Risk of Stem Undersizing with Direct Anterior Approach for Total HIP Arthroplasty

Rivera, Fabrizio; Leonardi, Francesco; Evangelista, Andrea; Pierannunzii, Luca

doi:10.5301/hipint.5000337

Cited by 41 publications

(39 citation statements)

References 20 publications

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“…The difficulties of exposure by the DAA and the risk of complication are described in literature [29][30][31]. The most commonly reported complication of DAA is femoral fracture or malposition of the femoral implants [32][33][34]. In literature, some cases of acetabular complications, during the surgery or at long term, have been reported with DAA, the acetabular exposure being relatively convenient by DAA.…”

Section: Discussionmentioning

confidence: 99%

Early low complication rate of ceramic-on-ceramic total hip arthroplasty by direct anterior approach

Bauwens

Fary

Servien

et al. 2020

SICOT-J

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Introduction: Ceramic-on-ceramic couplings are an alternative bearing surface to reduce the problems related to polyethylene wear and debris. However, ceramic articulations have their own risk of unique complications: fracture, squeaking, or dislocation. Few studies have assessed the outcomes of ceramic-on-ceramic total hip arthroplasties (THA) by direct anterior approach (DAA). The aim was to evaluate the early complications and revision rate of ceramic-on-ceramic THA by DAA. Material: A retrospective single-center study of 116 consecutive THAs was performed by DAA (106 patients) with ceramic-on-ceramic bearing from January 2015 to February 2018 with a minimum 24 months of follow-up. No patients were lost to follow-up. The mean age was of 55.3 years ± 11.3. The same cementless acetabular shell with a Biolox Delta ceramic insert and head were used. The complication and revision rates were collected at the last follow-up. The positioning of the acetabular implant was assessed on standard radiographs. Postoperative clinical outcomes were assessed by the Harris Hip Score. Results: At a mean follow-up of 31.9 months ± 5.5, no THA was revised. Five patients had late complications: 3 squeaking (2.6%) and 2 psoas impingements (1.7%) and were managed conservatively. All patients had satisfactory bony ingrowth of acetabular component, with no radiolucent lines and no osteolysis. Eight patients (6.9%) had an anterior overhang of the cup. The mean overhang for these patients was 4.1 mm. 111 hips (96%) were perceived as forgotten or having no limitations. Conclusion: This ceramic-on-ceramic coupling and shell by DAA produced excellent clinical outcomes and implant survival rate at a minimum two-year follow-up study. No serious complication was observed during the follow-up.

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Section: Discussionmentioning

confidence: 99%

Early low complication rate of ceramic-on-ceramic total hip arthroplasty by direct anterior approach

Bauwens

Fary

Servien

et al. 2020

SICOT-J

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“…Whether DAA is actually superior to other surgical approaches, however, remains controversial. Due to some concerns of less adequate exposure caused by difficulty elevating of proximal femur, some complications can occur during the operation, such as contusion of periarticular muscles, injury to the anterolateral femoral cutaneous nerve, and fractures around the prosthesis [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Zhao

Zhu

Jiang

et al. 2020

BMC Musculoskelet Disord

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Background: The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. Methods: Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue "pad" created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. Results: LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. Conclusions: Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. Trial registration: ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

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“…Due to some concerns of less adequate exposure caused by difficulty elevating of proximal femur, some complications can occur during the operation, such as contusion of periarticular muscles, injury to the anterolateral femoral cutaneous nerve, and fractures around the prosthesis. [10][11][12][13][14][15] By forming the lateral wall of the surgical wound, the muscle fibers of the tensor fascia lata muscle (TFLM) are often traumatized due to mechanical retraction by surgical instruments. While preparing the acetabulum for the prosthesis, the TFLM is often damaged by the handle of the acetabular reamer.…”

Section: Introductionmentioning

confidence: 99%

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Zhao

Zhu

Jiang

et al. 2020

Preprint

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Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

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Risk of Stem Undersizing with Direct Anterior Approach for Total HIP Arthroplasty

Abstract: The technical difficulty of femoral preparation and the surgeon's knowledge of possible related complications might lead to implant undersized stems more frequently through DAA than through PA, especially if intraoperative imaging controls are not used.

Cited by 41 publications

References 20 publications

Early low complication rate of ceramic-on-ceramic total hip arthroplasty by direct anterior approach

Early low complication rate of ceramic-on-ceramic total hip arthroplasty by direct anterior approach

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

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