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Ongkosit C, Kosuwon W. Direct Anterior Approach "No Trial Reduction Technique" in Bipolar Hemiarthroplasty for Treatment of Osteoporotic Femoral Neck Fracture: Surgical Techniques and Case Series. Orthopedics 2025; 48:74-78. [PMID: 39622072 DOI: 10.3928/01477447-20241127-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
Bipolar hemiarthroplasty (BHA) for osteoporotic femoral neck fractures has a risk of proximal femoral fracture during trials, especially with larger trial bipolar shells. This study introduces a novel technique for BHA via the direct anterior approach, aiming to reduce trial use and lower the risk of iatrogenic femoral fractures. The "no trial reduction technique" involves positioning only the trial neck segment against the acetabulum's me-dial wall, without the bipolar shell and trial head. Fluoros-copy measures limb length differences to determine optimal femoral head and bipolar shell thickness, resulting in comparable limb lengths without early complications. [Orthopedics. 2025;48(2):74-78.].
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Wilson JM, Hadley ML, Larson D, Ledford CK, Bingham JS, Wyles CC, Taunton MJ. Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study. J Bone Joint Surg Am 2025; 107:356-363. [PMID: 39715296 DOI: 10.2106/jbjs.24.00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
Abstract
BACKGROUND The direct anterior approach (DAA) is a popular approach for primary total hip arthroplasty (THA). However, the contemporary outcomes for DAA THA need further elucidation. Therefore, we aimed to describe implant survivorship, complications, and clinical outcomes after DAA THA. METHODS From our multi-institutional total joint registry, 3,184 patients who had undergone 3,698 primary DAA THA between 2010 and 2019 were identified. The identified patients had a mean age of 65 years and a mean body mass index (BMI) of 29 kg/m 2 , and 53% of patients were female. The indications for revision and reoperation and the incidence of complications were collected and analyzed. Potential risk factors, including age, sex, BMI, and high-volume compared with low-volume operating surgeons, were examined. Descriptive statistics and Kaplan-Meier survivorship with Cox regression analyses were performed. RESULTS At 10 years following primary DAA THA, the cohort had 96% (95% confidence interval [CI], 95% to 98%) survivorship free of any revision and 94% (95% CI, 92% to 96%) survivorship free of any reoperation. The leading indications for revision were periprosthetic joint infection (PJI) (n = 24; 5-year cumulative incidence, 0.93% [95% CI, 0.6% to 1.5%]), periprosthetic fracture (n = 20; 5-year cumulative incidence, 0.62% [95% CI, 0.4% to 1.0%]), and aseptic loosening (n = 14; 11 femoral, 3 acetabular; 5-year cumulative incidence, 0.84% [95% CI, 0.5% to 1.5%]). A BMI of ≥40 kg/m 2 was found to be significantly associated with PJI (hazard ratio [HR], 6.4; p < 0.001), reoperation (HR, 3.5; p < 0.001), and nonoperative complications (HR, 2.3; p = 0.018). Survivorship free of recurrent instability was 99.6% (95% CI, 99.4% to 99.8%) at 5 and 10 years, and the cumulative incidence of revision for instability was 0.14% at 5 years. CONCLUSIONS In one of the largest published series to date, survivorship following DAA THA was satisfactory at early to intermediate follow-up. The leading indications for revision were PJI, periprosthetic fracture, and aseptic loosening. Instability after DAA THA was uncommon and infrequently led to revision. As a note of caution, a BMI of ≥40 kg/m 2 was identified as a risk factor for adverse outcome after DAA THA. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia
| | - Matthew L Hadley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dirk Larson
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Cameron K Ledford
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Peuchot H, Jacquet C, Fabre-Aubrespy M, Ferguson D, Ollivier M, Flecher X, Argenson JN. No benefit of direct anterior over posterolateral approach in total hip arthroplasty using dual-mobility acetabular component for femoral neck fracture. Bone Joint J 2024; 106-B:133-138. [PMID: 38688506 DOI: 10.1302/0301-620x.106b5.bjj-2023-0832.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in femoral neck fractures (FNFs). In osteoarthritis, the direct anterior approach (DAA) has been promoted for improving early functional results compared with the posterolateral approach (PLA). The aim of this study was to compare these two approaches in FNF using DMC-THA. Methods A prospective continuous cohort study was conducted on patients undergoing operation for FNF using DMC by DAA or PLA. Functional outcome was evaluated using the Harris Hip Score (HHS) and Parker score at three months and one year. Perioperative complications were recorded, and radiological component positioning evaluated. Results There were 50 patients in the DAA group and 54 in the PLA group. The mean HHS was 85.5 (SD 8.8) for the DAA group and 81.8 (SD 11.9) for the PLA group (p = 0.064). In all, 35 patients in the DAA group and 40 in the PLA group returned to their pre-fracture Parker score (p = 0.641) in both groups. No statistically significant differences between groups were found at one year regarding these two scores (p = 0.062 and p = 0.723, respectively). The DAA was associated with more intraoperative complications (p = 0.013). There was one dislocation in each group, and four revisions for DAA and one for PLA, but this difference was not statistically significant. There were also no significant differences regarding blood loss, length of stay, or operating time. Conclusion In DMC-THA for FNF, DAA did not achieve better functional results than PLA, either at three months or at one year. Moreover, DAA presented an increased risk of intra-operative complications.
