1
|
Nakamura J, Hagiwara S, Kawarai Y, Hirasawa R, Akazawa T, Ohtori S. Is There a Learning Curve for the 5-Year Implant Survival Rate of Total Hip Arthroplasty Using the Direct Anterior Approach With a Traction Table? A Prospective Cohort Study. J Arthroplasty 2024:S0883-5403(24)00428-5. [PMID: 38710345 DOI: 10.1016/j.arth.2024.04.080] [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: 12/21/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) is attracting attention as a minimally invasive surgery, but the learning curve to master this approach is a concern, and its effect on long-term results is unknown. The purpose of this prospective cohort study was to clarify how the learning curve affects the 5-year results of DAA THA with a traction table. METHODS Of 402 THA cases using DAA with a mobile traction table and fluoroscopy, 249 cases composed of the first 50 cases for each surgeon were assessed during a learning curve, and 153 cases were evaluated after more than 50 cases of experience. RESULTS The 5-year-implant survival rate was 99.2% both during and after the learning curve. The 2-year complication rate in the learning curve group was 8.9 versus 5.9%, which was not statistically significant. The 2-to-5-year complication rates also did not differ between the cohorts (0 versus 0.7%). Both groups demonstrated decreased complication rates when comparing 2-year complications to 2-to-5-year complications. Clinical scores significantly improved by 2 years and were maintained at 5 years in both groups. The cup safe-zone success rates were 96.4% during the learning curve and 98.7% after the learning curve. The stem safe-zone success rates were 97.2% during the learning curve and 96.1% after the learning curve. Surgical time was approximately 20 minutes shorter after the first 50 cases than during the learning curve (70.8 versus 90.6 minutes, P = .001). Intraoperative blood loss was significantly less after the learning curve than during the learning curve. CONCLUSIONS This study implies that the learning curve affects perioperative results such as surgical time and intraoperative blood loss, but has little effect on short-term results up to 2 years after surgery and no effect on mid-term results from 2 to 5 years after surgery.
Collapse
Affiliation(s)
- Junichi Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba city, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba city, Chiba, Japan
| | - Yuya Kawarai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba city, Chiba, Japan
| | - Rui Hirasawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba city, Chiba, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University, Kawasaki city, Kanagawa, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba city, Chiba, Japan
| |
Collapse
|
2
|
Herzberg R, Tracey OC, Tahvilian S, Baksh N, Zikria B, Naziri Q. Incidence of heterotopic ossification following total hip arthroplasty by approach: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2089-2098. [PMID: 38536499 DOI: 10.1007/s00590-024-03896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/28/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA). Though, the overall incidence of HO following THA has been well-documented, it is often not reported by severity or by surgical approach. QUESTIONS/PURPOSES (1) What are the demographics of patients with HO? (2) What is the severity of HO following THA using the Brooker classification? (3) What is the incidence and class of HO following different THA approaches (anterior, posterior, posterolateral, anterolateral, superior, lateral, trans-gluteal)? (4) What are the number and training level of surgeons who performed each procedure? METHODS The PubMed, Embase, and Web of Science databases were queried, and PRISMA guidelines were followed. Qualitative and quantitative analyses were performed using Microsoft Excel. RESULTS We isolated 26 studies evaluating 6512 total hip arthroplasties (THA). The mean HO percentage overall was 28.8%, mostly Class I (54.2%) or Class II (29.6%). The highest percentage of HO was associated with the modified direct lateral (57.2%) and the traditional lateral (34.6%) approaches. The lowest HO percentages were identified following posterolateral (12.8%) and direct superior approaches (1%). Most studies reported a singular senior surgeon operating within the same approach for all patients. CONCLUSIONS The traditional lateral and modified direct lateral approaches to THA resulted in the highest percentage of HO postoperatively. However, most ossification cases were not clinically significant and did not strongly affect overall patient morbidity. Further studies are warranted to identify an association between severity of ossification and different arthroplasty approaches.
Collapse
Affiliation(s)
- Rex Herzberg
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Olivia C Tracey
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Shahriar Tahvilian
- Touro College of Osteopathic Medicine, 230 W 125th St 3rd Floor, New York, NY, 10027, USA
| | - Nayeem Baksh
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Bashir Zikria
- Department of Orthopedic Surgery, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Qais Naziri
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA.
| |
Collapse
|
3
|
Bourget-Murray J, Biniam B, Bhullar RS, Kim P, Gofton W, Beaulé PE, Grammatopoulos G. Early- to mid-term outcome of a short, cementless, titanium, flat, tapered stem for primary total hip arthroplasty: an independent series. Hip Int 2024; 34:327-335. [PMID: 38073478 PMCID: PMC11071641 DOI: 10.1177/11207000231216421] [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: 01/17/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively. METHODS A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling. RESULTS In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9-98.5) and 97.0% (95% CI, 95.6-98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09-1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign. CONCLUSIONS The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome.
