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Micicoi G, de Geofroy B, Chamoux J, Ghabi A, Gauci MO, Bernard de Dompsure R, Bronsard N, Gonzalez JF. Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach. Orthop Traumatol Surg Res 2024; 110:103911. [PMID: 38801888 DOI: 10.1016/j.otsr.2024.103911] [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: 11/08/2022] [Revised: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates. HYPOTHESIS Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach. MATERIAL AND METHODS This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative "hidden" blood loss. The risk of early dislocation (less than 6 months) was also analyzed. RESULTS Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03). CONCLUSION This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk. LEVEL OF PROOF III, comparative study of continuous series.
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Affiliation(s)
- Grégoire Micicoi
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France.
| | - Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Julien Chamoux
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Ammar Ghabi
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Marc-Olivier Gauci
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Régis Bernard de Dompsure
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Nicolas Bronsard
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Jean-François Gonzalez
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
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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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Yan TX, Dong SJ, Ning B, Zhao YC. Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures. World J Clin Cases 2024; 12:1076-1083. [PMID: 38464920 PMCID: PMC10921305 DOI: 10.12998/wjcc.v12.i6.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/30/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Hip fractures account for 23.8% of all fractures in patients over the age of 75 years. More than half of these patients are older than 80 years. Bipolar hemiarthroplasty (BHA) was established as an effective management option for these patients. Various approaches can be used for the BHA procedure. However, there is a high risk of postoperative dislocation. The conjoined tendon-preserving posterior (CPP) lateral approach was introduced to reduce postoperative dislocation rates. AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients. METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA. The patients were followed up for at least 1 year. Among the 80 patients, 57 (71.3%) were female. The time to operation averaged 2.3 d (range: 1-5 d). The mean age was 80.5 years (range: 67-90 years), and the mean body mass index was 24.9 kg/m2 (range: 17-36 kg/m2). According to the Garden classification, 42.5% of patients were type Ⅲ and 57.5% of patients were type Ⅳ. Uncemented bipolar hip prostheses were used for all patients. Torn conjoined tendons, dislocations, and adverse complications during and after surgery were recorded. RESULTS The mean postoperative follow-up time was 15.3 months (range: 12-18 months). The average surgery time was 52 min (range: 40-70 min) with an average blood loss of 120 mL (range: 80-320 mL). The transfusion rate was 10% (8 of 80 patients). The gemellus inferior was torn in 4 patients (5%), while it was difficult to identify in 2 patients (2.5%) during surgery. The posterior capsule was punctured by the fractured femoral neck in 3 patients, but the conjoined tendon and the piriformis tendon remained intact. No patients had stem varus greater than 3 degrees or femoral fracture. There were no patients with stem subsidence more than 5 mm at the last follow-up. No postoperative dislocations were observed throughout the follow-up period. No significance was found between preoperative and postoperative mean Health Service System scores (87.30 ± 2.98 vs 86.10 ± 6.10, t = 1.89, P = 0.063). CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications. For surgeons familiar with the posterior lateral approach, there is no need for additional surgical instruments, and it does not increase surgical difficulty.
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Affiliation(s)
- Ting-Xin Yan
- Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Sheng-Jie Dong
- Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Bo Ning
- Department of Joint Surgery, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Yu-Chi Zhao
- Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
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Huh JW, Kim MW, Noh YM, Seo HE, Lee DH. Retrospective Analysis of Ultrasound-Guided Serial-Injection Triple Nerve Block Efficacy in Cementless Bipolar Hemiarthroplasty for Femoral Neck Fracture. J Clin Med 2024; 13:338. [PMID: 38256472 PMCID: PMC10815972 DOI: 10.3390/jcm13020338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Femoral neck fractures are effectively treated with bipolar hemiarthroplasty (BHA) surgery, yet postoperative pain management remains a challenge. This study explores the efficacy of multimodal pain management in minimizing opioid use and enhancing recovery. METHODS A retrospective analysis of 87 patients who underwent BHA between September 2016 and September 2020 was conducted. Patients were analyzed in two groups: Group I (n = 42), receiving serial-injection nerve blocks (SINBs) before and after surgery, and Group II (n = 41), with no SINB. Notably, all nerve blocks for Group I were performed after November 2017, following the implementation of this technique in our protocol. Pain and analgesic medication usage were assessed over 72 h post-surgery, along with hospitalization duration and perioperative complications. RESULTS Group I patients exhibited significantly lower pain scores at 6, 12, 24, and 48 h post-surgery, alongside reduced incidences of postoperative nausea and vomiting (PONV) and delirium compared with Group II (p < 0.05). CONCLUSIONS Utilizing sequential lower limb nerve blocks under ultrasound guidance in BHA surgeries effectively reduces early postoperative pain and associated adverse effects. This approach demonstrates potential benefits in pain management, leading to diminished narcotic usage and lower risks of PONV and delirium.
