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DAA total hip arthroplasty

Y Ozaki, Y Homma, K Sano, T Baba, H Ochi, A Desroches, M Matsumoto, T Yuasa, K Kaneko
INTRODUCTION: Lateral femoral cutaneous nerve (LFCN) injury is a risk specific to the direct anterior approach (DAA) for total hip arthroplasty (THA). However, prevention strategies have not been established. This study aimed to identify the predisposing factors determining LFCN injury during THA via a DAA. HYPOTHESIS: Patients with LFCN injury after THA via DAA would demonstrate predisposing factors. MATERIAL AND METHODS: LFCN injury was identified using a patient questionnaire...
October 21, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Tze E Cheng, Jason A Wallis, Nicholas F Taylor, Chris T Holden, Paul Marks, Catherine L Smith, Michael S Armstrong, Parminder J Singh
BACKGROUND: We report a prospective randomized study comparing early clinical results between the direct anterior approach (DAA) and posterior approach (PA) in primary hip arthroplasty. METHODS: Surgeries were performed by 2 senior hip arthroplasty surgeons. Seventy-two patients with complete data were assessed preoperatively 2, 6, and 12 weeks postoperatively. The primary outcomes were the Western Ontario McMasters Arthritis Index and Oxford Hip Scores. Secondary outcome measures included the EuroQoL, 10-meter walk test, and clinical and radiographic parameters...
August 31, 2016: Journal of Arthroplasty
Z L Luo, M Chen, X F Shang, F Hu, Z Ni, P Cheng, X F Ji, K R Wu, X Q Zhang
Objective: To compare the clinical efficacy of the direct anterior approach (DAA) and the posterolateral approach (PLA) for total hip arthroplasty (THA) in the lateral decubitus position. Methods: From July to December, 2014, 104 patients randomly divided into two equal groups of the DAA group and the PLA group underwent unilateral primary THA procedures.All procedures were performed by the same surgeon in the Department of Orthopaedics, the Affiliated Anhui Provincial Hospital of Anhui Medical University.General data, perioperative index, postoperative function and radiological evaluation were recorded and statistically analyzed...
September 20, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Yannick N T Van Den Eeden, Bruno J G De Turck, Frank M C Van Den Eeden
Background and purpose - The length of stay after total hip arthroplasty has been reduced to 2-4 days after implementing fast-track surgery. We investigated whether a new time-based patient-centered primary direct anterior approach (DAA) total hip arthroplasty (THA) treatment protocol in a specialized clinic, with a planned length of stay of about 24 hours, could be achieved in all patients or only in a selected group of patients. Patients and methods - We analyzed prospectively collected data in a cohort of 378 consecutive patients who underwent a primary direct anterior THA as a patient-centered time-based procedure between March 1, 2012 and December 31, 2015...
September 23, 2016: Acta Orthopaedica
Timothy J Lin, Ilya Bendich, Alex S Ha, Benjamin J Keeney, Wayne E Moschetti, Ivan M Tomek
BACKGROUND: Radiographic outcomes after total hip arthroplasty (THA) have been linked to clinical outcomes. The direct anterior approach (DAA) for THA has been criticized by some for providing limited exposure and compromised implant position but allows for routine use of intraoperative fluoroscopy. We sought to determine whether radiographic measurements differed by THA approach using prospective cohorts. METHODS: Two reviewers blinded to surgical approach examined 194 radiographs, obtained 4-6 weeks after primary THA, and obtained measurements for acetabular inclination angle, acetabular anteversion, radiographic limb length discrepancy (LLD), and femoral offset...
August 10, 2016: Journal of Arthroplasty
Stijn G M Ghijselings, Ronald Driesen, Jean-Pierre Simon, Kristoff Corten
BACKGROUND: The direct anterior approach (DAA) is becoming more popular as the standard surgical approach for primary total hip arthroplasty. However, femoral complications of up to 2.8% have been reported. Therefore, it is important for surgeons to understand the periarticular neurovascular anatomy in order to safely deal with intraoperative complications. METHODS: Anatomic dissections were performed on 20 cadaveric hips. The neurovascular structures anterior to the femur and distal to the intertrochanteric line were dissected and its position was described in relation to anatomic landmarks easily identified through the DAA: anterior superior iliac spine (ASIS), the insertion of the gluteus minimus (GM), and the lesser trochanter (LT)...
