Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study

Ilchmann, Thomas; Gersbach, Silke; Zwicky, Lukas; Clauss, Martin

doi:10.4081/or.2013.e31

Cited by 42 publications

(40 citation statements)

References 27 publications

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“…The overall infection rate was not different in the two groups. Thus, in contrast to published data [26] the introduction of the new approach was rather safe, which is probably due to the fact that the first 100 cases with the new incision site were operated by the same two experienced surgeons [15]. Exogenous polymicrobial infections were somewhat more frequent in the DAA- as compared to the LAT-group (50.0 % vs 33.3 %, P = 0.64), however, this difference was statistically not significant.…”

Section: Discussioncontrasting

confidence: 64%

“…We used the direct anterior approach (Fig. 1) according to Smith-Peterson [16] with a split of the fascia of the tensor fascia lata and preparation through the intramuscular plane between M. sartorius and M. tensor fascia latae [15]. Patients operated from lateral [17] were posed in supine position, the peri- and postoperative setting was the same.…”

Section: Methodsmentioning

confidence: 99%

“…Follow-up was scheduled at 6 and 12 weeks, and after 1, 2 and 5 years. A standardized clinical and radiological follow-up protocol was followed, including registration of any adverse events [15]. All patients were seen at every follow-up by one out of 3 consultants of the hip unit.…”

Section: Methodsmentioning

confidence: 99%

“…In our hospital, we introduced DAA according to Matta [14] as routine in 2009 for primary elective total hip replacement [15]. Three years after introduction we observed a clustering of early infections caused either by gram-negative bacilli or by multiple microorganisms (polymicrobial).…”

Section: Introductionmentioning

confidence: 99%

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Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Ilchmann

Zimmerli

Bolliger

et al. 2016

BMC Musculoskelet Disord

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BackgroundThe direct anterior approach (DAA) is increasingly popular for hip replacement. However, the small incision and the location near to the groin might increase the risk of periprosthetic joint infection (PJI). We asked the questions (i) whether there is an increased risk of infection for this approach, and (ii) whether the spectrum of microorganisms differs between patients with DAA and those with lateral transgluteal approach (LAT).MethodsAll patients operated between 08/2006 and 12/2013 were followed prospectively in an in house register. The DAA was introduced as routine in 02/2009 at our hospital. Patients with primary elective hip replacement without previous operations were included. Follow-up was scheduled after 6, 12 weeks and 1, 2 years. PJI was defined according to standardized criteria.ResultsOne thousand one hundred four patients were studied, 700 were operated with DAA and 404 with LAT. No patient was lost to follow-up. PJI was diagnosed in 23/1104 (2.1 %) patients, 16 (2.3 %) in the group with DAA, and 7 (1.7 %) in the group with LAT. Patients with infection had a higher BMI (p < 0.001) and a higher ASA score (p < 0.001). Only patients with the DAA had exogenous PJI caused by gramnegative bacilli (35.7 % vs 0 %, p = 0.26). In the DAA-group, the fraction of patients with polymicrobial infection was somewhat higher than in the LAT-group (50 % vs 33 %, P = 0.64).ConclusionThere was no increased risk of infection for the DAA.

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Section: Discussioncontrasting

confidence: 64%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Ilchmann

Zimmerli

Bolliger

et al. 2016

BMC Musculoskelet Disord

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“…al. [24] noted a significantly shorter stay in hospital after the AMIS approach compared to the STD-Bauer approach. Yue et.…”

Section: Discussionmentioning

confidence: 99%

Influence of surgical approach on heterotopic ossification after total hip arthroplasty – is minimal invasive better? A case control study

Hürlimann

Schiapparelli

Rotigliano

et al. 2017

BMC Musculoskelet Disord

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BackgroundHeterotopic ossification (HO) is a well-known complication after total hip arthroplasty (THA).Recently, the trend is to operate THA minimally invasive being less traumatic than standard approaches and promising a faster return to activity. The purpose of the study was to investigate if minimal invasive surgery (MIS), leads also to less HO after THA.MethodsThis retrospective study included 134 consecutive patients undergoing THA. In 42 (31.3%) patients a standard modified anterolateral (STD-Watson-Jones), in 28 (20.9%) patients a standard transgluteal Bauer approach (STD-Bauer), in 39 (29.1%) a MIS direct anterior approach (AMIS) and in 25 (18.7%) patients a MIS anterolateral (MIS-AL) approach was used. Standard preoperative anterior-posterior and lateral radiographs were assessed for occurrence of HO. HO was classified according to Brooker. In addition, short- and long-term adverse events were noted. Data was statistically analyzed using Chi-square tests, analysis of variance, multivariate data analysis and Pearson’s correlation (p < 0.05).ResultsOverall, HO was found in 38 caucasian patients (28.4%) after THA. The STD-Watson-Jones group showed the highest HO rate (45.2% n = 19) with a significant difference to the AMIS (23.1% n = 9) and STD-Bauer approach (14.3% n = 4). No statistical difference was found to the MIS-AL approach (24.0% n = 6). Postoperative complications did not differ significantly except for a higher incidence of Trendelenburg`s sign in STD-Bauer.ConclusionsThe rate and degree of HO after THA were significantly different with regards to the surgical approach. The standard modified anterolateral approach resulted in the highest HO rate, however, MIS approaches showed higher HO rates than the STD-Bauer.

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Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know

Huppertz

Radmer²,

Wagner

et al. 2014

Skeletal Radiol

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The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning.

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Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study

Cited by 42 publications

References 27 publications

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Risk of infection in primary, elective total hip arthroplasty with direct anterior approach or lateral transgluteal approach: a prospective cohort study of 1104 hips

Influence of surgical approach on heterotopic ossification after total hip arthroplasty – is minimal invasive better? A case control study

Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know

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