Collapse
Affiliation(s)
- Jonathan Bourget-Murray
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Brook Biniam
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Raman S Bhullar
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kim
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Wade Gofton
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
4
|
Melman WPR, Ettema HB, Edens MA, Verheyen CCPM. Mid-term results of cemented hip arthroplasties through the direct anterior approach in the lateral decubitus position: a retrospective cohort study. J Orthop Surg Res 2024; 19:206. [PMID: 38561763 PMCID: PMC10983692 DOI: 10.1186/s13018-024-04696-x] [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: 11/12/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Reports show a high complication rate when starting with the Direct Anterior Approach (DAA) in a supine position for hip arthroplasty. The DAA with the patient in lateral decubitus position may avoid this problem because it supposedly provides better visibility, especially on the femoral side. However, this approach did show a rather high complication rate during the adoption of the approach at 1 year follow up in our previous report. We were interested what the overall 7 year survival estimate would be and whether improvement could be seen with growing experience. METHODS A cohort of patients undergoing total hip arthroplasty right from the start of applying the DAA in lateral decubitus position was analysed. RESULTS In total 175 hip prostheses (162 patients) were evaluated. The 7-year survival estimate was 95.1%, 95 CI: 91.8-98.4%. In 6 of 8 revisions there was aseptic loosening of the stem. By dividing the cohort into 3 consecutive groups in time we did not see a significantly improving revision rate. CONCLUSIONS In our experience, the adoption of the direct anterior approach in lateral decubitus position caused a relatively low 7-year survival estimate without an apparent decrease with growing experience, however given the low number of cases further research is needed to investigate the long-term risk of adopting a new approach.
Collapse
Affiliation(s)
- Wietse P R Melman
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands.
- Department of Orthopedic Surgery and Traumatology, Saxenburgh Medisch Centrum, Jan Weitkamplaan 4a, Hardenberg, 7772 SE, The Netherlands.
| | - Harmen B Ettema
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
| | - Mireille A Edens
- Epidemiology Unit, Department Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Cees C P M Verheyen
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
| |
Collapse
|
5
|
Peeters W, Vandeputte FJ, Timmermans A, Roose S, Verhaegen JCF, Corten K. Can Patients Who Have Low-Grade Hip Osteoarthritis Expect the Same Outcome After Total Hip Arthroplasty Compared to Those Who Have End-Stage Osteoarthritis? - A Matched Case-Control Study. J Arthroplasty 2024:S0883-5403(24)00111-6. [PMID: 38369084 DOI: 10.1016/j.arth.2024.02.012] [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: 10/24/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is an effective procedure for patients with end-stage hip osteoarthritis (OA). In addition, when hip preservation surgery is no longer indicated due to the presence of early or mild arthritic changes, THA can also be considered. Whether these patients can expect the same outcome after THA as patients who have end-stage OA remains unclear. The goal of this study was to compare the clinical outcomes after THA of patients who have low-grade OA versus a matched cohort with end-stage OA. METHODS This is a retrospective, single-center, multisurgeon case-control study in a high-volume referral center. Based on a cohort of 2,189 primary anterior approach THAs (1,815 patients), 50 low-grade OA cases were matched 1:1 by age, sex, and body mass index to 50 controls who have end-stage OA. Patient-reported outcome measures (PROMs) were Hip Disability and Osteoarthritis Outcome Scores and Short Form-36. RESULTS No significant differences in preoperative PROMs between low-grade and end-stage OA patients were found, except for 36-item Short Form Survey pain (33.0 versus 41.0; P = .045). In both groups a significant improvement of all PROMs was found postoperatively. However, all Hip Disability and Osteoarthritis Outcome Scores were significantly lower in the low-grade OA group compared to the end-stage OA group. In the group with low-grade OA, a significantly lower percentage of patients achieved the minimal clinically important difference and substantial clinical benefit after THA compared to the group with end-stage OA. CONCLUSIONS Patients who have low-grade OA can expect substantial clinical improvement after THA. However, the improvement is lower compared to patients who have end-stage OA. A thorough understanding of the factors that may lead to inferior clinical outcomes is imperative to improving the indications for THA in individuals who have low-grade OA.