July 15, 2016: Journal of Arthroplasty
Min Chen, Zhengliang Luo, Xiaofeng Ji, Peng Cheng, Guolin Tang, Xifu Shang
BACKGROUND: The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject. METHODS: A total of 248 patients (295 hips) were recruited for primary THAs from July 1, 2014 to December 31, 2014...
June 7, 2016: Journal of Arthroplasty
Yasuhiro Homma, Tomonori Baba, Hironori Ochi, Yu Ozaki, Hideo Kobayashi, Mikio Matsumoto, Takahito Yuasa, Kazuo Kaneko
BACKGROUND: The direct anterior approach (DAA) for the treatment of total hip arthroplasty (THA) has gained popularity in recent years. Chip fractures of the greater trochanter are frequently seen, but the risk factors for such fractures are unknown. The study aimed to identify the risk factors for chip fractures in patients undergoing primary THA by the DAA during the surgeons' learning curve. MATERIALS AND METHODS: From November 2011 to April 2015, the first experiences of three surgeons who performed 120 THAs by the DAA (120 hips; 40 cases per beginner surgeon) were included...
August 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Yasuhiro Homma, Tomonori Baba, Hideo Kobayashi, Asuka Desroches, Hironori Ochi, Yu Ozaki, Mikio Matsumoto, Takahito Yuasa, Kazuo Kaneko
PURPOSE: No previous reports have described the benefits and risks associated with the dual mobility cup (DMC) in primary THA via direct anterior approach (DAA). The aim of this study was to compare the safety and rate of early postoperative complication of the DAA with the DMC for THA with those of the DAA with a single standard cup, and to investigate the influence of the learning curve of the use of DMC on intra- and perioperative outcomes. METHODS: We retrospectively investigated 60 hips treated in the single-DAA group and 60 hips treated in the dual-DAA group...
August 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Kenneth H Jahng, Marcel A Bas, Jose A Rodriguez, H John Cooper
BACKGROUND: Previous studies have suggested that wound complications may be higher after direct anterior approach (DAA) hip arthroplasty, but, specific risk factors have not been closely examined. METHODS: We conducted a retrospective case-control study of 651 consecutive DAA hip arthroplasty surgeries performed by 2 surgeons over a 3-year period. Outcome measures included any postoperative wound problem (including prolonged drainage, wound dehiscence, wound necrosis, suture granuloma, and superficial infection) requiring additional intervention or reoperation...
May 6, 2016: Journal of Arthroplasty
I A Malek, G Royce, S U Bhatti, J P Whittaker, S P Phillips, I R B Wilson, J R Wootton, I Starks
AIMS: We assessed the difference in hospital based and early clinical outcomes between the direct anterior approach and the posterior approach in patients who undergo total hip arthroplasty (THA). PATIENTS AND METHODS: The outcome was assessed in 448 (203 males, 245 females) consecutive patients undergoing unilateral primary THA after the implementation of an 'Enhanced Recovery' pathway. In all, 265 patients (mean age: 71 years (49 to 89); 117 males and 148 females) had surgery using the direct anterior approach (DAA) and 183 patients (mean age: 70 years (26 to 100); 86 males and 97 females) using a posterior approach...
June 2016: Bone & Joint Journal
Richard L Purcell, Nancy L Parks, Jeanine M Gargiulo, William G Hamilton
BACKGROUND: The orthopedic literature documents that obesity can place patients at increased risk for complications. This is the first study to document the increased risk of infection in obese patients after direct anterior approach (DAA) primary total hip arthroplasty (THA). METHODS: We retrospectively evaluated 1621 consecutive primary THAs performed with a DAA. Patients were stratified by body mass index <35 kg/m(2) (group 1) or ≥35 kg/m(2) (group 2). Rates of postoperative infection requiring revision, superficial wound dehiscence, return to the operating room, and total wound complications were compared...
September 2016: Journal of Arthroplasty
Joseph D Maratt, Joel J Gagnier, Paul D Butler, Brian R Hallstrom, Andrew G Urquhart, Karl C Roberts
BACKGROUND: The direct anterior approach (DAA) for total hip arthroplasty (THA) has rapidly become popular, but there is little consensus regarding the risks and benefits of this approach in comparison with a modern posterior approach (PA). METHODS: A total of 2147 patients who underwent DAA THA were propensity score matched with patients undergoing PA THA on the basis of age, gender, body mass index, and American Society of Anesthesia classification using data from a state joint replacement registry...
