Total hip arthroplasty via lateral approach in supine position.
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ABSTRACT:
SUBMITTER: Wang J
PROVIDER: S-EPMC6583161 | biostudies-literature | 2014 May
REPOSITORIES: biostudies-literature
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Total hip arthroplasty via lateral approach in supine position.
Orthopaedic surgery 20140501 2
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Project description:Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma, which is expected to result in improved recovery and rehabilitation. We presently perform total hip arthroplasty using minimally invasive techniques via an anterolateral modification of the Watson-Jones approach. This approach is performed in the supine position and requires sterile draping of both legs. It also involves a modified operative technique which preserves the pelvitrochanteric muscles and extends the release of the hip capsule. In order to employ a proven implant system (BICON-PLUS threaded cup, SL-PLUS stem), it was necessary to modify the stem rasps and use manipulation rasps as trial stems. In this report, we compare 50 conventional total hip replacements with 50 procedures performed using the minimally invasive procedure in terms of blood loss and the duration of the operation. The length of the skin incision varied between 7 and 12 cm with the minimally invasive technique, compared to 15 to 22 cm with the conventional procedure. Both groups were virtually identical with respect to average blood loss (haemoglobin on 10th post-operative day: minimally invasive group, 108.0 g/L; conventional group, 112.0 g/L) and the duration of the procedure (minimally invasive group, 60 minutes; conventional group, 58 minutes). The position of the implanted components correlated with the pre-operative planning with regard to medial head offset, centre of rotation of the hip, and leg length, and was as satisfactory as that observed with the conventional procedure. The complication rate was low (2.9%). Shaft fissures occurred in the first months of use of the minimally invasive procedure before adaptation of the shaft rasps. Dislocations were attributable to improper patient behaviour. Minimally invasive surgery via the anterolateral approach in the supine position was equivalent to the conventional procedure, had a low rate of complications, and did not adversely impact the technical success of the procedure.
| S-EPMC2267524 | biostudies-other
Project description:The two most common surgical approaches to total hip arthroplasty are the posterior approach and lateral approach. The surgical approach may influence cup positioning and restoration of the offset, which may affect the biomechanical properties of the hip joint. The primary aim was to compare cup position between posterior approach and lateral approach. Secondary aims were to compare femoral offset, abductor moment arm and leg length discrepancy between the two approaches. Eighty patients with primary hip osteoarthritis were included in a randomized controlled trial and assigned to total hip arthroplasty using posterior approach or lateral approach. Postoperative radiographs from 38 patients in each group were included in this study for measurement of cup anteversion and inclination. Femoral offset, cup offset, total offset, abductor moment arm and leg length discrepancy were measured on preoperative and postoperative radiographs in 28 patients in each group. We found that mean anteversion was 5° larger in the posterior approach group (95% CI, -8.1 to -1.4; p = 0.006), while mean inclination was 5° less steep (95% CI, 2.7 to 7.2; p<0.001) compared with the lateral approach group. The posterior approach group had a larger mean femoral offset of 4.3mm (95% CI, -7.4 to -1.3, p = 0.006), mean total offset of 6.3mm (95% CI, -9.6 to -3; p<0.001) and mean abductor moment arm of 4.8mm (95% CI, -7.6 to -1.9; p = 0.001) compared with the lateral approach group. We found a larger cup anteversion but less steep cup inclination in the posterior approach group compared with the lateral approach group. Femoral offset and abductor moment arm were restored after total hip arthroplasty using lateral approach but significantly increased when using posterior approach.
| S-EPMC5788339 | biostudies-literature
Project description:BackgroundAccurate cup placement during total hip arthroplasty (THA) is difficult because the intraoperative pelvic position changes even in supine patient position. We developed a device known as HipPointer; it corrects pelvic rotation and creates a functional pelvic plane as a reference. The aim of this study was to determine the device placement accuracy and investigate causes of error.Material and methodsHipPointer was used for cup placement in 353 hips of 308 patients who underwent direct-anterior-approach THA in supine position. The mean age at surgery and body mass index were 63.9 (17-90) years and 24.9 (16.6-42.0) kg/m2, respectively. The mean observation period was 40.5 (12-73) months. To investigate the accuracy of HipPointer, preoperative planning and postoperative cup placement angles relative to the functional pelvic plane were evaluated using a three-dimensional analysis software, and absolute errors were determined.ResultsThe means ± standard deviations of radiographic inclination (RI) and radiographic anteversion (RA) were 40.2 ± 3.0° and 15.8 ± 3.6°, respectively. The absolute errors of RI and RA were 2.2 ± 2.0° and 2.7 ± 2.3°, respectively. The ratio of the cup placement angle for which both RI and RA are ≤10° in the target zone was 99% (350/353 hips), and the ratio of the absolute errors for which both RI and RA are ≤5° was 80.4% (284/353 hips).ConclusionsHipPointer is simple in structure, easy to use, and useful for direct-anterior-approach THA in supine position. It provides good cup placement accuracy.
