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Direct anterior hip replacement

Brent A Lanting, Kirk C Hartley, Adam J Raffoul, Timothy A Burkhart, Lyndsay Sommerville, Glynn R Martin, James L Howard, Marjorie Johnson
INTRODUCTION: The direct anterior approach for total hip replacements has reported advantages of improved early function and muscle preservation. In an effort to improve healing and cosmesis, a change in the orientation of the incision has been proposed. Traditionally, the skin incision is in-line with the tensor fasciae latae muscle belly. The bikini incision is orthogonal to this orientation. The hypothesis was that muscle damage would be increased by using the bikini incision. METHODS: A traditional or bikini incision was performed on 18 cadaveric hips...
February 6, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Michael Wyatt, Jan Weidner, Dominik Pfluger, Martin Beck
BACKGROUND: The RM Pressfit vitamys is a titanium particle-coated monoblock cup with vitamin E stabilised highly cross-linked polyethylene. Initial fixation is achieved via press-fit with subsequent stability by bone on-growth. This is the first study to report the 5-year results of this design. METHODS: We performed a prospective cohort study according to STROBE guidelines of 100 consecutive total hip replacements (THRs) in 92 patients all with ceramic heads. Demographic data, pre/postoperative visual analogue scale (VAS) for pain and satisfaction, Harris Hip Scores (HHS) and complications were recorded...
January 20, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Udai S Sibia, Timothy R Turner, James H MacDonald, Paul J King
BACKGROUND: This study examines patient and surgeon reported outcome measures, complications during index admission, length of stay (LOS), and discharge disposition in a series of total hip replacements (THR) performed via the direct anterior (DA) or posterolateral (PL) approach. METHODS: Five surgeons performed 2698 total hip replacements (1457 DA vs 1241 PL) between January 2010 and June 2015. Complications during index admission were recorded using billing and claims data...
November 1, 2016: Journal of Arthroplasty
Thomas Ilchmann, Werner Zimmerli, Lilianna Bolliger, Peter Graber, Martin Clauss
BACKGROUND: The 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). METHODS: All patients operated between 08/2006 and 12/2013 were followed prospectively in an in house register...
November 14, 2016: BMC Musculoskeletal Disorders
Jetse Jelsma, Rik Pijnenburg, Harm W Boons, Peter J M G Eggen, Lucas L A Kleijn, Herman Lacroix, Hub J Noten
BACKGROUND: Since years a discussion is held on the best approach to perform total hip replacement (THR). Risk of dislocation, abductor weakness and a possible difference in rehabilitation are mentioned. We performed this study to objectify that the use of the direct anterior approach (DAA) results in a faster rehabilitation after THR compared to the non-DAA (posterolateral and anterolateral) approach. METHODS: A single centre prospective cohort study was conducted...
March 2017: Journal of Orthopaedics
Julia R Dahlqvist, Christoffer R Vissing, Gitte Hedermann, Carsten Thomsen, John Vissing
PURPOSE: The aims of this study were to investigate the age-related changes in fatty replacement and cross-sectional area (CSA) of cervical, thoracic, and lumbar paraspinal muscles versus leg muscles in healthy adults and to test for association between muscle fat fraction and lifestyle factors. METHODS: Fifty-three healthy adults (24-76 yr) were included. Dixon magnetic resonance imaging technique was used to determine CSA and to quantify the fat fraction of paraspinal and leg muscles...
March 2017: Medicine and Science in Sports and Exercise
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...
February 2017: Acta Orthopaedica
Csaba Forster-Horvath, Noah von Rotz, Brian D Giordano, Benjamin G Domb
PURPOSE: To perform a systematic review comparing outcomes of labral debridement/segmental resection with labral reconstruction as part of a comprehensive treatment strategy for femoroacetabular impingement. METHODS: A systematic review was conducted according to established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using defined inclusion and exclusion criteria. The study groups were divided into labral debridement/segmental resection (group 1) and labral reconstruction (group 2)...
July 27, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Yasuharu Nakashima, Takuaki Yamamoto, Jun-Ichi Fukushi, Goro Motomura, Satoshi Hamai, Yusuke Kohno, Yukihide Iwamoto
BACKGROUND: Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. METHODS: This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads...
November 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
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
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
Maximilian Rudert, Konstantin Horas, Maik Hoberg, Andre Steinert, Dominik Emanuel Holzapfel, Stefan Hübner, Boris Michael Holzapfel
BACKGROUND: The key for successful delivery in minimally-invasive hip replacement lies in the exact knowledge about the surgical anatomy. The minimally-invasive direct anterior approach to the hip joint makes it necessary to clearly identify the tensor fasciae latae muscle in order to enter the Hueter interval without damaging the lateral femoral cutaneous nerve. However, due to the inherently restricted overview in minimally-invasive surgery, this can be difficult even for experienced surgeons...
