Does Surgical Approach Affect Patient-reported Function After Primary THA?

Graves, Sara C.; Dropkin, Benjamin M.; Keeney, Benjamin J.; Lurie, Jon D.; Tomek, Ivan M.

doi:10.1007/s11999-015-4639-5

Cited by 118 publications

(79 citation statements)

References 48 publications

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“…7,27 Rathod et al published a similar study in 2014 comparing radiographic outcomes between the DAA with intra-operative fluoroscopy and the posterior approach and found results similar to ours with regard to acetabular inclination. They did not compare offset or LLD.…”

Section: Discussionsupporting

confidence: 81%

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A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

Lin

Bendich

et al. 2017

The Journal of Arthroplasty

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Background Radiographic outcomes after total hip arthroplasty (THA) have been linked to clinical outcomes. The direct-anterior approach (DAA) for THA has been criticized by some for providing limited exposure and compromised implant position, but allows for routine use of intra-operative fluoroscopy. We sought to determine whether radiographic measurements differed by THA approach using prospective cohorts. Methods Two reviewers blinded to surgical approach examined 194 radiographs, obtained 4–6 weeks after primary THA, and obtained measurements for acetabular inclination angle, acetabular anteversion, radiographic limb length discrepancy (LLD), and femoral offset. All surgeries were performed at a tertiary academic medical center in rural New England by an experienced fellowship-trained arthroplasty surgeon. Measurements for inclination angle, anteversion, LLD, and offset were made into binary yes/no responses based on whether the mean measurement (between the two reviewers) was acceptable or not based on established criteria. Multivariate logistic regression analyses were performed using pre-operative and intra-operative characteristics to identify predictors of acceptability for each measurement. Results The DAA group had higher rates of acceptable acetabular angle (96 vs. 85%, P=0.005), and was protective against an unacceptable angle in an adjusted predictive model (OR 0.16, P=0.005). There were no significant differences between approaches for acceptable anteversion, LLD, or offset. Body mass index of 30–34 was associated with higher odds of unacceptable inclination angle compared to the non-obese group (aOR 6.82, P=0.013). Conclusion DAA for THA was associated with lower odds of unacceptable inclination angle compared to the posterior approach, with no differences in anteversion, LLD, or offset.

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Section: Discussionsupporting

confidence: 81%

“…1 Several studies have demonstrated benefits of the DAA, including decreased narcotic consumption, more soft tissue and muscle preservation, faster recovery, shorter hospital stay, improved restoration of gait mechanics, and decreased dislocation rate. 2–7 …”

Section: Introductionmentioning

confidence: 99%

A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

Lin

Bendich

et al. 2017

The Journal of Arthroplasty

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“…Many authors claim that this approach would result in less muscle damage and rapid recovery, although only limited data exist to support these claims [34][35][36]. Nevertheless, any attempt to decrease pain, blood loss and recovery time may be a benefit for the patient, which would enable a quick return to daily routine.…”

Section: Discussionmentioning

confidence: 99%

Eponymous hip joint approaches

Somford

Hoornenborg

Wiegerinck³

et al. 2016

Arch Orthop Trauma Surg

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After the low friction arthroplasty by John Charnley was no longer confined to specialized hospitals but commonplace in the general orthopedic practice, the issue remained how to most optimally reach the hip. The names of the authors of these approaches remain in a lot of cases connected to the approach. By evaluating the original articles in which the approaches are described we ascertain the original description and technique. By various sources we obtained the (short) biography of the people whose name is connected to the approach. Our research covers the biographies of colleagues Smith-Petersen, Watson-Jones, Hardinge, Charnley, Moore and Ludloff. The eponymous approaches are shown and described after the short biography on each individual. This study shows that without the work of our colleagues we cannot proceed in our profession. An understanding and knowledge of the people who dedicated themselves to developing the orthopedic surgery to the high standard it has today is the least honour we should give them.

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“…There are many studies in which it could be shown that after hip arthroplasty, the patients improved significantly measured by scores like Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris Hip Score (HHS) in a short and long term [1, 2]. Several studies could show good results after minimal invasive THA in the early postoperative period measured by HHS and WOMAC [3–5]. …”

Section: Introductionmentioning

confidence: 99%

Clinical outcome and physical activity measured with StepWatch 3™ Activity Monitor after minimally invasive total hip arthroplasty

et al. 2018

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BackgroundSubjective data and physical examinations of patients after total hip arthroplasty are used to assess the outcome. But regarding the physical activity, no objective data can be delivered by existing scores. The level of activity can be measured objectively by counting gait cycles. The aim of this study was to measure activity levels of patients before and after total hip arthroplasty (THA).MethodsForty-six patients were included in this prospective study. Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Score (HHS), and physical activity level based on the number of steps per day were assessed 1 week before surgery, 6 weeks postoperatively, and 3 months postoperatively. To assess the general constitution of the patients, the American Society of Anesthesiologists (ASA) score and BMI were determined. The physical activity level was measured by StepWatch 3™ Activity Monitor (SAM; Orthocare Innovations, Seattle, WA, USA). The number of GCs per day was assessed. Spearman’s rank correlation coefficients were used to identify an association between age, body mass index (BMI), and American Society of Anesthesiologists classification with the number of gait cycles and to detect correlation between GCs and HHS and GCs and WOMAC.ResultsFrom preoperatively to 6 weeks postoperatively, the number of gait cycles did not alter significantly. Three months postoperatively, the number of GC/d and GC/h improved significantly. HHS and WOMAC improved significantly from before surgery to 6 weeks and to 3 months follow-up. The number of gait cycles per day did not correlate with the HHS and the WOMAC score at any point of measurement. Age, BMI, and ASA classification did not influence the results.ConclusionBy using a StepWatch 3™ Activity Monitor objective data about physical activity before and after THA can be measured reliable. Subjective and objective data in the postoperative period show different results. Physical activity seems to take longer to reach significantly improved values. By counting gait cycles, surgeons do have an additional tool to measure success after THA.

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Does Surgical Approach Affect Patient-reported Function After Primary THA?

Cited by 118 publications

References 48 publications

A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

Eponymous hip joint approaches

Clinical outcome and physical activity measured with StepWatch 3™ Activity Monitor after minimally invasive total hip arthroplasty

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