Component positioning in primary total hip replacement: A prospective comparative study of two anterolateral approaches, minimally invasive versus gluteus medius hemimyotomy

Mouilhade, F.; Matsoukis, Jean; Oger, Philippe; Mandereau, C.; Brzakala, V.; Dujardin, F.

doi:10.1016/j.otsr.2010.05.013

Cited by 31 publications

(21 citation statements)

References 45 publications

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“…However, some studies have expressed concern regarding implant malposition that could compromise long-term survival of the implant [3,33]. There are other complications of concern, not seen with traditional approaches, such as greater trochanter fracture, canal perforation, and remote site fractures [3,11,34,37,38]. The learning curve associated with newer approaches may also have negative implications on the results [10,28,50].…”

Section: Introductionmentioning

confidence: 99%

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

199

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Background Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. Questions/purposes (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? Methods The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011. Endpoints were septic revisions, aseptic revisions, and dislocations. The exposure of interest was surgical approach (posterior, anterolateral, direct lateral, direct anterior). Patient, implant, surgeon, and hospital factors were evaluated as possible confounders. Survival analysis was performed with marginal multivariate Cox models. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. A total of 42,438 primary THAs were available for analysis of revision outcomes and 22,237 for dislocation. Median followup was 3 years (interquartile range, 1-5 years). The registry's voluntary participation is 95%. The most commonly used approach was posterior (75%, N = 31,747) followed by anterolateral (10%, N = 4226), direct anterior (4%, N = 1851), and direct lateral (2%, N = 667). Results During the study period 785 hips (2%) were revised for aseptic reasons, 213 (0.5%) for septic reasons, and 276 (1%) experienced a dislocation. The revision rate per 100 years of observation was 0.54 for aseptic revisions, 0.15 for septic revisions, and 0.58 for dislocations. There were no differences in adjusted risk of revision (either septic or aseptic) across the different THA approaches. However, the anterolateral approach (adjusted HR, 0.29; 95% CI, 0.13-0.63, p = 0.002) and direct anterior approach (adjusted HR, 0.44; 95% CI, 0.22-0.87, p = 0.017) had a lower risk of dislocation relative to the posterior approach. There were no differences in any of the outcomes when comparing the direct anterior approach with the anterolateral approach. Conclusions Anterior and anterolateral surgical approaches had the advantage of a lower risk of dislocation without increasing the risk of early revision. Level of Evidence Level III, therapeutic study.

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Section: Introductionmentioning

confidence: 99%

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

199

View full text Add to dashboard Cite

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“…Overall, we found the mean inclination angle in our study to be comparable to studies in the literature. 25,26,[32][33][34][35] The mean anteversion angle of 21.82° found in our study, however, is the highest among these studies.…”

Section: Resultsmentioning

confidence: 60%

“…25,26,[32][33][34][35] We used the method outlined by Tiberi and colleagues, 28 which is comparatively reliable to edge detection software. Overall, we found the mean inclination angle in our study to be comparable to studies in the literature.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of the modified Hardinge approach in acetabular positioning

Goyal

Lau

McCalden

et al. 2016

cjs

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Background:The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. Methods:We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1-3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. Results:We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. Conclusion:Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone.

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“…This is consistent with findings of other studies. 3,5,19,20,22,23,26 However, a wider range in anteversion 24 and increased malpositioning of the acetabular component have been reported after a posterior 21 or an anterolateral 27 approach with a mini-incision technique.…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty through the Mini-Incision (Micro-Hip) Approach versus the Standard Transgluteal (Bauer) Approach: A Prospective, Randomised Study

Dienstknecht

Lüring

Tingart

et al. 2014

J Orthop Surg (Hong Kong)

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Purpose. To compare outcome after total hip arthroplasty (THA) through the mini-incision approach versus the standard transgluteal approach. Methods. 80 women and 63 men aged 33 to 89 (mean, 62) years with primary osteoarthritis of the hip were randomised to undergo unilateral THA through a mini-incision approach (Micro-hip, n=55) or standard, lateral, transgluteal approach (Bauer, n=88). Levels of haemoglobin, haematocrit, serum creatine kinase, and C-reactive protein, length of hospital stay, mobilisation, and any complication were recorded. Visual analogue scale (VAS) for pain was assessed. Hip function was assessed using the Harris Hip Score and the Oxford Hip Score, whereas general health was assessed using the EQ-5D general health questionnaire. The cup inclination and varus/ valgus of the stem position were measured using a goniometer. Results. The Micro-hip group achieved a significantly lower mean incision length (9.3 vs. 13.4 cm, p<0.001),Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study

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Component positioning in primary total hip replacement: A prospective comparative study of two anterolateral approaches, minimally invasive versus gluteus medius hemimyotomy

Abstract: Level III. Prospective, comparative, non-randomized.

Cited by 31 publications

References 45 publications

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Accuracy of the modified Hardinge approach in acetabular positioning

Total Hip Arthroplasty through the Mini-Incision (Micro-Hip) Approach versus the Standard Transgluteal (Bauer) Approach: A Prospective, Randomised Study

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