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Affiliation(s)
- Henri Peuchot
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Christophe Jacquet
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - David Ferguson
- Trauma & Orthopaedic Department, Royal London Hospital, London, UK
| | - Matthieu Ollivier
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Xavier Flecher
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Marseille, France
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Fraval A, Hegeman EM, Krueger CA. Management of Isolated Greater Trochanter Fractures Associated With Total Hip Arthroplasty. J Am Acad Orthop Surg 2024; 32:196-204. [PMID: 38147680 DOI: 10.5435/jaaos-d-23-00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023] Open
Abstract
Periprosthetic hip fractures are recognized complications associated with total hip arthroplasty. Over the past decade, there has been a 2.5-fold increase in the incidence of periprosthetic fractures which is expected to grow exponentially in the future. Most of these fractures require surgical fixation or revision arthroplasty. Fractures of the greater trochanter represent a subset of periprosthetic fractures for which there is currently no consensus in the literature regarding the optimal management. The purpose of this review was to outline the management strategies available to address these fractures, with formulation of recommendations for fractures sustained intraoperatively, postoperatively, and in the setting of primary and revision total hip arthroplasty.
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Affiliation(s)
- Andrew Fraval
- From the Rothman Orthopedic Institute at Thomas Jefferson University (Fraval, and Krueger), and Department of Orthopaedic Surgery, San Antonio Military Medical Center (Hegeman)
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Verhaegen JCF, Schmidt-Braekling T, Wei R, Beaulé PE, Grammatopoulos G. Periprosthetic fracture following anterior approach or dislocation after posterior approach: which one is the lesser evil? Arch Orthop Trauma Surg 2024; 144:465-473. [PMID: 37620685 DOI: 10.1007/s00402-023-05034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The most common approaches in total hip arthroplasty (THA) have different complication profiles; anterior-approach (AA-THA) has an increased risk of periprosthetic fractures (PPF); posterior-approach (PA-THA) is associated with higher dislocation risk. However, the relative severity of one versus the other is unknown. This study aims to compare outcome of patients who suffered PPF after AA-THA with those that sustained dislocation after PA-THA. METHODS This is a retrospective, single-center, multi-surgeon, consecutive case-series of primary THA patients. In a cohort of 9867 patients who underwent THA, 79 fulfilled the approach-specific, post-operative complication criteria, of which 44 were PPF after AA-THA and 35 with dislocation after PA-THA (age 67.9 years (range: 38.0-88.1), 58.2% women). Outcome included complication- and revision- rates, and patient-reported outcomes including Oxford Hip Score (OHS). RESULTS At 5.8 years follow-up (range: 2.0-18.5), reoperation was more common in the dislocation after PA-THA group (23/35 vs. 20/44; p = 0.072). Change of surgical approach occurred in 15/20 of patients with PPF after AA-THA, but none in those with dislocation after PA-THA. Following re-operation, complication rate was greater in the PPF group (9/20 vs. 4/23; p = 0.049). At latest follow-up, OHS were superior in the PPF after AA-THA group [42.6 (range: 25.0-48.0) vs. 36.6 (range: 21.0-47.0); p = 0.006]. CONCLUSION Dislocation following PA-THA is more likely to require revision. However, PPF following AA-THA requires more often a different surgical approach and is at higher risk of complications. Despite the increased surgical burden post-operative PROMs are better in the peri-prosthetic fracture group, especially in cases not requiring reoperation. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Jeroen C F Verhaegen
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, 501 Smyth RoadSuite CCW 1638, Ottawa, ON, K1H 8L6, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopaedic Centre Antwerp, Antwerp, Belgium
| | - Tom Schmidt-Braekling
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, 501 Smyth RoadSuite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Roger Wei