| S-EPMC9133511 | biostudies-literature
Project description:BackgroundSupercapsular Percutaneously Assisted total hip arthroplasty (SuperPATH approach) is a relatively new minimal invasive approach which has been associated with encouraging postoperative outcomes. The aim of this study is to compare the minimal invasive (MIS) SuperPATHapproach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data.Material and methodsForty eight (48) consecutive patients undergone primary total hip arthroplasty (THA) by the same surgeon (GD), were enrolled in our study. From this study population, the modified Hardinge approach was performed in 23 patients and the SuperPATH approach was performed in 25 patients. Soft tissue impairment was studied based on three representative markers, C-reactive-protein (CRP) and two enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH). We measured these markers 10 min after surgery, on 1st and 2nd postoperative day. The levels of the perceived pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS) score which was registered 6 h, 12 h, 1 day and 2 days postoperatively. The functional and clinical evaluation of the patients was achieved with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9) and neuropathic pain questionnaire (DN-4) 6 months and 1 year postoperatively. The rest of the collected data included patient's age, gender, body mass index (BMI), other comorbitities, the American Society of Anesthiologists score (ASA), Charlson Index score, the pre-operative diagnosis, implant positioning through radiographic evaluation, the type of anesthesia, the days of hospitalization, the operating time, incision length, blood loss and blood transfusion requirements and complication rates.ResultsSuperPATH approach was related with statistically considerable lower levels of CRP at 10 min (p = 0,001) and at 24 h (p = 0,047) postoperatively, as well as lower LDH levels in all time points postoperatively. It was also associated with shorter incision length (p < 0.001), longer operating time (p < 0.001), higher mean cup inclination p < 0.001, decreased postoperative pain levels the first 6 and 12 h (p < 0.001) and relatively better clinical and functional results 6 months after surgery, but not at 12 months.ConclusionOur study revealed some advantages in favor of the SuperPATH approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is required in order to further elucidate its efficacy.
| S-EPMC7476237 | biostudies-literature
Project description:BackgroundTo determine any differences in clinical outcomes between patients in the supine vs the lateral position during anterior-based muscle sparing (ABMS) total hip arthroplasty (THA).MethodsA retrospective review was performed of 368 patients undergoing THA via the ABMS approach (201 lateral vs 167 supine position) at our institution (2015-2019) with a minimum follow-up of 12 months. Inclusion criteria were all patients undergoing primary THA. Exclusion criteria were any revision surgeries and patients who did not undergo the ABMS THA. Outcomes assessed were postoperative complication rates, ambulation distance, length of stay, and Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and physical function scores at 3 time periods (preoperative, 3 months postoperative, and 1 year postoperative).ResultsThe supine group had significantly greater postoperative day 0 ambulation distance (150 vs 60 meters; P < .001), while no difference was observed on postoperative day 1 (210 meters in supine vs 200 in lateral; P = .921). Median length of stay was significantly shorter in the supine group (1; interquartile range 0-1) with respect to the lateral group (1; interquartile range 0-2; P < .001). The in-hospital complication rates (2.4% in supine vs 1.5% in lateral; P = .780), return to operating room rates (2.4% in supine vs 1.5% in lateral; P = .780), and readmission rates (5.4% in supine vs 5.0% in lateral; P = .631) were not significantly different between the groups. No significant differences were observed across any Western Ontario and McMaster Universities Osteoarthritis Index scores.ConclusionsBoth supine and lateral patient positioning provide acceptable early surgical outcomes, suggesting that satisfactory results can be obtained via both positions in THAs.
