Surgical Approaches of the Hip

Kenanidis, Eustathios; Rigkos, Dimitrios; Paparoidamis, Georgios; Yfantis, Aristotelis; Gamie, Zakareya; Tsiridis, Eleftherios; Feldstein, Michael J.; Hozack, William J.

doi:10.1007/978-3-319-64177-5_2

Cited by 2 publications

(7 citation statements)

References 41 publications

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“…All patients were positioned in the lateral decubitus position. 7 The skin incision for SPA began 5 cm distal to the greater trochanter; it was centred on the femoral diaphysis up to the greater trochanter, where it curved toward the posterior superior iliac spine for 6–8 cm. The fascia lata and iliotibial band were then incised, and the muscle fibres of the gluteus maximus were bluntly split down to the short external rotators.…”

Section: Methodsmentioning

confidence: 99%

“…The SER, quadratus femoris, and capsule were tenotomised at their insertion into the greater trochanter. 7 At the end of the operation, the SER and the capsule were repaired with absorbable sutures. DSA has been previously described in detail.…”

Section: Methodsmentioning

confidence: 99%

“…Preparation of acetabulum and femur and implantation was performed with standard non-offset instruments. 1,7 During femoral preparation, the hip was placed in flexion, adduction, internal rotation, and knee flexion of 90° with the tibia vertical. A blunt Hohmann was positioned under the anterior femoral neck to lift the femur and the second on the calcar to retract muscles away.…”

Section: Methodsmentioning

confidence: 99%

“…Once the definite implants were positioned, the capsular flap was repaired first, followed by the musculotendinous flap with tagging sutures passing through a transosseous channel made in the greater trochanter and lower part of GMed. 1,7…”

Section: Methodsmentioning

confidence: 99%

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Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study

et al. 2022

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Background: The direct superior hip approach (DSA) has been less researched than other approaches in the literature. We retrospectively compared the early postoperative and functional outcomes of patients with hip osteoarthritis undergoing total hip arthroplasty (THA) via DSA with a matched control group using a standard posterior approach (SPA). Methods: The DSA group comprised 100 THAs performed via DSA by a senior surgeon between January 2018 and May 2019. Patients with primary osteoarthritis and ASA score ⩽3 who were eligible for surgery were included. The DSA group was compared to a matched cohort of 100 patients operated on with a SPA in the same period by another chief surgeon. Patients were matched for age, sex, and ASA score. All patients received the same postoperative chemoprophylaxis, pain management and physiotherapy. 2 independent attending arthroplasty surgeons assessed the incision length, operative time, blood loss, hospital stay, and complications. VAS, HHS, and HOOS scores were also evaluated for a year postoperatively. Results: Mean incision length and hospital stay were significantly lower in the DSA group. DSA patients had non-significantly lower intraoperative blood loss, transfusion needs, and postoperative pain than SPA patients. Mean operation time and complication rate did not differ between groups. The DSA group demonstrated significantly greater functional scores than the SPA group at the first postoperative month. No differences in scores were recorded following the third month. Conclusions: The DSA approach may provide earlier functional recovery and hospital discharge for THA patients compared with SPA. DSA was equivalent to SPA concerning pain and blood loss, showing minimal complication rates.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study

et al. 2022

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“…The ideal hip approach for total hip arthroplasty (THA) should be simple, muscle-sparing, providing unimpeded exposure and rapid, painless recovery with a minimal hospital stay [ 1 – 3 ]. The Direct Superior approach (DSA) is a minimally invasive (MIS) hip approach, protecting the iliotibial band and quadratus femoris but not the piriformis (PF) and the other short external rotators (SERs) [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Superior Transverse Atraumatic Reconstruction (STAR) approach provides a better-compared outcome to standard Direct Superior Approach (DSA): a matched, prospective comparative single-surgeon study

Kenanidis

Milonakis

Georgios

et al. 2023

SICOT-J

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Introduction: The Direct Superior Approach (DSA) is a muscle-sparing hip approach that does not protect the piriformis and the other short external rotators. We present a DSA modification we named STAR (Superior Transverse Atraumatic Reconstruction), which has DSA advantages but always preserves piriformis. Our study compared the early postoperative, radiological, and functional results of patients undergoing primary total hip arthroplasty (THA) through the STAR approach with a matched DSA group performed by a senior surgeon. Methods: Each group, DSA, and STAR included 200 elective primary unilateral THAs performed by the surgeon between 2016–2017 and 2020–2021, respectively. Patients were included in both groups using the same inclusion criteria. Both groups were matched for age and sex. The same postoperative pain management, chemoprophylaxis, and physiotherapy protocols were followed in both groups. Two independent orthopaedic surgeons performed the clinical and radiological follow-up. Results: The STAR group had significantly lower mean incision length (p = 0.042) and hospital stay (p = 0.002) than the DSA group. The mean intraoperative blood loss (p = 0.085) and the need for blood transfusion (p = 0.228) were less for the STAR than the DSA group. The mean postoperative functional scores improvement was significantly higher for the STAR than the DSA group at the end of the first and third postoperative months. Conclusions: The STAR approach offers earlier functional improvement, shorter hospital stay and less transfusion need than DSA for patients undergoing primary THA. Both approaches showed a limited complication risk and an outstanding acetabular and femoral access enabling the procedure.

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Surgical Approaches of the Hip

Cited by 2 publications

References 41 publications

Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study

Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study

Superior Transverse Atraumatic Reconstruction (STAR) approach provides a better-compared outcome to standard Direct Superior Approach (DSA): a matched, prospective comparative single-surgeon study

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