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Affiliation(s)
- Jung Wook Huh
- Department of Orthopedic Surgery, Busan Medical Center, Busan 47527, Republic of Korea
| | - Min Woo Kim
- Department of Orthopedic Surgery, Busan Medical Center, Busan 47527, Republic of Korea
| | - Young Min Noh
- Department of Orthopedic Surgery, Busan Medical Center, Busan 47527, Republic of Korea
| | - Han Eol Seo
- Department of Orthopedic Surgery, Busan Medical Center, Busan 47527, Republic of Korea
| | - Dong Ha Lee
- Department of Orthopedic Surgery, Busan Medical Center, Busan 47527, Republic of Korea
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Xiong HZ, Yang LD, Bao G, Peng JC, Liu ZH. Improved surgical exposure and early clinical outcomes using a femoral-release-first technique in direct anterior approach during total hip arthroplasty. J Orthop Surg Res 2023; 18:878. [PMID: 37980499 PMCID: PMC10656993 DOI: 10.1186/s13018-023-04334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) performed using the direct anterior approach (DAA) has demonstrated favourable early-, mid-, and long-term outcomes. However, the traditional femoral release technique remains technically demanding and is associated with challenges and a heightened risk of complications. This study aimed to compare the clinical outcomes of patients who underwent THA with DAA performed using either the femoral-release-first (FRF) or the traditional approach (TA) strategy. METHODS A retrospective analysis of demographics, clinical and radiological outcomes, and occurrence of complications was performed using data from 106 patients between 2018 and 2019. The patients were categorised into two groups: FRF (44 hips) and TA (69 hips). RESULTS The FRF group showed a reduced operative time, haemoglobin (Hb) drop, postoperative hospital stay, and more optimal acetabular cup anteversion angles. Furthermore, during the first 2 months postoperatively, the FRF group demonstrated superior visual analogue scale, Harris Hip, and Oxford Hip scores. In the TA group, two hips experienced greater trochanter fractures, and one experienced delayed incision healing. CONCLUSIONS Compared with the TA, employing the FRF strategy during THA with DAA resulted in improved outcomes within the first 2 months postoperatively and comparable functional recovery beyond this period. The FRF method exhibited advantages such as favourable acetabular exposure and alignment and a reduced risk of complications. Therefore, the FRF strategy may be a favourable option.
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Affiliation(s)
- Hua-Zhang Xiong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Li-Dan Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Gang Bao
- Department of Orthopedic Surgery, People's Hospital of Yinjiang Tujia and Miao Autonomous County, 52# Xiyuan Road, Yinjiang, 555200, People's Republic of China
| | - Jia-Chen Peng
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China.
| | - Zhi-Hong Liu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Second Road, Shanghai, 200025, People's Republic of China.
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Di Martino A, Pederiva D, Brunello M, Tassinari L, Geraci G, Stefanini N, Faldini C. Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients. BMC Musculoskelet Disord 2023; 24:776. [PMID: 37784090 PMCID: PMC10544374 DOI: 10.1186/s12891-023-06919-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery. METHODS A total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77). RESULTS Group A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041). CONCLUSION The use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.
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Affiliation(s)
- Alberto Di Martino
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy.
