Anatomical basis for surgical approaches to the hip

Onyemaechi, Noc; Anyanwu, EG; Obikili, EN; Ekezie, J

doi:10.4103/2141-9248.139278

Cited by 29 publications

(9 citation statements)

References 37 publications

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“…If a “Watson-Jones” type approach was referenced it was considered an anterolateral approach and not included in this review. This follows the classification system of Onyemaechi et al [ 5 ], and various surgical textbooks.…”

Section: Methodsmentioning

confidence: 99%

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A scoping review comparing two common surgical approaches to the hip for hemiarthroplasty

et al. 2019

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Background Hemiarthroplasty for hip fracture is a common surgical procedure. A number of distinct approaches are used to access the hip joint. The most commonly used are the direct lateral approach (DLA), and the posterior approach (PA). Internationally there is little consensus on which of these approaches to use. Current guidance is based on a limited selection of evidence and choice of approach is frequently based on surgeon preference. Historically, recommendations have been made based on dislocation rates. In light of technical advancements and greater recognition of patient priorities, outcomes such as post-operative function and pain may be considered more important in the modern context. The aim of this scoping review was to summarise the literature pertaining to the comparison of common surgical approaches to the hip for hemiarthroplasty. Methods A scoping review methodology was used to examine the range and nature of primary research. Using systematic methods we searched for studies that directly compared the DLA and PA. Studies reporting the following outcomes were considered; dislocation, mortality, pain, activities of daily living, functionality, health-related quality of life, length of stay, surgeon assessment of difficulty, and adverse events. MEDLINE, EMBASE and The Cochrane Library were searched. Relevant information was extracted and synthesis of the retrieved data followed a basic content analytical approach. Results A total of 13 studies were retrieved: 12 observational studies and 1 randomised trial. The majority of studies were based at single sites. Larger observational studies using multi-site and national registry data have emerged in recent years. Reporting of technique and outcomes is inconsistent. A trend for higher rates of dislocation using the PA was observed and eight studies recommended the use of the DLA over the PA. Conclusions This scoping review demonstrates that the existing evidence is highly heterogeneous in nature and not of a sufficient quality to inform practice recommendations. This issue would be best addressed by additional RCTs, and high quality national-level observational data. Standardisation of the recording of patient risk factors, surgical and post-operative intervention protocols, and outcomes in all study designs would strengthen the potential for valid comparison of future findings.

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Section: Methodsmentioning

confidence: 99%

“…Anterior and anterolateral approaches are also used, but less often. Internationally it appears that choice of approach is frequently based on surgeon preference, as a result of training and experience, rather than rigid adherence to guidelines or evidence guided [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

A scoping review comparing two common surgical approaches to the hip for hemiarthroplasty

et al. 2019

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“…Many studies have tried to explore and quantify a potential abductor muscle strength deficit after THA as well as identify possible causes and treatment options. 4 5 17 Furthermore, surgical approaches avoiding any damage to the abductor mechanism have been established 18 and rehabilitation programmes have been developed to prevent or reduce this strength deficit. 17 19 20 However, results reported in the literature are controversial, and the factors influencing abductor muscle strength deficit after THA are poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis

et al. 2020

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IntroductionConservation of abductor muscle strength is directly associated with physical function after total hip replacement (THA). Although many studies have tried to explore and quantify a potential abductor muscle strength deficit after THA as well as identify possible causes and treatment options, this topic has not been addressed systematically.Methods and analysisHuman-based studies reporting measurements of hip abductor strength will be included in this review. Studies reporting on hip abductor strength measured manually or isometric measurements at an abduction angle other than 0° will not be considered. No restriction will be placed on study design, publication date operative approach, prosthesis design, age and sex of the patients or severity of OA. Data sources will be Embase via embase.com, Medline ALL via Ovid and the Cochrane Central Register of Controlled Trials. The preliminary search was conducted on 5 May 2019. Data regarding absolute values or torque ratio of hip abductor torque between sides as well as patient demographic data, surgical approaches and rehabilitation protocols will be extracted. The assessment of quality and risk of bias will be performed with the modified Newcastle-Ottawa Scale. The screening, data extraction and quality assessment will be performed by two reviewers independently. Where necessary, a third review author will make a final judgement. Narrative synthesis as well as tabular presentation of the extracted data will be included. Whenever possible, metaregression and subgroup specific meta-analyses will be used to investigate the influence of time since THA and type of measurement (isokinetic or isometric) on the different outcomes. In case of sufficient information, these analyses will be extended to include characteristics such as age, sex, surgical approach or rehabilitation programme.Ethics and disseminationNo ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42020153185.

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“…During the direct anterior approach (DAA) for total hip arthroplasty (THA), the tensor fascia is incised, and a deep dissection is made through the inter-nervous interval between the rectus femoris (femoral n.) and the gluteus medius (superior gluteal n.) [ 2 , 3 ]. The rectus femoris is retracted medially often via an anterior acetabular retractor placed deep to the iliocapsularis over the anterior pelvic brim just medial to the iliopectineal eminence.…”

Section: Introductionmentioning

confidence: 99%

Femoral neuropathy following direct anterior total hip arthroplasty: an anatomic review and case series†

Patton

Runner

Lazarus

et al. 2018

Journal of Surgical Case Reports

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The popularity of the direct anterior approach for total hip arthroplasty (THA) has dramatically increased in recent years. Many patients request this muscle sparing approach for the theorized benefits of quicker recovery and reduced post-operative pain. Femoral nerve injury is a rare, yet serious complication following the anterior approach for THA. During the 7-year period from 2008 to 2016, 1756 patients underwent primary THA with a direct anterior approach by a single senior surgeon for end-stage osteoarthritis. Six (0.34%) of these patients had a post-operative femoral nerve palsy. We aim to discuss anatomic considerations, risk factors, and a timeline of severity and recovery for femoral nerve palsy following direct anterior THA in six patients.

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Anatomical basis for surgical approaches to the hip

Cited by 29 publications

References 37 publications

A scoping review comparing two common surgical approaches to the hip for hemiarthroplasty

A scoping review comparing two common surgical approaches to the hip for hemiarthroplasty

Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis

Femoral neuropathy following direct anterior total hip arthroplasty: an anatomic review and case series†

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