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, 501 Smyth RoadSuite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, 501 Smyth RoadSuite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, 501 Smyth RoadSuite CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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Inoue D, Kabata T, Kajino Y, Yamamuro Y, Taninaka A, Kataoka T, Saiki Y, Yanagi Y, Ima M, Iyobe T, Tsuchiya H. Influence of greater trochanteric bone density and three-dimensional morphology on perioperative greater trochanteric fracture following total hip arthroplasty via an anterolateral approach. BMC Musculoskelet Disord 2023; 24:856. [PMID: 37907894 PMCID: PMC10619302 DOI: 10.1186/s12891-023-06988-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Perioperative greater trochanteric fracture following total hip arthroplasty (THA) using the anterolateral approach is a recognized perioperative complication. There was no previous study to determine the relationship between bone mineral density (BMD) and three-dimensional greater trochanter morphology for perioperative greater trochanter fractures. The purpose of this study is to identify the influence of greater trochanteric bone density and three-dimensional morphology on perioperative greater trochanteric fracture following THA using the anterolateral approach. METHODS We investigated 209 hips done primary THA using the anterolateral approach and preoperative BMD test for the proximal femoral bone with a minimum of 6 months follow-up. We picked up all patients who had perioperative greater trochanteric fractures. Multivariate analysis was done in order to investigate the influence of the greater trochanter young adult mean (YAM) and three-dimensional morphology on perioperative greater trochanteric fractures. RESULTS There were 10 joints (10/209, 4.8%) with perioperative greater trochanteric fractures. Osteosynthesis was required only in one joint (1/209, 0.5%) because the bone fragments were significantly displaced proximally by the gluteus medius. Multivariate analysis showed the combination of Type B femoral shape (in cases where the top of the great trochanter was inside the longitudinal central axis of the planned femoral stem in computed tomography (CT)- based three-dimensional templating) and a YAM of < 80% was the only risk factor for fracture. CONCLUSIONS The preoperative greater trochanter BMD test (YAM < 80%) and three-dimensional femoral morphology (Type B femoral shape) provide useful information to mitigate the occurrence of perioperative greater trochanter fractures associated with THA using the anterolateral approach.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Atsushi Taninaka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoyuki Kataoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshitomo Saiki
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yu Yanagi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Musashi Ima
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takahiro Iyobe
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Foissey C, Batailler C, Coulomb R, Giebaly DE, Coulin B, Lustig S, Kouyoumdjian P. Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure. INTERNATIONAL ORTHOPAEDICS 2023; 47:691-699. [PMID: 36348089 DOI: 10.1007/s00264-022-05624-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim was to investigate the contribution of robotics assisted total hip arthroplasty (THA) through direct anterior approach (DAA) in improving radiographic precision, functional results and complications. METHODS This retrospective study compared 100 primary conventional THA (cTHA) to 50 primary robotic THA (rTHA) through DAA. All cups were placed with the objective of having no anterior overhang while respecting the safe zones (SZ). Radiographic analysis included cup inclination and anteversion, vertical and horizontal changes of the rotation centre (ΔVCOR, ΔHCOR), acetabular and femoral offset. SZ were 30-50° of inclination and 10-30° of anteversion. Outliers were defined as medial displacement of the COR > 5 mm, vertical displacement of the COR > 3 mm superiorly. Harris hip score (HHS) and complications were compared at one year of follow-up. RESULTS The robotic cups were better oriented with 98% in the global SZ versus 68% in the cTHA group (p = 0.0002). The COR was on average better restored in the robotic group in both the horizontal and vertical planes (Δ HCOR = - 5.0 ± 5.0 vs - 3.4 ± 4.9, p = 0.03; Δ VCOR = 1.6 ± 3.3 vs 0.2 ± 2.7, p = 0.04). There were fewer outliers in the rTHA group concerning VCOR (28% versus 10%, p = 0.03). There was no significant difference in HHS and complication rate at one year. CONCLUSION The use of robotics for THA by DAA provided an advantage in controlling the orientation of the cup and the restoration of its rotation centre. Thanks to the 3D planning on CT scan, it allowed to respect the thresholds while avoiding the anterior overhangs.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France.