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy.
| | - Davide Pederiva
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy
| | - Matteo Brunello
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy
| | - Leonardo Tassinari
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy
| | - Giuseppe Geraci
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy
| | - Niccolò Stefanini
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy
| | - Cesare Faldini
- IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Sciences - DIBINEM, University of Bologna, Bologna, Italy
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Filippini M, Bortoli M, Montanari A, Pace A, Di Prinzio L, Lonardo G, Parisi SC, Persiani V, De Cristofaro R, Sambri A, De Paolis M, Fiore M. Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1220. [PMID: 37512031 PMCID: PMC10385644 DOI: 10.3390/medicina59071220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Background: Femoral neck fractures are an epidemiologically significant issue with major effects on patients and health care systems, as they account for a large percentage of bone injuries in the elderly. Hip hemiarthroplasty is a common surgical procedure in the treatment of displaced femoral neck fractures. Several surgical approaches may be used to access the hip joint in case of femoral neck fractures, each with its own benefits and potential drawbacks, but none of them has consistently been found to be superior to the others. This article aims to systematically review and compare the different approaches in terms of the complication rate at the last follow-up. Methods: an in-depth search on PubMed/Scopus/Web of Science databases and a cross-referencing search was carried out concerning the articles comparing different approaches in hemiarthroplasty and reporting detailed data. Results: A total of 97,576 hips were included: 1030 treated with a direct anterior approach, 4131 with an anterolateral approach, 59,110 with a direct lateral approach, and 33,007 with a posterolateral approach. Comparing the different approaches, significant differences were found in both the overall complication rate and the rate of revision surgery performed (p < 0.05). In particular, the posterolateral approach showed a significantly higher complication rate than the lateral approach (8.4% vs. 3.2%, p < 0.001). Furthermore, the dislocation rate in the posterolateral group was significantly higher than in the other three groups considered (p < 0.026). However, the posterolateral group showed less blood loss than the anterolateral group (p < 0.001), a lower intraoperative fractures rate than the direct anterior group (p < 0.035), and shorter mean operative time than the direct lateral group (p < 0.018). Conclusions: The posterolateral approach showed a higher complication rate than direct lateral approach and a higher prosthetic dislocation rate than the other three types of surgical approaches. On the other hand, patients treated with posterolateral approach showed better outcomes in other parameters considered, such as mean operative time, mean blood loss and intraoperative fractures rate. The knowledge of the limitations of each approach and the most common associated complications can lead to choosing a surgical technique based on the patient's individual risk.
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Affiliation(s)
- Matteo Filippini
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Andrea Montanari
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Andrea Pace
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | | | - Gianluca Lonardo
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Valentina Persiani
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Roberto De Cristofaro
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Sambri
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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傅 凯, 朱 博, 蒋 青, 陈 东. [Effectiveness analysis of MAKO robotic-arm assisted total hip arthroplasty via direct anterior approach for bony fused hips]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1357-1362. [PMID: 36382452 PMCID: PMC9681582 DOI: 10.7507/1002-1892.202206101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Indexed: 01/25/2023]
Abstract
Objective To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS). Methods Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured. Results The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, -5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation ( P<0.05). Conclusion The MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.
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Affiliation(s)
- 凯 傅
- 南京大学医学院附属鼓楼医院骨科 运动医学与成人重建外科(南京 210008)Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China
- 国家骨科与运动康复临床医学研究中心分中心(南京 210008)Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China
| | - 博闻 朱
- 南京大学医学院附属鼓楼医院骨科 运动医学与成人重建外科(南京 210008)Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China
- 国家骨科与运动康复临床医学研究中心分中心(南京 210008)Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China
| | - 青 蒋
- 南京大学医学院附属鼓楼医院骨科 运动医学与成人重建外科(南京 210008)Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China
- 国家骨科与运动康复临床医学研究中心分中心(南京 210008)Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China
| | - 东阳 陈
- 南京大学医学院附属鼓楼医院骨科 运动医学与成人重建外科(南京 210008)Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China
- 国家骨科与运动康复临床医学研究中心分中心(南京 210008)Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China
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9
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Faggiani M, Risitano S, Rissolio L, Baroni C, Alberghina F, Conforti L. Comparison of Anterior and Lateral Approach in Hip Hemiarthroplasty for Femur Neck Fractures in the Elderly: Clinical and Radiographic Outcomes. Malays Orthop J 2022; 16:113-119. [PMID: 36589369 PMCID: PMC9791902 DOI: 10.5704/moj.2211.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/13/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 - dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.
