Early surgical complications of total hip arthroplasty related to surgical approach

Abstract

Background: Total hip arthroplasty (THA) can be performed through a number of surgical approaches. The aim was to compare the incidence of early surgical complications in THA related to approach. Methods: A retrospective review of prospectively recorded data extracted from St. Vincent's Melbourne Arthroplasty Registry was performed between January 2006 and December 2016. Surgical approach was identified: lateral, posterior, anterior and superior. Primary outcome measure was return to theatre (RTT) for any cause within 1 year. Age, comorbidity, body mass index and femoral fixation were assessed for potential confounding. Secondary outcomes were RTT for revision procedure and for specific complications: intra or post-operative fracture, dislocation/instability, aseptic loosening and prosthetic joint injection (PJI). Variables were assessed for their association with outcome using unadjusted and adjusted quantile median regression for continuous outcomes and Cox proportional hazards regression for binary time-to-event outcomes. Results: There were a total of 2906 consecutive THA's recorded, 1413 lateral, 1188 posterior, 233 anterior and 72 superior. A total of 140 cases (4.5%) required RTT within 1 year. No approach was associated with RTT on unadjusted analyses or multivariate modelling. There was no association between approach and revision, PJI or periprosthetic fracture. The posterior approach was associated with 2.90 times the rate of dislocation relative to the lateral (P = 0.005). Conclusions: There was no difference in the RTT rate between surgical approaches for THA. There was no difference in revision rates, PJI or periprosthetic fracture. The posterior approach was associated with a higher rate of dislocation relative to the lateral, but not the anterior.

In Revision THA, Is the Re-revision Risk for Dislocation and Aseptic Causes Greater in Dual-mobility Constructs or Large Femoral Head Bearings? A Study from the Australian Orthopaedic Association National Joint Replacement Registry

“…Selection bias might also be minimized because data collection commenced at the same time point for each prosthesis, was recorded over the same time period, and the Kaplan-Meier estimates of revision and Cox proportional HRs account for time-dependent variation. Complications have been reported to decrease with more recent surgery [20], and this is why we had the same data collection start point. The dual-mobility construct group and the large femoral head bearing group were similar regarding patient age, ASA class, and BMI, but there were gender differences that we adjusted for in our statistical analysis.…”

The length of distal skin incision of the postero-lateral approach affects the cup inclination during the total hip arthroplasty

“…Although surgeons attempt to accomplish accurate component position during the procedure, obtaining the targeted cup orientation remains a significant challenge for surgeons who have found high variability in the angle of acetabular cup radiographic inclination and anteversion (2). The inclination angle of the acetabular component may be related to implant failure due to suboptimal implant positioning and impingement, especially in the posterior approach that may lead to the increased risk of dislocation (31,32). A vertical acetabular cup with an inclination angle of more than 55° has been reported to be the most crucial factor related to higher rates of dislocations (23,33).…”

Direct Anterior Approach in Lateral Decubitus Position Versus Supine Position for Unilateral Total Hip Arthroplasty: A Comparative Study

“…Not only does it affect hip function, but it is also more likely to require revision surgery. Some authors concluded that dislocation of THA was related to the tension from surrounding soft tissue, the integrity of abductor muscle, and the placement of prosthesis 14 . DAA is applied in the neuromuscular space with no damage to muscle or posterior structure of the hip joint.…”