September 2016: Journal of Arthroplasty
Krishna R Tripuraneni, Natalie R Munson, Michael J Archibeck, Joshua T Carothers
BACKGROUND: There is purported improvement in component positioning and hip stability with the use of direct anterior approach (DAA) total hip arthroplasty (THA). We sought to determine if there is a difference in acetabular component position or dislocation frequency between DAA and posterior THA. METHODS: One arthroplasty fellowship-trained surgeon introduced DAA THA into his practice. From the initiation of DAA in 4/2012-8/2015, this comparative series resulted in 66 DAA THAs...
October 2016: Journal of Arthroplasty
Fabrizio Rivera, Francesco Leonardi, Andrea Evangelista, Luca Pierannunzii
PURPOSE: The direct anterior approach (DAA) for total hip arthroplasty (THA) is claimed to be as effective but less invasive than the conventional posterior approach (PA). However, the higher risk of femoral fracture and soft tissue damage cannot be underestimated. The present authors believe that the difficult femoral exposure and the surgeon's knowledge of possible complications related to femoral preparation may result in a higher rate of undersized stems when compared to PA, even when a short femoral component is employed to minimise these risks...
May 16, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Mariska Wesseling, Christophe Meyer, Kristoff Corten, Jean-Pierre Simon, Kaat Desloovere, Ilse Jonkers
Several approaches may be used for hip replacement surgery either in combination with conventional total hip arthroplasty (THA) or resurfacing hip arthroplasty (RHA). This study investigates the differences in hip loading during gait one year or more after surgery in three cohorts presenting different surgical procedures, more specific RHA placed using the direct lateral (RHA-DLA, n=8) and posterolateral (RHA-PLA, n=14) approach as well as THA placed using the direct anterior (THA-DAA, n=12) approach. For the DAA and control subjects, hip loading was also evaluated during stair ascent and descent to evaluate whether these motions can better discriminate between patients and controls compared to gait...
February 2016: Gait & Posture
Yasuhiro Homma, Tomonori Baba, Hideo Kobayashi, Asuka Desroches, Yu Ozaki, Hironori Ochi, Mikio Matsumoto, Takahito Yuasa, Kazuo Kaneko
BACKGROUND AND PURPOSE: An encouraging result with direct anterior approach (DAA) is attractive for both patients and surgeons. However, the risks associated with beginning to use DAA require further analysis of the learning curve and better countermeasures to ensure safety. We ask whether the complication rate in the DAA by the inexperienced surgeon could be decreased with specific countermeasures. Our hypothesis was that the complication rate would be low even in early phase of the learning curve using the DAA with these particular countermeasures...
March 19, 2016: International Orthopaedics
Christopher L Pomeroy, J Bohannon Mason, Thomas K Fehring, John L Masonis, Brian M Curtin
BACKGROUND: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in the last decade with fluoroscopy often used to confirm implant position, leg length, and offset. Radiation exposure thresholds around 800 mGy are published for the risk of cataracts. We hypothesized that surgeon eye exposure during fluoro-assisted DAA total hip arthroplasty would be well below these published thresholds. METHODS: Three experienced orthopedic surgeons performed 30 consecutive fluoro-assisted DAA THAs...
August 2016: Journal of Arthroplasty
Brian M Curtin, Lucas C Armstrong, Brandon T Bucker, Susan M Odum, William A Jiranek
BACKGROUND: This study sought to quantify the total patient radiation exposure during fluoro-assisted direct anterior approach (DAA) total hip arthroplasty (THA). We hypothesized that the patient radiation exposure would fall within acceptable published limits for a 1-time patient exposure. METHODS: After institutional review board approval, we performed a retrospective chart review of consecutive unilateral primary DAA THAs at 2 institutions (N = 157) between 2012 and 2014 by a single fellowship-trained arthroplasty surgeon assisted by residents and fellows...
June 2016: Journal of Arthroplasty
Chen Yue, Pengde Kang, Fuxing Pei
The direct anterior approach (DAA) to total hip arthroplasty has been promoted as a minimally invasive alternative to the lateral approach, which we sought to verify by systematically reviewing and meta-analyzing the literature comparing clinical, radiographic, and surgical outcomes. Two reviewers independently searched PubMed, OVID, and Web of Science databases for randomized controlled trials (RCTs) and cohort studies comparing the DAA and lateral approach for total hip arthroplasty. Quality of RCTs was assessed using the Jadad scoring system, quality of cohort studies, using the Minors system...
December 2015: Medicine (Baltimore)
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