Total hip arthroplasty: comparison of two-incision and standard techniques at an AOA-accredited community hospital.

CONTEXT: The two-incision approach to total hip arthroplasty (THA) has received increasing attention in recent years. However, the benefits of this procedure have been debated. OBJECTIVES: To evaluate the two-incision THA technique compared to the standard anterolateral THA approach in a community hospital setting. METHODS: A retrospective review of records from patients who had THA at Memorial Hospital of York in Pennsylvania. Outcomes for patients who received the two-incision THA technique were compared to those who had a standard anterolateral THA approach. Perioperative parameters included operation duration and complication rates. Early function was evaluated by hospital length of stay and whether patients were discharged home or to a rehabilitation center. RESULTS: Twenty-eight patients had 30 THAs with a two-incision technique, and 30 patients had a standard anterolateral THA. Demographic parameters were similar among both groups. The two-incision THA group had a longer mean operation time by 34 minutes but shorter hospital stay by 0.8 days. Patients in the two-incision THA group were discharged to home 87% of the time compared to 43% in the anterolateral group. In addition, 4 patients (13%) in the two-incision group had an orthopedic complication compared to no complications in the anterolateral group. CONCLUSION: There were longer operative times, shorter hospital stays, and higher complication rates among patients who received the two-incision THA. Patients who receive the two-incision THA should be selected carefully and advised about the potential for increased complications.

Sciatic nerve injury in total hip resurfacing: a biomechanical analysis.

The condition of the gluteal sling was a significant factor in determining the pressure experienced by the sciatic nerve during acetabular exposure in total hip resurfacing via a posterior approach. The position of the knee did not play a significant role at this stage of the procedure. Average pressures were not elevated above a predefined injury level during positioning for femoral preparation. During hip reduction, knee positioning seemed to play a significant role in pressures placed on the sciatic nerve. These findings suggest that releasing the gluteal sling during a posterior approach for total hip resurfacing may help to prevent postoperative sciatic nerve palsies. Consideration should also be given to at least partially flexing the knee during hip reduction in this procedure.

Total hip resurfacing in patients who are sixty years of age or older.

BACKGROUND: Metal-on-metal total hip resurfacing arthroplasty has been associated with excellent early results in patients who are younger than sixty years of age, but it remains controversial whether this procedure is appropriate in older patients. The purpose of the present study was to compare the clinical and radiographic outcomes after hip resurfacing in two cohorts of patients: those who were sixty years of age or older, and those who were younger than sixty years of age. METHODS: Between November 2002 and August 2005, thirty-five patients (forty hips) who were sixty years of age or older were managed with metal-on-metal total hip resurfacing arthroplasty. The outcomes of these patients were compared with those of 130 patients (153 hips) who were younger than sixty years of age but otherwise had similar preoperative parameters and who had resurfacing arthroplasty performed during the same time interval and by the same surgeon. We evaluated Harris hip scores, Short Form-12 scores, and complications as well as radiographic alignment and radiolucencies. RESULTS: At a mean follow-up time of thirty-six months, the mean Harris hip scores improved from 52 points to 94 points in the older patient cohort and from 53 points to 92 points in the younger patient cohort. The final Short Form-12 scores of the two groups were also similar. Two patients who were sixty years or older and five of the younger patients required conversion to a conventional total hip arthroplasty. Femoral neck fracture was the reason for one conversion in each group. There were no impending radiographic failures in either cohort. CONCLUSIONS: Although national registries indicate that the risk of femoral neck fracture is higher in older patients, the present study found that these patients had excellent clinical outcomes that were similar to those of patients who were younger. We await longer follow-up results to determine further outcomes in these patients.