February 3, 2016: BMC Musculoskeletal Disorders
Keith P Connolly, Atul F Kamath
The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval between the tensor fasciae latae and sartorius muscles. Recent increased interest in tissue-sparing and minimally-invasive arthroplasty has given rise to a sharp increase in the utilization of direct anterior total hip arthroplasty. A number of variations of the procedure have been described and several authors have published their experiences and feedback to successfully accomplishing this procedure...
January 18, 2016: World Journal of Orthopedics
K Benad, C Delay, S Putman, J Girard, G Pasquier, H Migaud
Iliopsoas irritation due to acetabular cup component impingement following total hip arthroplasty (THA) is usually treated by infiltration or by distal iliopsoas tenotomy in case of recurrence; however, this can result in an active flexion deficit of the thigh. To prevent this complication, we developed an original technique that we performed between 2012 and 2014 in patients with recurrent impingement following extraarticular corticosteroid injections. This included 5 patients (mean age: 64 [53-75] years old) in whom we performed an ambulatory bursectomy by the Hueter approach and placed a polyglactin 910 (Vicryl™) mesh plate on the entire anterior hip capsule...
December 2015: Orthopaedics & Traumatology, Surgery & Research: OTSR
Shanika Arachchi, Rocco P Pitto, Iain A Anderson, Vickie B Shim
BACKGROUND: Computational models in the form of finite element analysis technique that incorporates bone remodeling theories along with DEXA scans has been extensively used in predicting bone remodeling patterns around the implant. However, majority of such studies used generic models. Therefore, the aim of this study is to develop patient-specific finite element models of total hip replacement patients using their quantitative computed tomography (QCT) scans and accurately analyse bone remodelling patterns after total hip arthroplasty (THA)...
August 2015: Quantitative Imaging in Medicine and Surgery
Rami Madanat, Daniel K Hussey, Gabrielle S Donahue, Hollis G Potter, Robert Wallace, Charles Bragdon, Orhun Muratoglu, Henrik Malchau
BACKGROUND: Adverse local tissue reactions (ALTRs) around hip arthroplasties are an important reason for failure of metal-on-metal (MoM) hip implants. Little is known about capsular dehiscence patterns as ALTRs decompress from the hip into the surrounding tissue planes; these patterns may also influence the onset and severity of patient symptoms. QUESTIONS/PURPOSES: Through a multicenter study approach, we asked: (1) Is ALTR location related to the surgical approach used for arthroplasty in patients who underwent hip arthroplasty (resurfacing or THA) with a single, recalled hip arthroplasty system? (2) Do ALTR severity and location affect patient-reported outcomes in these patients? (3) Is ALTR severity different between patients who received the resurfacing version of this component (Articular Surface Replacement [ASR]) and those who received the THA implant in this system (ASR XL)? METHODS: In a multicenter prospective study of patients who had undergone surgery with use of the ASR and ASR XL hip system (DePuy Orthopaedics, Warsaw, IN, USA), 288 patients (333 hips) from two centers had a metal artifact reduction sequence MRI of the hip performed at a mean time of 6 years postsurgery...
January 2016: Clinical Orthopaedics and related Research
Andrea Colli, Roberto Bellu, Demetrio Pittarello, Gino Gerosa
A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). The TOP-MINI procedure was performed under general anaesthesia and transoesophageal echocardiographic guidance...
October 2015: Interactive Cardiovascular and Thoracic Surgery
Weifeng Ji, Nathaniel Stewart
PURPOSE: Acetabular component position is important for stability and wear. Fluoroscopy can improve the accuracy of acetabular component placement in the posterior approach and the direct anterior approach (DAA). The purpose of this study was to determine if the direct anterior approach in the supine position facilitates the accurate use of fluoroscopy and improves acetabular component position. METHODS: This retrospective, comparative study of 60 THAs with fluoroscopic guidance (30 in posterior approach group and 30 in DAA group) was performed by one surgeon from 2012 to 2014 at a single institution...
January 2016: International Orthopaedics
Dhiren Sheth, Guy Cafri, Maria C S Inacio, Elizabeth W Paxton, Robert S Namba
BACKGROUND: Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. QUESTIONS/PURPOSES: (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? METHODS: The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011...
November 2015: Clinical Orthopaedics and related Research
Rohith Mohan, Paul H Yi, Erik N Hansen
We evaluated the quality of information available on the Internet regarding the direct anterior approach (DAA). The top 50 Web sites from three major search engines (Google, Yahoo!, and Bing) were tabulated utilizing the search term direct anterior hip replacement. Of these, only 22% were authored by a hospital/university, while 60% were by a private physician/clinic. Most Web sites presented the DAA as "better" than other surgical approaches describing benefits, such as accelerated recovery though only 35% described risks of the approach...
May 2015: Journal of Arthroplasty
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