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Direct anterior hip arthroplasty

Brian P Gladnick, John L Masonis
Release of the conjoined tendon has been reported to facilitate femoral exposure during a direct anterior hip approach. However, the authors are not familiar with any description of an anterior approach repair technique for this important structure. Conjoined tendon repair is commonly performed in the posterior approach to help preserve hip biomechanics and restore anatomic tissue planes. The authors describe their algorithm for sequential soft tissue releases to facilitate femoral exposure and a technique for repairing the insertion of the conjoined tendon after it has been released for exposure during the direct anterior approach...
June 18, 2018: Orthopedics
Sherif Dabash, Leticia C Barksdale, Colin A McNamara, Preetesh D Patel, Juan C Suarez
The purpose of this study is to determine the effectiveness of tranexamic acid (TXA) alone and in conjunction with a bipolar sealer in reducing postoperative transfusions during direct anterior (DA) total hip arthroplasty (THA).In this retrospective review, we analyzed 173 consecutive patients who underwent primary unilateral DA THA performed by 2 surgeons during a 1-year period. Subjects were divided into 3 groups based on TXA use: 63 patients received TXA alone (TXA group), 49 patients received TXA in addition to a bipolar sealer (TXA + bipolar sealer group), and 61 patients received neither TXA nor a bipolar sealer (control group)...
May 2018: American Journal of Orthopedics
Eugene S Jang, James D Lin, Roshan P Shah, Jeffrey A Geller, H John Cooper
Intraoperative fluoroscopy can improve the precision of acetabular component positioning during direct anterior hip arthroplasty. However, changes in pelvic tilt with c-arm positioning may compromise accuracy. A geometric model of an acetabular component's projection onto fluoroscopy images was created and manipulated to simulate c-arm tilt. An apparently ideally-placed cup will have its effective anteversion changed by 7.5° with just 10° of caudal/cephalad tilt of the c-arm. This effect is greater in cups that are more horizontally placed or less anteverted...
June 2018: Journal of Orthopaedics
Takahito Yuasa, Katsuhiko Maezawa, Hironobu Sato, Yuichiro Maruyama, Kazuo Kaneko
Purpose: We compare the complication rate in transition to direct anterior (DAA) from posterior approach (PA) for total hip arthroplasty (THA). Methods: This is a retrospective cohort single-surgeon study of consecutive primary THAs over a transition period from PA to DAA. Results: There were no significant differences in dislocation rate, femoral fracture, lateral femoral cutaneous nerve injury or success rate in cup inclination and anteversion angle between two groups...
June 2018: Journal of Orthopaedics
Ronen Debi, Evyatar Slamowicz, Ornit Cohen, Avi Elbaz, Omri Lubovsky, Dror Lakstein, Zachary Tan, Ehud Atoun
BACKGROUND: Total hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches...
June 8, 2018: BMC Musculoskeletal Disorders
Sun-Jung Yoon, Myung-Sik Park, Dean K Matsuda, Yun Ho Choi
BACKGROUND: Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery...
June 4, 2018: BMC Musculoskeletal Disorders
Dragan Radoicic, Vladimir Zec, Walaa Ikram Elassuity, Mostafa Abdelmaboud Azab
PURPOSE: Total hip arthroplasty approach comparison focused on patient's perspective. The direct anterior approach (DAA) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome. However, the question if the level of DAA promotion is justified seems to be rarely posed. METHODS: A single-surgeon consecutive series of patients who underwent bilateral THA, one in DAA and the other in posterior approach (PA)...
June 1, 2018: International Orthopaedics
Ryan S Patton, Robert P Runner, Riley J Lyons, Thomas L Bradbury
BACKGROUND: Direct anterior total hip arthroplasty (THA) is an increasingly utilized and patient-requested approach for arthroplasty carrying a unique set of complications. Injury to the lateral femoral cutaneous nerve (LFCN) can have a wide range of clinical symptoms ranging from hypesthesia to painful paresthesia. Long-term effects of this injury have not been well studied. We describe duration and severity of these symptoms and correlate their relationship with hip functional scores...
April 24, 2018: Journal of Arthroplasty
Ziqi Zhang, Chunsheng Wang, Pei Yang, Xiaoqian Dang, Kunzheng Wang
Objective: To compare the early rehabilitation effects of total hip arthroplasty (THA) with direct anterior approach (DAA) versus posterior approach (PA). Methods: A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups ( P >0...
March 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
R S Camenzind, K Stoffel, N J Lash, M Beck
SURGICAL PRINCIPLE AND OBJECTIVE: The direct anterior approach for total hip arthroplasty is associated with higher complication rates and difficult femoral component positioning. Performing a modified technique in the lateral position allows secure component positioning. INDICATIONS: Primary hip replacement (including femoral neck fracture) and cup revision without bone deficiency. CONTRAINDICATIONS: Destruction/deformities of proximal femur or acetabulum, bone deficiency or malignancy...
May 25, 2018: Operative Orthopädie und Traumatologie
Yanfeng Tang, Hongjun Li, Youwen Liu, Yuxia Yang, Wuyin Li, Hongmin Cai
Objective: To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Methods: Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases...
