“Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty

Allison, Daniel C.; Menendez, Lawrence R.; Brien, W W; McTighe, Timothy

doi:10.15438/rr.5.3.122

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…In addition, the lack of difference in patient demographics between the 2 techniques suggest that the DAA can be performed safely in similar patient populations with or without a traction table. Despite the purported advantages of traction table DAA in male patients with high BMI, 15 this review finds that patients selected for traction versus standard table are similar in terms of age, sex, and BMI. Perioperative outcomes seem to favour standard table DAA.…”

Section: Discussionmentioning

confidence: 87%

“…[7][8][9][10][11][12][13][14] THA through the DAA was originally performed on a specialised traction/fracture table (traction table) but can also be performed on a standard operating room table (standard table). Benefits of the standard table approach include enabling preparation of the entire operative limb in the surgical field, providing improved control and feel of the limb; 15 and potentially allowing for easier intraoperative testing of leg-length and stability. Furthermore, the standard table approach may add some benefit in reducing intraoperative femoral fracture, a known complication of the DAA, by preventing transmission of excessive forces to the bone.…”

Section: Introductionmentioning

confidence: 99%

“…16 Traction table benefits include decreased need for assistants in facilitating challenging exposures and ease of intraoperative imaging. 15 Given that traction tables are not universally available and cost from $100,000 to $200,000+ CAD (Canadian Dollars), it is certainly worth evaluating their use in order to understand the differences between these techniques. 17 With the current lack of literature comparing them, the choice of DAA operative table is largely dictated by surgeon preference alone.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

et al. 2020

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Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. Methods: The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Results: Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table ( n = 4402) and 100.1 ± 32.6 minutes for traction table ( n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard ( n = 2992) and 531.7 ± 364.3 mL for traction table ( n = 2675). Intra-operative fracture rate was 1.3% for standard table ( n = 3940) and 1.7% for traction table ( n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Conclusion: Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

et al. 2020

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“…27 Although novel PROMs including FJS-12 and PJP are becoming more popular, there are limited studies with which to compare findings along these variables. [27][28][29][30][31][32][33][34][35][36][37][38][39] Although novel PROMs including FJS-12 and PJP are becoming more popular, there are limited studies with which to compare findings along these scales. [27][28][29][30][31][32][33] Our study has included a wide variety of PROMs to serve as a standard to compare existing data and as a baseline for the evolving trends.…”

Section: Discussionmentioning

confidence: 99%

Good long-term outcomes for Direct Anterior Approach Total Hip Arthroplasty in South Africa

Pietrzak

Maharaj

Cakic

2020

Journal of Orthopaedics

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“…To the best of our knowledge, no studies to date have specifically addressed the appropriate utilization of the DAA for THA in a PYA population, and therefore we reviewed our DAA cases separately from other approaches to define our technique and examine trends in that practice. All DAA cases were performed by a single surgeon with over 10 years of DAA experience (Daniel C. Allison) using the technique published by Allison et al 8 Both lower extremities were prepped into the surgical field to help optimize intraoperative limb length assessment. The standard DAA interval was utilized, with the Heuter modification to remain outside of the sartorial sheath.…”

Section: Surgical Techniquementioning

confidence: 99%

Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience

Whitmarsh-Brown

Christ

Lin

et al. 2023

Journal of Pediatric Orthopaedics

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Introduction: Pediatric hip disorders represent a broad range of pathology and remain a significant source of morbidity for children and young adults. Surgical intervention is often required for joint preservation, but when salvage is not possible, joint replacement may be indicated to eliminate pain and preserve function. Although there have been significant updates in the management of both pediatric hip disease and the field of total hip arthroplasty (THA), there is a paucity of literature reflecting advancements in the area of pediatric and young adult (PYA) arthroplasty. No study has investigated the impact of approach on outcomes after PYA THA. The purpose of this study is to describe the indications, techniques, and early outcomes of THA in the PYA population in a modern practice setting. Methods: We performed a retrospective descriptive analysis of all patients undergoing primary THA performed at a tertiary care children’s hospital from 2004 to 2019. Ninety-three hips in 76 patients were evaluated. Demographics, intraoperative variables, postoperative pain and function ratings, and complication and revision rates were collected. Results: Eighty-five hips in 69 patients were included. Patients were aged 12 to 23 years old, with males and females represented equally (33 vs. 36, respectively). The most common cause of hip pain was avascular necrosis (AVN, 56/85, 66%), most commonly due to slipped capital femoral epiphysis (13/56, 23%) idiopathic AVN (12/56, 21%), and chemotherapy (12/56, 21%). Half of all hips had been previously operated before THA (43/85). Thirty-six procedures were performed via the posterolateral approach (36/85, 42%), 33 were performed via direct anterior approach (33/85, 39%), and 16 were performed via the lateral approach (LAT, 16/85, 19%). At final follow-up, 98% (83/85) of patients had complete resolution of pain, 82% (70/85) had no notable limp, and 95% (81/85) had returned to all activities. There were 6 complications and 1 early revision. Average Hip disability and Osteoarthritis Outcomes Score for Joint Replacement scores increased by 37 points from 56 to 93. The overall revision-free survival rate for PYA THA was 98.8% (at average 19-mo follow-up). Conclusions: Modern PYA THA is dissimilar in indications and surgical techniques to historic cohorts, and conclusions from prior studies should not be generalized to modern practice. In our practice, PYA patients most commonly carry a diagnosis of AVN, and THA can be performed with modern cementless fixation with large cup and head sizes and ceramic-on-cross-linked polyethylene bearings utilizing any approach. Further study is required to better characterize middle-term and long-term results and patient-reported outcomes. Level of Evidence: Therapeutic Level IV—retrospective case series.

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“Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty

Cited by 3 publications

References 6 publications

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Good long-term outcomes for Direct Anterior Approach Total Hip Arthroplasty in South Africa

Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience

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