High Complication Rate With Anterior Total Hip Arthroplasties on a Fracture Table

Jewett, Brian A.; Collis, Dennis K.

doi:10.1007/s11999-010-1568-1

Cited by 250 publications

(186 citation statements)

References 18 publications

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“…Spaans et al [6] reported also a high complication rate in the early experience of DAA THA, with no benefit shown when compared with the posterior approach. High complication rates were also reported by Jewett et al [5] who shown intra-operative complications in 26 out of 800 patients including trochanteric fractures (2.3 %) and femoral perforation (0.37 %). These two complications are related in our experience to either a coxa vara morphotype or a high anterior curvature of the proximal femur that requires a more important posterolateral release that may be difficult to achieve, especially in the early experience.…”

Section: Discussionsupporting

confidence: 51%

“…However, this cohort included his learning curve, suggesting that 3D planning may help decrease the intra-operative complication rate in the early experience of DAA. Indeed, with respect to the intra-operative complications, the learning curve varies according to the authors from 20 [18] to 200 [1,5]. In our future work, we will replicate this study with a variety of surgeons with different skill levels.…”

Section: Discussionmentioning

confidence: 93%

“…However, this surgical technique presents a longer learning curve and a higher complications rate, especially on the femoral side including femoral stem malposition [3] and intraoperative femur fractures [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Sariali

Catonné

Pascal‐Moussellard

2016

International Orthopaedics (SICOT)

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Purpose The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD). Methods One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up. Results No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved. Conclusions This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure.Level of Evidence: Level IV

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 93%

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Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Sariali

Catonné

Pascal‐Moussellard

2016

International Orthopaedics (SICOT)

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“…Numerous authors have reported low dislocation rates and rapid early functional recovery [1,29,31,33,36,40,46] with this approach. However, some studies have shown higher surgical blood loss and complication rates [6,47], particularly for less-experienced surgeons [16,43] or for patients who are obese [39]. Additionally, the distal extension of the approach is less familiar to most surgeons and a recent anatomic study by Grob et al [10] suggested that it may pose a risk to the neurovascular supply to portions of the vastus lateralis.…”

Section: Introductionmentioning

confidence: 99%

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

Graves

Dropkin

Keeney

et al. 2016

Clinical Orthopaedics &Amp; Related Research

118

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Background Total hip arthroplasty (THA) relieves pain and improves physical function in patients with hip osteoarthritis, but requires a year or more for full postoperative recovery. Proponents of intermuscular surgical approaches believe that the direct-anterior approach may restore physical function more quickly than transgluteal approaches, perhaps because of diminished muscle trauma. To evaluate this, we compared patient-reported physical function and other outcome metrics during the first year after surgery between groups of patients who underwent primary THA either through the direct-anterior approach or posterior approach. Questions/purposes We asked: (1) Is a primary THA using a direct-anterior approach associated with better patient-reported physical function at early postoperative times (1 and 3 months) compared with a THA performed through the posterior approach? (2) Is the direct-anterior approach THA associated with shorter operative times and higher rates of noninstitutional discharge than a posterior approach THA? Methods Between

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“…The anterolateral (AL), or Rottinger, approach, as with the DL approach, allows for maintenance of posterior capsular attachments and short external rotators, which reduces postoperative instability while maintaining abductor integrity [10][11][12]. However, anterior approaches to the hip, possibly including the AL approach, have been associated with increased rates of lateral femoral cutaneous nerve injury [13] and fractures of the greater trochanter and femur [14,15].…”

Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

Queen

Appleton

Butler

et al. 2013

PM&R

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Objective: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. Design: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty (THA). Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries. Setting: A controlled laboratory study. Participants: This study examined 35 patients with primary, unilateral THA. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior, and 11 anterolateral. All the patients were assessed 1 year after THA. Patients were excluded from the study if they had contralateral hip pain or pathology, or any prior lower extremity total joint replacements. Main Outcome Measurements: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected. Results: No main effects for the physical performance measures or biomechanical variables were observed among the approach groups. Significant limb-to-limb asymmetries were observed among all the patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side. Conclusion:The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable. However, 1 year after THA, the patients demonstrated asymmetric gait patterns regardless of surgical approach, which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA.

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High Complication Rate With Anterior Total Hip Arthroplasties on a Fracture Table

Abstract: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 250 publications

References 18 publications

Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

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

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

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