October 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Dawei Gong, Yunkang Yang, Yiran Yin, Ge Chen
Objective: To compare the effectiveness of one-stage bilateral total hip arthroplasty by direct anterior approach (DAA) and by posterolateral approach, and to investigate the application value of DAA in one-stage bilateral total hip arthroplasty. Methods: The clinical data of 65 patients who underwent one-stage bilateral total hip arthroplasty by DAA or posterolateral approach between June 2010 and November 2015 were analyzed retrospectively. DAA was used in 34 cases (group A) and posterolateral approach was used in 31 cases (group B)...
September 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Libo Zhu, Jinzhong Ma, Weilin Sang, Haiming Lu, Cong Wang, Yafei Jiang
Objective: To retrospectively compare the mid-term effectiveness between by direct anterior approach (DAA) and by posterolateral approach in total hip arthroplasty (THA). Methods: Between January 2009 and December 2010, 110 patients (110 hips) treated with THA and followed up more than 5 years were chosen in the study. THA was performed on 55 patients by DAA (DAA group), and on 55 patients by posterolateral approach (PL group). There was no significant difference in gender, age, body mass index, types of hip joint disease, and preoperative Harris score between 2 groups ( P >0...
September 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Yu Liu, Weilin Sang, Yafei Jiang, Jinzhong Ma
Objective: To compare the differences in acetabular position during total hip arthroplasty (THA) between by direct anterior approach and by posterolateral approach. Methods: Between December 2008 and December 2015, 102 patients undergoing THA were included in the study. THA was performed by anterior approach in 51 cases (anterior group) and by posterolateral approach in 51 cases (posterolateral group). There was no significant difference in gender, age, body mass index, side, and cause of illness between 2 groups ( P >0...
July 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Hannes A Rüdiger, Benjamin Fritz, Franco M Impellizzeri, Michael Leunig, Christian W Pfirrmann, Reto Sutter
BACKGROUND: Anatomical landmarks for templating of total hip arthroplasty (THA) that are visible both during surgery and on radiographs are rare. If surgery is performed through a direct anterior approach the external obturator tendon (EO) is consistently visible. To use this point as a reference the exact position and dimensions of the footprint need to be known. AIM: To determine the location and dimension of the EO footprint on pelvic radiographs by correlating the EO anatomy in CT scans with conventional radiographs...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Bryn O Zomar, Dianne Bryant, Susan Hunter, James L Howard, Edward M Vasarhelyi, Brent A Lanting
INTRODUCTION: Total hip arthroplasty (THA) is a successful procedure for relieving symptoms of severe osteoarthritis. Surgical approach is a key factor in early recovery and although controversial, little has been written about the direct anterior (DA) approach using objective early measures. METHODS: 78 participants were prospectively enrolled to undergo a THA through either a DA or direct lateral (DL) surgical approach. Outcome measures were collected preoperatively and at discharge from the hospital, and 2-, 6- and 12-weeks...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Thom E Snijders, Koen Willemsen, Steven M van Gaalen, Rene M Castelein, Harrie Weinans, Arthur de Gast
INTRODUCTION: Dislocation is one of the main reasons for revision of total hip arthroplasty but dislocation rates have not changed in the past decades, compromising patients' well-being. Acetabular cup orientation plays a key role in implant stability and has been widely studied. This article investigates whether there is a consensus on optimal cup orientation, which is necessary when using a navigation system. METHODS: A systematic search of the literature in the PubMed, Embase and Cochrane databases was performed (March 2017) to identify articles that investigated the direct relationship between cup orientation and dislocation, including a thorough evaluation of postoperative cup orientation assessment methods...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Sean A Sutphen, Keith R Berend, Michael J Morris, Adolph V Lombardi
Debate continues over the direct anterior (DA) approach. The purpose of this study is to compare the frequency of deep infection between a DA approach and a less invasive direct lateral (LIDL) approach in a large consecutive series of primary total hip arthroplasty (THA). The authors identified 5702 primary THAs performed between 2007 and 2014. DA approach was used in 3540 hips and LIDL in 2162. Patient records were reviewed. Statistical analysis of reoperation, infection- or wound-related complication, and deep infection was performed...
2018: Journal of Surgical Orthopaedic Advances
Jules Bernard, Fredson Razanabola, Julien Beldame, Stéphane Van Driessche, Helena Brunel, Thomas Poirier, Jean Matsoukis, Fabien Billuart
BACKGROUND: The functional and clinical benefit of minimally invasive total hip arthroplasty (THA) is well-known, but the literature reports impaired gait and posture parameters as compared to the general population, especially following use of the anterior minimally invasive approach, which has more severe impact on posture than the posterior approach. The reasons for this impairment, however, remain unexplained. We therefore conducted a surface electromyography (sEMG) study of the hip muscles liable to be affected by arthroplasty surgery: gluteus maximus (GMax), gluteus medius (GMed, tensor fasciae latae (TFL), and sartorius (S)...
May 10, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Christophe Tissot, Matthias Vautrin, Anais Luyet, Olivier Borens
INTRODUCTION: Compared to a lateral or posterior approach (PA), the direct anterior approach (DAA) does permit a better muscle preservation for total hip arthroplasty (THA). However, there is concern whether this advantage come with increased wound complication and infection leading to reoperation or sometimes major procedures. METHOD: We retrospectively reviewed all patients who underwent primary THA through the PA between January 2009 and April 2013 ( n = 796) and through the DAA between January 2011 and April 2013 ( n = 399) at our institution with a minimum of 2 years follow up regarding all wound complications and all infections...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
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