Direct anterior approach in total hip arthroplasty: influence of stem length on clinical and radiological outcomes at medium-term follow-up

Risitano, Salvatore; Piccato, Alice; Fusini, Federico; Rissolio, Lorenzo; Marcarelli, Marco; Bosa, Gianmarco; Indelli, Pier Francesco

doi:10.1007/s12306-022-00758-7

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Compared to patients implanted with conventional stems, those implanted with shortened stems had significantly higher preoperative mHHS, but significantly lower net improvement in mHHS, which could be explained by the ceiling effect of HHS [40]. Mean postoperative mHHS values in the present study (87.3 ± 11.9 vs 89.4 ± 9.6) are comparable to those reported in the literature for primary THA using other conventional or short cementless stems, which ranged between 82–97 points [10, 14, 18, 24, 34], with the study by Risitano et al [34] also reporting a tendency for short stems to have better postoperative HHS than conventional stems (83 ± 13.4 vs 87 ± 14.1, p = 0.148).…”

Section: Discussionsupporting

confidence: 66%

No significant differences in 60‐day postoperative complication rates between conventional and shortened stems

Girardot,

Guy,

Bonin

2023

J. exp. orthop.

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Purpose To compare 60-day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study. Methods The authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery. Results Compared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60-day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109). Conclusions There were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS. Level of Evidence Level IV, Retrospective comparative cohort study

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Section: Discussionsupporting

confidence: 66%

No significant differences in 60‐day postoperative complication rates between conventional and shortened stems

Girardot,

Guy,

Bonin

2023

J. exp. orthop.

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“…High dysplastic hips with osteoarthritis can be managed by THA through different approaches. Most available literature reports good outcomes, in terms of clinical and radiological improvement, when THA is performed by direct lateral or postero-lateral approach [24][25][26][27]. Only recently, studies investigating the performance of THAs in Crowe III and IV hips by DAA have been reported.…”

Section: Discussionmentioning

confidence: 99%

Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

Faldini

Brunello

Pilla

et al. 2023

JCM

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The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero–lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5° ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of −29.5 ± 10.5 mm at the affected side, with a significant improvement to −2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from −9.5° ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6° ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum.

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The minimally invasive anterolateral approach promotes faster rehabilitation than the lateral approach after total hip arthroplasty: a retrospective case-control study of Asian patients

Gao

Huang

Chen

et al. 2023

Preprint

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Background: This study sought to compare the differences in the early postoperative clinical outcomes of Asian patients who underwent total hip arthroplasty (THA) using the minimally invasive anterolateral approach (MIAL) or the lateral approach (LA). Methods: This retrospective study examined the data of 80 consecutive patients who underwent THA between January 2020 and September 2021. Of the patients, the MIAL was used in 41 patients, and the LA was used in 39 patients. The modified Harris Hip Score (mHHS) survey and the 36-item Short-Form Health Survey (SF-36) were administered during the first 3 postoperative months. Surgical parameters, the time it took to complete indoor self-care activities, and complications were also analyzed. Results: No significant differences were found in the patients’ baseline characteristics. At 5 days postoperatively, the mHHS, visual analogue scale (VAS) score, and positive rate of the Trendelenburg test were significantly better in the MIAL group than the LA group. The time it took to engage in indoor self-care was significantly shorter in the MIAL group than the LA group. At 6 weeks postoperatively, the results of the mHHS and the majority of the SF-36 items were significantly higher in the MIAL group than the LA group. At 12 weeks postoperatively, there was no statistical difference in the mHHSs between the two groups; however, the scores for most SF-36 items, except the vitality and emotional role items, were significantly higher in the MIAL group than the LA group. The complication rates were comparable between the two groups. Conclusions: The MIAL facilitated quicker recovery for Asian patients, who showed earlier indoor self-care, better hip function, and better health related quality of life; however, the complication rates of the MIAL and LA groups were comparable.

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Direct anterior approach in total hip arthroplasty: influence of stem length on clinical and radiological outcomes at medium-term follow-up

Cited by 3 publications

References 21 publications

No significant differences in 60‐day postoperative complication rates between conventional and shortened stems

No significant differences in 60‐day postoperative complication rates between conventional and shortened stems

Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

The minimally invasive anterolateral approach promotes faster rehabilitation than the lateral approach after total hip arthroplasty: a retrospective case-control study of Asian patients

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