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Affiliation(s)
- M Faggiani
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy,Corresponding Author: Marianna Faggiani, Department of Orthopaedics and Traumatology, ASL TO5, Piazza Silvio Pellico, 1, Chieri, Turin, 10023, Piedmont, Italy
| | - S Risitano
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - L Rissolio
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - C Baroni
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - F Alberghina
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
| | - L Conforti
- Department of Orthopaedics and Traumatology, ASL TO 5, Turin, Italy
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10
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Orth M, Osche D, Mörsdorf P, Holstein JH, Rollmann MF, Fritz T, Pohlemann T, Pizanis A. Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures. Arch Orthop Trauma Surg 2022; 143:3173-3181. [PMID: 36053291 DOI: 10.1007/s00402-022-04602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases. MATERIAL AND METHODS In the present retrospective study geriatric patients with FNF (n = 100) treated either by anterior minimal-invasive surgery (AMIS; n = 50) or lateral conventional surgery (LCS; n = 50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed. RESULTS Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not differ between the two groups. Further, more patients in the AMIS group achieved full weight-bearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No significant differences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively. CONCLUSIONS In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients.
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Affiliation(s)
- M Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.
| | - D Osche
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - P Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - J H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.,Ethianum Clinic, Heidelberg, Germany
| | - M F Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.,BG Klinik Tuebingen on behalf of the Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - T Fritz
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - T Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - A Pizanis
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
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11
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Khan IA, Magnuson JA, Arshi A, Krueger CA, Freedman KB, Fillingham YA. Direct Anterior Approach in Hip Hemiarthroplasty for Femoral Neck Fractures: Do Short-Term Outcomes Differ with Approach?: A Systematic Review and Meta-Analysis. JBJS Rev 2022; 10:01874474-202209000-00001. [PMID: 36053029 DOI: 10.2106/jbjs.rvw.21.00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hip hemiarthroplasty (HA) is commonly used to treat femoral neck fractures, but it remains unclear if the surgical approach impacts patient outcomes for this commonly performed procedure. The objective of this systematic review and meta-analysis was to assess early postoperative outcomes in patients undergoing HA for femoral neck fracture with the direct anterior approach (DAA) compared with other approaches. METHODS The Cochrane Central Registry of Controlled Trials, MEDLINE, and Google Scholar databases were searched for randomized controlled trials, prospective nonrandomized trials, and retrospective studies published prior to September 7, 2021, comparing DAA with other approaches (anterolateral approach [ALA], direct lateral approach [DLA], and posterior-based approach [PA]) in HA for femoral neck fractures. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes included functional outcomes, total complications, prosthetic dislocation, periprosthetic fracture, periprosthetic joint infection (PJI), reoperation, mortality, pain, operative time, and perioperative blood loss. Fixed effect odds ratios, along with their 95% confidence intervals, were used to analyze dichotomous variables. Significance was set at p < 0.05. Meta-analysis was conducted with Review Manager 5.4. RESULTS In total, 19 studies were included for qualitative analysis and 16 studies were included for quantitative analysis, with a total of 1,604 cases analyzed (723 DAA, 215 ALA, 301 DLA, and 365 PA). Compared with other approaches, the use of the DAA for HA was associated with improved early postoperative functional outcomes, lower early postoperative pain scores, fewer total complications, and fewer prosthetic hip dislocations. The rates of periprosthetic fracture, PJI, and reoperation, pain scores beyond 40 days, operative time, perioperative blood loss, and mortality were not significantly different between surgical approaches. CONCLUSIONS Utilizing the DAA while performing HA for femoral neck fractures is associated with improved functional outcomes, lower early postoperative pain scores, lower incidence of prosthetic hip dislocation, and potentially fewer total complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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12
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Maccagnano G, Maruccia F, Rauseo M, Noia G, Coviello M, Laneve A, Quitadamo AP, Trivellin G, Malavolta M, Pesce V. Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease. J Clin Med 2022; 11:jcm11164785. [PMID: 36013024 PMCID: PMC9410486 DOI: 10.3390/jcm11164785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Francesco Maruccia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michela Rauseo