| S-EPMC11447336 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). However, few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment.MethodsHere, 127 hips (65 DAA, 62 PLA) were retrospectively evaluated. Early postoperative functional outcomes of DAA and PLA groups were assessed using Harris score and Oxford Hip Score (OHS) and standard anteroposterior hip radiographs. Surgical characteristics, perioperative results, and complications within 6 months postoperatively were recorded.ResultsThough baseline values were similar, Harris and OHS scores were better in the DAA group than in the PLA group at 1 and 3 months postoperatively. The average cup anteversion angle was significantly greater in the DAA group than in the PLA group (12.7° vs. 11.1°). More hips undergoing DAA were successfully orientated in both inclination and anteversion angles (46 vs. 32). Early postoperative hip function predictors were preoperative fused hip position, surgical approach, and range of motion. DAA was associated with reduced postoperative blood loss and shorter hospital stays. Furthermore, 14 vs. 8 complications occurred in the DAA vs. PLA group. Lateral femoral cutaneous nerve injuries were observed in eight hips (12.3%) of the DAA group.ConclusionFor fused or ankylosed hips, THA using DAA in the lateral decubitus position may result in excellent prosthesis positioning and faster postoperative recovery throughout early follow-up vs. PLA.
| S-EPMC8861463 | biostudies-literature
Project description:BackgroundNo reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA.MethodsOf 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients' subjective health status was categorized as "healthy" or "unhealthy". Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a "healthy" status.ResultsThe pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered "healthy". Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a "healthy" status.ConclusionPatients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered "healthy" have higher FJS and EQ-5D-5L scores.
| S-EPMC9617043 | biostudies-literature
Project description:Background and purpose - Criticism of the lateral approach (LA) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach (PA). However, there have been no controlled studies comparing patient-reported outcomes between them. In this randomized controlled trial, we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty (THA) with PA than in those who have undergone THA with LA, 12 months postoperatively. Patients and methods - 80 patients with hip osteoarthritis (mean age 61 years) were randomized to THA using PA or the modified direct LA. We recorded outcome measures preoperatively and 3, 6, and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) as the primary outcome. Secondary outcomes were HOOS-Pain, HOOS-Quality-Of-Life, EQ-5D, UCLA Activity Score, and limping. Results - We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up. All secondary outcomes showed similar results except for limping, where PA patients improved significantly more than LA patients. Interpretation - Contrary to our hypothesis, patients treated with PA did not improve more than patients treated with LA regarding physical function, pain, physical activity, and quality of life 12 months postoperatively. However, limping was more pronounced in the LA patients.
| S-EPMC5434589 | biostudies-literature
Project description:Lower limb amputation has been well characterized in the literature to cause resultant osteoarthritis in the hip of the contralateral limb. This further amplifies the already significant physical disability and morbidity that come with lower limb amputation. The use of total hip arthroplasty (THA) in patients with lower limb amputations is rare, with available literature subsequently also limited. In this case report, we describe a 52-year-old female with a right proximal femur (subtrochanteric) amputation who underwent left THA due to osteoarthritis. To our knowledge, this is the first published report describing THA, via direct anterior approach, in a patient with contralateral proximal femur (subtrochanteric) amputation. We discuss the complex surgical considerations for this patient population, selection of approach, prosthesis, and postoperative outcomes.
| S-EPMC11665467 | biostudies-literature
Project description:BackgroundLeg length discrepancy (LLD) after total hip arthroplasty (THA) is a clinical entity that deteriorates clinical outcomes and patients' satisfaction. Few articles have compared LLD after THA by different surgical approaches.MethodsA total of 358 consecutive patients who underwent primary THA between January 2016 and November 2018 were retrospectively reviewed. All 4 surgeons performed THA through both direct anterior approach (DAA) and posterior lateral approach (PLA). The primary outcome measurement was LLD. LLD was measured on post-operative anteroposterior bilateral hip radiograph. The secondary outcomes were acetabular abduction, acetabular anteversion, perceived LLD (pLLD) and HHS at 6 weeks, 1 year and 5 years. Intergroup analyses were performed using the Chi-square test for enumeration data and the independent sample t-test for quantitative data.ResultsThere was no inter-group difference in terms of patients' demographics. The DAA group had decreased LLD compared to the PLA group (3.0 ± 5.9mm vs. 4.2 ± 4.5mm, p = 0.027). Meanwhile, the DAA group had a smaller acetabular anteversion than the PLA group (12.9 ± 2.9 vs. 18.4 ± 2.9, p < 0.01). At 6-week follow-up, the DAA group had higher HHS (82.2 + 6.2 vs. 80.5 + 6.6, p = 0.015) and less pLLD (P = 0.001) compared to the PLA group.ConclusionsDAA results in more accurate leg length equalization, reduced pLLD, and improved short-term outcomes compared with PLA.
| S-EPMC11856386 | biostudies-literature