Collapse
Affiliation(s)
- Wouter Peeters
- Orthopaedic Center Antwerp, AZ Monica Hospitals, Antwerp, Belgium
| | - Frans-Jozef Vandeputte
- Hip Unit, Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium; REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, Belgium
| | - Annick Timmermans
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, Belgium
| | | | - Jeroen C F Verhaegen
- Orthopaedic Center Antwerp, AZ Monica Hospitals, Antwerp, Belgium; Department of Orthopaedics, Antwerp University Hospital, Antwerp, Belgium
| | - Kristoff Corten
- Hip Unit, Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium; Heuppraktijk, Herselt, Belgium
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Verhaegen JCF, Ojaghi R, Kim P, Schwarz AJ, Bingham J, Grammatopoulos G. Selective THA-approach use amongst junior surgeons improves safety of introducing the anterior approach: a prospective, multi-surgeon, comparative, study. Arch Orthop Trauma Surg 2023; 143:6829-6836. [PMID: 37119326 DOI: 10.1007/s00402-023-04895-x] [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: 01/03/2023] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Learning curves associated with independent practice and anterior approach total hip arthroplasty (AA-THA) has been associated with inferior outcome. This study compared outcome of junior, fellowship-trained, surgeons who perform THA through both anterior and posterior (PA) approach, with senior surgeons who perform either AA or PA, to determine whether: 1. Fellowship training and selective practice allows for safe introduction of AA into practice; and 2. Whether selective approach-use influences outcome. METHODS This is a prospective, consecutive study comparing the first 800 THAs of two junior, dual-approach, surgeons (AA/PA: 455/345), with 400 THAs cases of two senior, single-approach, surgeons (AA/PA: 200/200), between 2018 and 2020. Most patients were female (54.4%), mean age was 65 years-old (range 19-96) and mean BMI was 29 kg/m2 (range 16-66). Outcome included radiologic measurements (inclination/anteversion and leg-length), complication- and revision rates, and patient-reported outcomes including Oxford Hip Score (OHS). RESULTS At 3.1 years (range 2.0-6.8) follow-up, there were 43 complications (3.6%), including 27 re-operations (2.3%); with no difference between junior and senior surgeons for AA-THA (Junior: 8/455 vs. Senior: 3/200; p = 0.355) or PA-THA (Junior: 11/345 vs. Senior: 5/200; p = 0.400). Amongst juniors, there was no difference in complications (AA:8/455 vs. PA:11/345; p = 0.140) and in ΔOHS (AA:20.5 ± 7.7 vs. PA:20.5 ± 8.0; p = 0.581) between approaches. CONCLUSION Contemporary training and selective approach-use minimizes the learning curve, allowing junior staff to have equivalent outcome to established, senior surgeons in both AA and PA. We would advocate for selective approach use amongst junior arthroplasty surgeons when introducing the AA into independent practice.
Collapse
Affiliation(s)
- Jeroen C F Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopaedic Centre Antwerp, Antwerp, Belgium
| | - Reza Ojaghi
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Adam J Schwarz
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Josh Bingham
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada.
| |
Collapse
|
8
|
Bourget-Murray J, Horton I, Meniawy SE, Papp S, Kim PR, Grammatopoulos G. The direct anterior approach is safe and shortens hospital length of stay following hemiarthroplasty for neck of femur fracture. Injury 2023; 54:1186-1190. [PMID: 36775793 DOI: 10.1016/j.injury.2023.02.016] [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: 04/13/2022] [Revised: 08/22/2022] [Accepted: 02/05/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To investigate the safety of using the anterior approach (AA), compared to the lateral approach (LA), in hemiarthroplasty for the treatment of displaced neck of femur fractures. DESIGN Retrospective case-control match cohort study. SETTING Level 1 trauma center. PATIENTS Retrospective review of prospectively collected data for 39 consecutive intracapsular hip fractures treated with hemiarthroplasty using an AA between 2017 and 2021. Patients operated with the AA were matched in 1:2 ratio with patients that had hemiarthroplasty via a LA. MAIN OUTCOME MEASURES Discharge destination, 90-day emergency room (ER) visit or readmission rate, inpatient and 90-day mortality rate, inpatient medical complications, 90-day mechanical complications, 90-day reoperation, and length of hospital stay (LOS). RESULTS Discharge destination (p = 0.695), 90-day ER visit or readmission rate (p = 0.315), inpatient (p = 0.719) and 90-day mortality rate (p = 0.815), medical complications (p = 0.524), mechanical complications (p = 0.150) were similar between cohorts. Five patients, all in the LA-group, required re-operations within 90-days (p = 0.106). Patients in AA-group had shorter LOS (9.3 days, 95% CI [7.6-11.1] vs. 14.7 days [95% CI 12.2-17.3], p = 0.002). CONCLUSIONS The AA can be safely introduced for the treatment of hip fractures. Similar short-term outcomes relative to the LA were identified. The shorter LOS may reflect the improved early functional recovery offered from the muscle-sparing AA technique. Future, level-1 data should include early- and longer term functional outcome along with cost-effectiveness.
