A posterior approach to the hip joint with complete posterior capsular and muscular repair

Hedley, Anthony K.; Hendren, Douglas H.; Mead, Leon P.

doi:10.1016/s0883-5403(08)80027-7

Cited by 75 publications

(35 citation statements)

References 8 publications

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“…Prior studies have found the incidence of dislocation after primary THA to range from 4% to 15% [9,13]. With the advent of larger femoral head sizes, capsular repair, and newer approaches, dislocation rates have decreased [4,18]. The etiology of the increased dislocation incidence in the octogenarian undergoing primary THA likely is multifactorial and may include lax capsular structures, weak musculature, impaired proprioception, and cognitive problems that may predispose them to a higher risk of dislocation.…”

Section: Discussionmentioning

confidence: 99%

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Malkani

Dilworth

Ong

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background As life expectancy increases, more elderly patients with end-stage hip arthritis are electing to undergo primary THA. Octogenarians undergoing THA have more comorbidities than younger patients, but this is not reflected in risk adjustment models for bundled care programs. The burden of care associated with THA in octogenarians has not been well characterized, and doing so may help these value-based programs make adjustments so that this vulnerable patient population does not risk losing access under accountable care models.Questions/purposes The purpose of this study was to describe care use, comorbidities, and complications among octogenarians undergoing primary THA. Methods Five percent of the Medicare national administrative claims data was queried to identify patients diagnosed with hip osteoarthritis between January 1, 1998, and December 31, 2013. Patients who underwent primary THA were identified and followed longitudinally during the study period using their unique, encrypted Medicare beneficiary identifiers. We compared risk factors and complications between the octogenarian group versus those aged 65 to 69 years. Multivariate Cox regression was used to evaluate the effect of patient/hospital factors on risk of revision, periprosthetic joint infection, dislocation, venous thromboembolism (VTE), and mortality. Patient factors in the model included age, sex, race, region, socioeconomic status, and health status based on Charlson comorbidity score 12 months before replacement surgery. Results There were 11,960 THAs in the octogenarians in 1998, which increased to 21,620 in 2013, an 81% increase during this study period. Octogenarians were more likely to have a Charlson score of 3 or higher than those patients aged 65 to 69 years (30% versus 17%, odds ratio [OR] 2.07 [1.98-2.20]; p \ 0.001), and they were more likely to have coronary artery disease or congestive heart failure (47% versus 29%, OR 2.16 [2.06-2.26]; p \ 0.001). The octogenarian group had a greater risk of dislocation (+12%, p = 0.01), VTE (+14%, p\0.001), and mortality (+150%, p\ 0.001) compared with the younger age cohort. A total of 21% of the octogenarians were readmitted after surgery compared with 12% for patients in the younger group (OR=1.64, 95% confidence interval 1.54-1.75; p \ 0.001). Conclusions Because octogenarians are at increased risk of dislocation, VTE, medical complications, and mortality after THA, value-based care models that penalize hospitals One or more of the authors (KO, DB, EL) are employees of Exponent, Inc. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. This work was performed at

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Section: Discussionmentioning

confidence: 99%

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Malkani

Dilworth

Ong

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Multiple studies have shown improvement in postoperative hip stability when the short external rotators are repaired after THA using a posterior approach [11,14,22,29]. However, the failure rate of surgically repaired short external rotators after posterior THA is as much as 80% [28].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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Background Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a singleincision modification of this technique in 135 patients. Description of TechniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue. Methods For the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months). Results There were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41°(range, 21°-49°) and anteversion averaged 21°(range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2°varus and 2°v algus alignment, respectively.

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“…The posterior capsule and short rotators were re-attached together to the posterior femur through two drill holes. This capsular repair is similar to the technique of Hedley [5]. A wound drainage system was inserted and the wound closed.…”

Section: Methodsmentioning

confidence: 99%

Mini-incision posterior approach for total hip arthroplasty

Nakamura

Matsuda

Arai

et al. 2004

International Orthopaedics (SICOT)

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We compared the short-term outcomes of 50 total hip arthroplasties performed through a mini-incision posterior approach with those of 42 arthroplasties performed through a conventional posterior approach. There were no significant differences in age, gender, and bodymass index between groups. The mean operative time was shorter (99±26 versus 123±30 min), and the peroperative mean blood loss was smaller with the miniincision (339±210 versus 422±177 ml). There was no significant difference between groups in post-operative mean blood loss, mean inclination angle of acetabular components, percentage of hips with good inclination angle, and mean hip score at 6 months after surgery. There was one infection in the conventional group but none in the mini group. There were no dislocations or symptomatic pulmonary embolism in either group. With the miniincision posterior approach, surgical invasion was reduced, and short-term outcome was as good as with a conventional posterior approach.

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A posterior approach to the hip joint with complete posterior capsular and muscular repair

Cited by 75 publications

References 8 publications

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Mini-incision posterior approach for total hip arthroplasty

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