,postoperative Harris score were observed and specially the hip functional recovery was fully assessed.Results: (1) All the incisions healed by first intention.No complications were found in both groups.The length of incision:DAA group:(9.2±0.7) cm and Mis-PLA group:(9.5±0.6) cm.No statistical significant differences were found (P=0.053).The operation time:DAA group (74.3±10.1) min and Mis-PLA group(37.5±4.3) min,which showed statistically significant differences(P<0.01).Blood loss:DAA group(229.6±79.2) mL and Mis-PLA group (215.7±56.0) mL.Nostatistical significant differences were found (P=0.366).(2) The patients in both groups were followed up for 6-12 months.The Harris hip scores for 6 weeks' follow-up:(85.5±4.1) in DAA group and (79.0±4.4) in Mis-PLA group,which indicated statistically significant differences (P<0.01).The Harris scores for the 6-month follow-up:(94.3±2.7) in DAA group and (95.2±1.9) in Mis-PLA group.No statistically significant differences were found (P=0.125).The basic daily hip function analysis for the 6-week follow-up:walking speed: no statistically significant differences were found between the two groups(P=0.298);Climbing stairs: Mis-PLA group' outcome was better than DAA group's with statistical differences (P=0.047);Circling,sitting and wearing shoes and socks: outcomes in DAA group exceeded Mis-PLA group's with statistically significant differences (P<0.01,P=0.016,P<0.01).Conclusion: Total hip arthroplasty through either DAA or Mis-PLA approaches could result in very satisfactory clinical effect.Comparing with DAA,Mis-PLA requires less operation time,shorter learning curve,which indicates that it is a re-latively safer approach.The advantages of total hip arthroplasty through direct anterior approach lie in less positional limitation in the early stage of postoperative period,as well as a faster recovery of hip function.
ABSTRACT
PURPOSE: The aim of the current study is to report the advantage and disadvantage of total hip arthroplasty performed in direct anterior approach (DAA) by comparing it to the posterolateral approach (PLA). MATERIALS AND METHODS: Twenty-five hip arthroplasty done in DAA (12 total hip arthroplasty [THA] and 13 bipolar hemiarthroplasty [BHA]) were compared with the same number done in PLA (13 THA and 12 BHA). Intraoperative assessments including operation time, anesthetic time, bleeding amount were recorded with intraoperative complications. Immediate postoperatively, position of the prosthesis and leg length discrepancy were measured and were compared between the two approaches. RESULTS: The operation time was 22 minutes and 19 minutes longer in DAA for THA and BHA respectively while the anesthetic time difference was 26 and 10 respectively. However, these parameters showed no statistical difference. No significance was found when bleeding amount was compared. For DAA, cup alignment was within safe zone in 100% both for inclination and for anteversion while this was 83.3% and 75.0% respectively in PLA. Leg length difference was 3 mm in DAA and 5 mm in PLA but had no significant difference. Tensor fascia lata tear was the most common complication occurring in 9 patients. CONCLUSION: Although significant was not reached there was trend toward more operation time and anesthetic time when DAA was used. However, the trend also showed that cup and stem were likely to be in more accurate position and in adequate size which is likely due to the accurate use of fluoroscopy.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Bleeding Time , Butylated Hydroxyanisole , Fascia Lata , Fluoroscopy , Hemiarthroplasty , Hemorrhage , Hip , Intraoperative Complications , Leg , Prostheses and Implants , TearsABSTRACT
<p><b>OBJECTIVE</b>To compare clinical results of treating femoral head necrosis staged Ficat III or IV with total hip arthroplasty (THA) between mini invasive direct anterior approach (DAA) and posterolateral approach.</p><p><b>METHODS</b>From January 2008 to December 2009, 48 patients with femoral head necrosis staged Ficat III or IV treated with THA were compared and analyzed. There were 21 patients in mini invasive direct anterior approach group including 11 males and 10 females with an average age of (65.2±4.3) years old;while there were 27 patients in posterolateral approach group including 16 males and 11 females with an average age of (63.6±4.0) years old. Operative time, blood loss during operation, bed rest time and complications of two groups were observed and compared. Acetabular abduction and stem shaft angle were measured 1 month after operation and compared between two groups. Postoperative Harris Hip scoring and VAS scoring were applied for evaluating hip function and pain at 1, 6 months and 5 years after operation respectively.</p><p><b>RESULTS</b>All patients were followed up for 48 to 73 months with an average of 60.4 months. Operative time, blood loss in DAA group was (78.30±5.08) min, (351.30±21.46) ml, respectively, in posterolateral approach group was (75.61±10.60) min, (362.20±26.15) ml, and no significant differences between two groups. Bed rest time in DAA group was (2.05±1.10) days, better than that of in posterolateral approach which was (3.30±1.35) days. No significant differences were found between two groups in acetabular abduction and stem shaft angle at 1 month after operation. There was no significant differences between two groups in HHS and VAS score at 1, 6 months and 5 years after operation. There was 1 case with injury of ascending branch of the lateral circumflex femoral artery, 1 case with great trochanter fracture and 1 case with superficial infection in DAA group, 1 case with dislocation in posterolateral group. No prosthesis loosening occurred in two groups.</p><p><b>CONCLUSIONS</b>Both DAA and posterolateral approach are effective in treating femoral head necrosis staged Ficat III or IV, and could obtain excellent outcomes. However, DAA seemed to has disadvantage in learing curve compared posteriolateral approach in complex cases.</p>