Collapse
Affiliation(s)
- Jonathan Bourget-Murray
- Investigations performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabel Horton
- Investigations performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Sherif El Meniawy
- Investigations performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Papp
- Investigations performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul R Kim
- Investigations performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Investigations performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
9
|
Muffly BT, Kluemper JC, Jacobs CA, Landy DC, Duncan ST. Penalty for Switching Implants? Assessing the Learning Curve With a Collarless, Tapered Wedge Cementless Femoral Component. Arthroplast Today 2023; 20:101119. [PMID: 36923057 PMCID: PMC10009679 DOI: 10.1016/j.artd.2023.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/01/2023] [Accepted: 01/28/2023] [Indexed: 03/18/2023] Open
Abstract
Background Surgeon learning curve associated with a tapered wedge femoral implant as measured by early femoral component subsidence and 90-day risk of reoperation was evaluated. Methods The first 451 patients undergoing primary, cementless total hip arthroplasty by a single, fellowship-trained arthroplasty surgeon with a tapered wedge stem design were retrospectively reviewed. Early radiographic femoral component subsidence during the first 6 weeks postoperatively and 90-day reoperations was recorded. Results When stratified by approach, there was no association between date of surgery and femoral component subsidence in the posterior approach (P-value for linear trend over time = 0.44). In the direct anterior approach, there was a significant association between date of surgery and early femoral component subsidence (P-value for linear trend over time = 0.01). For both approaches, there was an increase in implanted stem size relative to templated stem size over time (P < .01 and P = .03, respectively). There was no association between the date of surgery and risk of 90-day reoperation (P = .45). Conclusions In a single surgeon's initial use of a tapered cementless wedge stem, early femoral component subsidence was not impacted by the surgeon's learning curve when the posterior approach was utilized. Although subsidence was associated with date of surgery in the direct anterior cohort, this was not associated with increased risk of 90-day reoperation. Should a surgeon adopt a new tapered-wedge stem, these findings suggest that the stem is forgiving both in relation to subsidence and 90-day reoperation risk when appropriate surgical technique is utilized.
Collapse
Affiliation(s)
- Brian T Muffly
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Jude C Kluemper
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Cale A Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - David C Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Stephen T Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
10
|
Is outcome of total hip arthroplasty for hip fracture inferior to that of arthritis in a contemporary arthroplasty practice? J Arthroplasty 2023:S0883-5403(23)00201-2. [PMID: 36889530 DOI: 10.1016/j.arth.2023.02.069] [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: 11/30/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Outcome of total hip arthroplasty (THA) for femoral neck fractures (FNF) has been associated with higher complication rates. However, THA for FNF is not always performed by arthroplasty-surgeons. This study aimed to compare THA outcomes for FNF to osteoarthritis (OA). In doing so, we described contemporary THA failure modes for FNF performed by arthroplasty surgeons. METHODS This was a retrospective, multi-surgeon study from an academic center. Of FNF treated between 2010 and 2020, 177 received THA by an arthroplasty-surgeon [mean age 67 years (range, 42 to 97), sex: 64.4% women]. These were matched (1:2) for age and sex with 354 THAs performed for hip OA, by the same surgeons. No dual-mobilities were used. Outcomes included radiologic measurements (inclination/anteversion and leg-length), mortality, complications, reoperation rates and patient-reported outcomes including Oxford Hip Score (OHS). RESULTS Post-operative mean leg-length difference was 0 millimeters (mm) (range, -10 to -10 mm), with a mean cup inclination and anteversion of 41 and 26° respectively. There was no difference in radiological measurements between FNF and OA patients (p=0.3). At 5 years follow-up, mortality rate was significantly higher in the FNF-THA compared to the OA-THA group (15.3 vs. 1.1%; p<0.001). There was no difference in complications (7.3 vs. 4.2%; p=0.098) or reoperation rates (5.1 vs. 2.9%; p=0.142) between groups. Dislocation rate was 1.7%. OHS at final follow-up was similar [43.7 points (range, 10 to 48) vs. 43.6 points (range, 10 to 48); p=0.030]. CONCLUSION Total hip arthroplasty for the treatment of FNF is a reliable option and is associated with satisfactory outcomes. Instability was not a common reason of failure, despite not using dual-mobility articulations in this at-risk population. This is likely due to THAs being performed by the arthroplasty staff. When patients live beyond 2-years, similar clinical and radiographic outcomes with low rates of revision can be expected, comparable to elective THA for OA.