- Department of Anesthesia and Intensive Care, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giovanni Noia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michele Coviello
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico. Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico. Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Andrea Laneve
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Alessandro Pio Quitadamo
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giacomo Trivellin
- Hip and Trauma Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Michele Malavolta
- Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Vito Pesce
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
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13
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The Feasibility of Using the Direct Anterior Approach for Total Hip Arthroplasty or Bipolar Hemiarthroplasty to Treat Femoral Neck Fractures among the Elderly. Adv Orthop 2022; 2022:2115586. [PMID: 35910812 PMCID: PMC9328964 DOI: 10.1155/2022/2115586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly. Total hip arthroplasty (THA) is the preferred treatment method in active, cognitively intact patients. In less active or cognitively impaired patients, bipolar hemiarthroplasty (BHA) is the practical option in Japan. Even with the direct anterior approach (DAA), clinical concerns about conducting THA in elderly patients include possible dislocations, critical complications, and medical cost-effectiveness. This study is aimed at rethinking the practical surgical indications for FNFs. Methods Between April 2019 and March 2021, BHA patients with displaced FNF (n = 21) performed through the DAA were compared with THA patients with displaced FNF (n = 19). The perioperative complications, clinical and radiologic outcomes, and mortality were compared between groups retrospectively at six months. Results THA patients had an increased average operation time (103.3 min vs. 89.1 min, P < 0.05) and similar amounts of bleeding (183.16 ml. vs. 121.1 ml.). The percentages of patients who received biological transfusion showed no difference, with low rates of perioperative complications (4% vs. 0%) and similar mortality rates compared to BHA patients. One THA patient experienced posterior dislocation during a state of postoperative delirium. Conclusion THA through the DAA might be a credible and safe option for FNF patients, with excellent functional outcomes and fewer surgery-related complications. Early posterior dislocation might be related to optimized offset distance and not related to leg discrepancy or other radiographic items. Hence, orthopedic surgeons should reconsider their options before conducting BPH for elderly and cognitively intact FNF patients.
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Sang W, Xue S, Xu Y, Liu Y, Zhu L, Ma J. Bikini Incision Increases the Incidence of Lateral Femoral Cutaneous Nerve Injury in Direct Anterior Approach Hip Arthroplasty: A Prospective Ultrasonic, Electrophysiological, and Clinical Study. J Arthroplasty 2021; 36:3463-3470. [PMID: 34074541 DOI: 10.1016/j.arth.2021.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lateral femoral cutaneous nerve (LFCN) injury has been widely reported as one of the most common complications of direct anterior approach (DAA) hip arthroplasty. Bikini incision is considered to increase the incidence of this complication. METHODS A prospective randomized study was conducted after including ninety-nine bikini and ninety-six longitudinal incision DAA cases from May to November 2020. The occurrence of LFCN was examined using ultrasound before and after surgery. The recovery of injury symptoms was evaluated by continuous clinical follow-up until six months, and the patients were treated with mecobalamin and/or celecoxib. Sensory conduction velocity and sensory action potential amplitude of the LFCN were measured after surgery in symptomatic patients. RESULTS Eighty five (43.6%), sixty seven (34.4%), and forty three (22.0%) cases of LFCN were of the anterior trunk, posterior trunk, and fan types, respectively, before surgery. All one hundred ninety five patients completed the follow-up period. Fifty-seven patients had symptoms of LFCN injury, including thirty six and twenty one patients in the bikini group and longitudinal group, respectively, with significantly different incidence rates (36.4% and 21.9%, respectively; P < .05). Of these, thirty two (56.1%), thirteen (22.8%), and twelve (21.1%) cases were of the anterior trunk, posterior trunk, and fan types, respectively. Sensory conduction velocity and sensory action potential amplitude significantly decreased after surgery in both groups (P < .05). Seventeen cases showed reduction of symptoms within three months. Forty six cases showed self-recovery within six months and eleven cases showed persistent symptoms at the final follow-up. CONCLUSION Bikini incision DAA hip arthroplasty may increase the incidence of LFCN injury, and the anterior trunk distribution type is most likely to be affected. (Clinical Trial Registration Number: CHICTR2000035107).
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Affiliation(s)
- Weilin Sang
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Song Xue
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yiming Xu
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yu Liu
- Department of Orthopedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Libo Zhu
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jinzhong Ma
- Department of Joint Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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