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Rémy Coulomb
- 2 Rue de L'École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedics Surgery, University College Hospital, London, UK
| | - Benoit Coulin
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Pascal Kouyoumdjian
- 2 Rue de L'École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France
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Foissey C, Batailler C, Rajput V, Premkumar AB, Servien E, Lustig S. No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up. SICOT J 2023; 9:1. [PMID: 36648274 PMCID: PMC9878999 DOI: 10.1051/sicotj/2022050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Despite its excellent results in preventing dislocation, the dual mobility cup (DMC) is still struggling to be adopted by some teams due to premature wear and loosening reported on first-generation implants. Therefore, this study aimed to assess the mid-term survivorship of a modern DMC with a pre-impacted head and the radio-clinical results at a minimum follow-up of 5 years. METHODS This was a retrospective single-centre study performed on patients who had a primary total hip replacement for osteoarthritis in 2016. The cup was a third-generation DMC with a pre-impacted femoral head. Clinical (harris hip score (HHS)) and radiological (cup abduction, anteversion, overhang, and radiolucent lines) results were recorded, as well as complications, particularly dislocations and survivorship. A minimum of five years of follow-ups was required. RESULTS One hundred and seventy-five hips (167 patients) met the inclusion criteria. Five hips (2.9%, 5/175) were lost to follow-up and excluded from the postoperative analysis. The mean follow-up period was 70 ± 2.9 months [63.6-76.5]. Three cups needed revision surgery (1.8%, 3/170): one for septic loosening, and two for chronic infection. At 77 months, the global survival probability was 98.2% ± 1, and the survival probability excluding septic aetiology was 100%. There was a significant improvement in the HHS from pre-operatively (48.3 ± 6.0 [14.0-70.0]) to post-operatively (96 ± 4.5 [50-100]) (p < 0.0001). There were no postoperative dislocations recorded, nor any iliopsoas-impingement or symptomatic cam-effect. DISCUSSION This study showed excellent survival and good radiological and clinical results of this dual mobility cup at a mid-term follow-up. None of the patients had dislocation or any specific complication feared with dual mobility cups.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France,Corresponding author:
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France
| | - Vishal Rajput
- The Midyorkshire Hospitals NHS Trust WF14DG Wakefield United Kingdom
| | | | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1 69100 Lyon France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
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Inoue D, Kabata T, Kajino Y, Ohmori T, Yamamuro Y, Tsuchiya H. Risk factor analysis on perioperative greater trochanteric fracture of total hip arthroplasty via anterolateral approach. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04715-8. [PMID: 36454305 DOI: 10.1007/s00402-022-04715-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION A greater trochanteric fracture is a perioperative complication of primary total hip arthroplasty (THA) via an anterolateral approach. Although surgeons determine risk factors in the preoperative planning phase, no study explored the relationship between the planned femoral implant and greater trochanter. This study attempts to determine the risk factors for perioperative greater trochanteric fractures in primary THA via an anterolateral approach. MATERIALS AND METHODS This retrospective single-institution study enrolled 440 patients (66 males and 374 females) who underwent primary THA via an anterolateral approach with a minimum follow-up of six months. First, we selected patients with perioperative greater trochanteric fractures, regardless of the need for additional surgery. Second, we investigated the risk factors for perioperative greater trochanteric fractures using the patients' demographic data, operative data, and femoral geometry data via univariate and multivariate analyses. RESULTS Perioperative greater trochanteric fractures occurred in 30 joints (30/440, 6.8%), and all cases were reported in women. Multivariate analysis revealed that in cases where the top of the great trochanter was inside the longitudinal central axis of the planned femoral stem in three-dimensional templating (Type B) was the only independent risk factor for perioperative greater trochanteric fracture (odds ratio, 14.6; 95% confidence interval, 5.88-36.1; P < 0.001). CONCLUSION This study identified female sex and Type B femoral geometry as risk factors for perioperative greater trochanteric fracture via an anterolateral approach. Our results may reduce the incidence of perioperative greater trochanteric fractures associated with primary THA.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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