Collapse
|
11
|
Verhaegen JCF, Vandeputte FJ, Van den Broecke R, Roose S, Driesen R, Timmermans A, Corten K. Risk Factors for Iliopsoas Tendinopathy After Anterior Approach Total Hip Arthroplasty. J Arthroplasty 2023; 38:511-518. [PMID: 36257506 DOI: 10.1016/j.arth.2022.10.015] [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: 07/04/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Iliopsoas tendinopathy is a cause of groin pain following total hip arthroplasty (THA). With the anterior approach becoming increasingly popular, our aim was to determine the prevalence of iliopsoas tendinopathy following anterior approach THA, to identify risk factors and to determine an influence on patient-reported outcomes. METHODS This is a retrospective case-control study of prospectively recorded data on 2,120 primary anterior approach THA (1,815 patients). The diagnosis of iliopsoas tendinopathy was based on (1) persistent postoperative groin pain, triggered by hip flexion; (2) absence of dislocation, infection, loosening, or fracture; and (3) decrease of pain after fluoroscopy-guided iliopsoas tendon sheet injection with xylocaine and corticosteroid. Outcomes included hip reconstruction (inclination/anteversion and leg-length), complication rates, reoperation rates, and patient-reported outcomes including Hip disability and Osteoarthritis Outcome Score. RESULTS Forty four patients (46 THAs) (2.2%) were diagnosed with iliopsoas tendinopathy. They were younger than patients who did not have iliopsoas tendinopathy (51 years [range, 27-76] versus 62 years [range, 20-90]; P < .001). Logistic regression analyses demonstrated that younger age (P < .001) and presence of a spine fusion (P = .008) (odds ratio 4.6) were the significant predictors of iliopsoas tendinopathy. These patients had lower Hip disability and Osteoarthritis Outcome scores, reported more often low back pain (odds ratio 4.8), and greater trochanter pain (odds ratio 5.4). CONCLUSION We found an incidence of 2.2% of iliopsoas tendinopathy patients after anterior approach THA that compromised outcomes. Younger age and previous spine fusion were identified as most important risk factors. These patients were 5 times more likely to report low back pain and greater trochanter pain post-THA.
Collapse
Affiliation(s)
- Jeroen C F Verhaegen
- Ziekenhuis Oost-Limburg, Genk, Belgium; University of Antwerp, Antwerp, Belgium; Orthopaedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | | | | | - Stijn Roose
- Heuppraktijk/European Hip Clinic, Herselt, Belgium
| | | | | | - Kristoff Corten
- Ziekenhuis Oost-Limburg, Genk, Belgium; University of Hasselt, Hasselt, Belgium; Heuppraktijk/European Hip Clinic, Herselt, Belgium
| |
Collapse
|
12
|
Verhaegen JCF, Wei R, Kim P, Beaulé PE, Corten K, Grammatopoulos G. The Safety and Efficacy of the Anterior Approach Total Hip Arthroplasty as per Body Mass Index. J Arthroplasty 2023; 38:314-322.e1. [PMID: 35987493 DOI: 10.1016/j.arth.2022.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Obesity is associated with component malpositioning and increased revision risk after total hip arthroplasty (THA). With anterior approaches (AAs) becoming increasingly popular, the goal of this study was to assess whether clinical outcome post-AA-THA is affected by body mass index (BMI). METHODS This multicenter, multisurgeon, consecutive case series used a prospective database of 1,784 AA-THAs (1,597 patients) through bikini (n = 1,172) or standard (n = 612) incisions. Mean age was 63 years (range, 20-94 years) and there were 57.5% women, who had a mean follow-up of 2.7 years (range, 2.0-4.1 years). Patients were classified into the following BMI groups: normal (BMI < 25.0; n = 572); overweight (BMI: 25.0-29.9; n = 739); obese (BMI: 30.0-34.9; n = 330); and severely obese (BMI ≥ 35.0; n = 143). Outcomes evaluated included hip reconstruction (inclination/anteversion and leg-length, complications, and revision rates) and patient-reported outcomes including Oxford Hip Scores (OHS). RESULTS Mean postoperative leg-length difference was 2.0 mm (range: -17.5 to 39.0) with a mean cup inclination of 34.8° (range, 14.0-58.0°) and anteversion of 20.3° (range, 8.0-38.6°). Radiographic measurements were similar between BMI groups (P = .1-.7). Complication and revision rates were 2.5% and 1.7%, respectively. The most common complications were fracture (0.7%), periprosthetic joint infection (PJI) (0.5%), and dislocation (0.5%). There was no difference in dislocation (P = .885) or fracture rates (P = .588) between BMI groups. There was a higher rate of wound complications (1.8%; P = .053) and PJIs (2.1%; P = .029) among obese and severely obese patients. Wound complications were less common among obese patients with the 'bikini' incision (odds ratio 2.7). Preoperative OHS was worse among the severely obese (P < .001), which showed similar improvements (Change in OHS; P = .144). CONCLUSION AA-THA is a credible option for obese patients, with low dislocation or fracture risk and excellent ability to reconstruct the hip, leading to comparable functional improvements among BMI groups. Obese patients have a higher risk of PJIs. Bikini incision for AA-THA can help minimize the risk of wound complications.
Collapse
Affiliation(s)
- Jeroen C F Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada; Department of Orthopaedics and Traumatology, Ziekenhuis Oost-Limburg, Genk, Belgium; University of Antwerp, Antwerp, Belgium
| | - Roger Wei
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada
| | - Paul Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada
| | - Kristoff Corten
- Department of Orthopaedics and Traumatology, Ziekenhuis Oost-Limburg, Genk, Belgium; University of Hasselt, Hasselt, Belgium
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada
| |
Collapse
|
13
|
Gauthier P, Slullitel PA, Speirs A, Laude F, Gofton WT, Beaule PE. Cerclage wire or positional cortical screw for the treatment of intraoperative calcar fractures during primary total hip arthroplasty? A biomechanical study. Clin Biomech (Bristol, Avon) 2023; 101:105848. [PMID: 36512944 DOI: 10.1016/j.clinbiomech.2022.105848] [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: 08/10/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND During primary total hip arthroplasty, intra-operative calcar fractures have been historically treated with cerclage wires. However, interfragmentary screw fixation technique can possibly achieve the same results with technical advantages. The aim of this biomechanical study was to assess stability of calcar fractures fixed using interfragmentary screw technique compared to a traditional cerclage system specifically in context of total hip arthroplasty. METHODS Thirty-two periprosthetic fractures were reduced using either a single cerclage cable or an intracortical positional screw perpendicular to the fracture line. Axial and torsional load testing was terminated after experimental model failure. FINDINGS No significant difference was obtained for all output parameters when comparing cerclage wires versus interfragmentary screw fixation respectively. Load at failure: 8043 ± 712 N vs 7425 ± 854 N (p = 0.115). Load at calcar fracture propagation: 6240 ± 2207 N versus 6220 ± 966 N (p = 0.668). Maximum stiffness before failure: 617 ± 115 N/mm vs 839 ± 175 N/mm (p = 0.100) and stiffness at calcar fracture propagation reached 771 ± 153 Nmm vs 886 ± 129 N/mm (p = 0.197). Torque to failure levels obtained were 59.4 ± 7.1 N*m vs 60.9 ± 12.0 N*m (p = 0.908). Torque to calcar fracture propagation, 51.6 ± 6.1 N*m vs 48.5 ± 9.8 N*m (p = 0.298). Torsional stiffness at failure, 0.38 ± 0.03 N*m\deg. vs 0.43 ± 0.13 N*m\deg. (p = 0.465). Torsional stiffness at calcar fracture propagation were 0.37 ± 0.03 N*m\deg. vs 0.45 ± 0.17 N*m\deg. (p = 0.462). INTERPRETATION The strength of fixation and stability of the implant were similar for both techniques. In the synthetic bone model tested, using an interfragmentary screw conveyed similar stability to the constructs in the management of an intra-operative medial calcar fractures. Thus, potentially giving surgeons an alternative option for intraoperative fracture fixation during primary total hip arthroplasty.
Collapse
Affiliation(s)
- Paul Gauthier
- University of Ottawa, Division of Orthopaedic Surgery, Ottawa, Ontario, Canada.
| | - Pablo A Slullitel
- Hospital Italiano de Buenos Aires, Department of Orthopaedic Surgery, Buenos Aires, Argentina
| | - Andrew Speirs
- Carleton University, Department of Engineering, Ottawa, Ontario, Canada
| | | | - Wade T Gofton
- University of Ottawa, Division of Orthopaedic Surgery, Ottawa, Ontario, Canada
| | - Paul E Beaule
- University of Ottawa, Division of Orthopaedic Surgery, Ottawa, Ontario, Canada
| |
Collapse
|
14
|
Bourget-Murray J, Horton I, Morris J, Bureau A, Garceau S, Abdelbary H, Grammatopoulos G. Periprosthetic joint infection following hip hemiarthroplasty : factors associated with infection and treatment outcome. Bone Jt Open 2022; 3:924-932. [PMID: 36454723 PMCID: PMC9783270 DOI: 10.1302/2633-1462.312.bjo-2022-0138.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. METHODS A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years' follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined. RESULTS A total of 1,984 HAs were performed during the study period, and 44 sustained a PJI (2.2%). Multiple logistic regression analysis revealed that a higher CCI score (odds ratio (OR) 1.56 (95% confidence interval (CI) 1.117 to 2.187); p = 0.003), peripheral vascular disease (OR 11.34 (95% CI 1.897 to 67.810); p = 0.008), cerebrovascular disease (OR 65.32 (95% CI 22.783 to 187.278); p < 0.001), diabetes (OR 4.82 (95% CI 1.903 to 12.218); p < 0.001), moderate-to-severe renal disease (OR 5.84 (95% CI 1.116 to 30.589); p = 0.037), cancer without metastasis (OR 6.42 (95% CI 1.643 to 25.006); p = 0.007), and metastatic solid tumour (OR 15.64 (95% CI 1.499 to 163.087); p = 0.022) were associated with increasing PJI risk. Upon final follow-up, 17 patients (38.6%) failed initial treatment and required further surgery for HA PJI. One-year mortality was 22.7%. Factors associated with treatment outcome included lower preoperative Hgb level (97.9 g/l (SD 11.4) vs 107.0 g/l (SD 16.1); p = 0.009), elevated CRP level (99.1 mg/l (SD 63.4) vs 56.6 mg/l (SD 47.1); p = 0.030), and type of surgery. There was lower chance of success with DAIR (42.3%) compared to revision HA (66.7%) or revision with conversion to total hip arthroplasty (100%). Early-onset PJI (≤ six weeks) was associated with a higher likelihood of treatment failure (OR 3.5 (95% CI 1.2 to 10.6); p = 0.007) along with patients treated by a non-arthroplasty surgeon (OR 2.5 (95% CI 1.2 to 5.3); p = 0.014). CONCLUSION HA PJI initially treated with DAIR is associated with poor chances of success and its value is limited. We strongly recommend consideration of a single-stage revision arthroplasty with cemented components.Cite this article: Bone Jt Open 2022;3(12):924-932.
Collapse
Affiliation(s)
| | - Isabel Horton
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jared Morris
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Antoine Bureau
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Simon Garceau
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Hesham Abdelbary
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada,Correspondence should be sent to George Grammatopoulos. E-mail:
| |
Collapse
|
15
|
Dion CA, Schmidt-Braekling T, Falsetto A, Kreviazuk C, Beaulé PE, Grammatopoulos G. Does Surgical Approach Influence the Natural History of the Unstable Total Hip Arthroplasty? J Arthroplasty 2022; 37:787-794. [PMID: 34923093 DOI: 10.1016/j.arth.2021.12.012] [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: 08/03/2021] [Revised: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dislocation following total hip arthroplasty (THA) is a significant complication that occurs in 0.3%-10% of cases with 13%-42% of patients requiring revision surgery. The literature has primarily focused on the dislocation risk associated with different surgical approaches. However, little is known about the natural history of the dislocated hip and whether surgical approach of the index THA is associated with further instability and revision surgery. METHODS This is a retrospective, single-center, multi-surgeon consecutive case series of all patients who experienced THA dislocation from 2002 to 2020. Patients were excluded if the initial dislocation was secondary to infection or fracture. The natural history of the cohort as per approach was determined. Outcome measurements of interest were the number of dislocations; the treatment surrounding each dislocation; the necessity and type of revision; and the complications encountered. RESULTS Of the 75 patients, 58 (77%) dislocated within 6 months following primary THA. The anterior group had greater odds of dislocation within 2 weeks post-THA compared to the lateral and posterior groups (P = .04). The mean number of dislocations per patient was significantly lower in the anterior (1.5 ± 0.7) compared to the lateral (2.4 ± 1.2) and posterior (2.1 ± 1.0) groups (P = .02). Revision surgery was needed in 30% (6/20) of patients in the anterior, 69% (25/36) of the posterior, and 68% (13/19) of the lateral groups (P = .01). CONCLUSION This study illustrates that while primary THA dislocations happen earlier with the anterior approach, they are typically less complicated and have a lower risk of recurrent instability and revision surgery.
Collapse
Affiliation(s)
- Charles-Antoine Dion
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tom Schmidt-Braekling
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amedeo Falsetto
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | |
Collapse
|
16
|
Nairn L, Gyemi L, Gouveia K, Ekhtiari S, Khanna V. The learning curve for the direct anterior total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:1971-1982. [PMID: 33629172 DOI: 10.1007/s00264-021-04986-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) is a muscle-sparing approach thought to have less post-operative pain and quicker recovery, with similar functional outcomes to other approaches. However, it is technically challenging and transitioning surgeons may experience increased complication rates. The purpose of this systematic review is to identify reported learning curves associated with the DAA. METHODS Three databases (MEDLINE, Embase, and Web of Science) were searched using terms including "total hip arthroplasty," "direct anterior approach," and "learning curve." Study characteristics, patient demographics, learning curve analyses, and complications were abstracted. RESULTS Twenty-one studies met inclusion criteria, with a total of 9738 patients (60% female), an average age of 63.7 years (range: 13-94), body mass index of 27.0 kg/m2 (range: 16.8-58.9), and follow-up of 19 months (range: 1.5-100). There were five retrospective cohort studies and 13 case series representing fair methodological quality. Six studies depicted a true learning curve, with mean operative time of 156.59 ± 41.71 minutes for the first case, 93.18 ± 14.68 minutes by case 30, and 80.45 ± 12.28 minutes by case 100. Mean complication rate was 20.8 ± 12.7% in early groups and decreased to 7.6 ± 7.1% in late groups. CONCLUSION This review demonstrated a substantial learning curve associated with the DAA to THA. Operative time plateaued after approximately 100 cases. Complication rates decreased substantially from early to late groups.
Collapse
Affiliation(s)
- Leah Nairn
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Lauren Gyemi
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| |
Collapse
|
17
|
Comeau-Gauthier M, Zura RD, Bzovsky S, Schemitsch EH, Axelrod D, Avram V, Manjoo A, Poolman RW, Frihagen F, Heels-Ansdell D, Bhandari M, Sprague S. Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture. J Bone Joint Surg Am 2021; 103:1328-1334. [PMID: 33764913 PMCID: PMC8388546 DOI: 10.2106/jbjs.20.01586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. METHODS We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. RESULTS Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. CONCLUSIONS The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | - Robert D. Zura
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Sofia Bzovsky
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Emil H. Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Daniel Axelrod
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Avram
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajay Manjoo
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Rudolf W. Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, and OLVG (Onze Lieve Vrouwe Gasthuis), Amsterdam, the Netherlands
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
18
|
Alva A, Nizam I, Gogos S. Minimizing complications in bikini incision direct anterior approach total hip arthroplasty: A single surgeon series of 865 cases. J Exp Orthop 2021; 8:1. [PMID: 33394190 PMCID: PMC7782761 DOI: 10.1186/s40634-020-00318-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure. Methods We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA’s over a period of 6 years (mean = 3.9yrs from 0.9 to 6.8 years). Results The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40–58) preoperatively to 3.5(range 0–8.8) and similarly, HHS scores improved from 53(range 40–56) to 92.5(range 63–100) at final follow-up (mean = 3.9 yrs) when compared to preoperative scores. Conclusions These results suggest that bikini incision DAA technique can be safely utilised to perform THA.
Collapse
Affiliation(s)
- Avinash Alva
- Mulgrave Private Hospital, Cnr Police Rd and Gladstone Rd, Mulgrave, VIC, 3170, Australia
| | - Ikram Nizam
- Centre for Adult Joint Arthroplasty, 1356 High Street, Malvern, VIC, 3144, Australia.
| | - Sophia Gogos
- Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|