Influence de l’indice de masse corporelle sur la réalisation d’une prothèse totale de hanche par voie d’abord antérieure réduite

Patient Characteristics Related to Blood Loss in High Tibial Osteotomy in Novel Multiple Linear Regression Analysis

The purpose of the study was to identify patient characteristics related to blood loss following high tibial osteotomy (HTO). We evaluated 48 patients undergoing HTO from August 2018 to August 2019. The data of 48 patients were collected, including gender, age, height, weight, body mass index (BMI), smoking, alcohol consumption, hypertension, diabetes, history of aspirin, and pre-postoperative hematocrit (Hct). Multiple linear regression analysis was used to analyze the risk factors related to blood loss in HTO. The mean age of patients was 56.6 ± 10.2 years, including 22 males and 26 females. The mean BMI was 28.5 ± 4.2 kg/m2, and the mean blood loss volume was 383.3 ± 181.3 mL, 13 patients with smoking (27.1%), 15 patients with alcohol consumption (31.3%), 23 patients with hypertension (47.9%), 10 patients with diabetes mellitus (20.8%), and 12 patients with history of aspirin (25.0%). Multiple linear regression model suggested alcohol consumption and BMI were associated with blood loss in HTO, R 2 = 0.451, F(9, 38) = 3.462 (P < 0.05). Our study indicates that alcohol consumption and BMI are important risk factors related to blood loss in HTO.

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

INTRODUCTION

The direct anterior approach (DAA) is an increasingly popular technique for performing total hip arthroplasty (THA). This muscle-sparing approach may yield functional benefits. However, DAA has been associated with an increased risk incidence (RI) of intra- and postoperative complications.

MATERIALS AND METHODS

A systematic review of the published literature was conducted to document the cumulative RI of intra- and postoperative complications, as well as the presence of a learning curve in subjects undergoing THA with a DAA. Study selection and data extraction were carried out independently in duplicate. A Bayesian zero-inflated random-effect model was used to calculate pooled estimates for the different endpoints.

RESULTS

Thirty-eight studies (6485 patients) were analysed. RIs of 0.8 % [95 % confidence interval (CI): 0.4-1.6 %] and 0.5 % (95 % CI: 0.3-0.9 %) were found for intra-operative trochanter and femoral fractures, respectively, and of 0.9 % (95 CI: 0.3-2.6 %) for postoperative transient lateral cutaneous femoral nerve (LCFN) impairment. A clear RI for early revisions (2.1 %; 95 % CI: 1.4-2.8 %) and other surgical re-interventions (1.3 %; 95 % CI: 0.7-1.9 %) was present, but these values do not differ from reported RIs for THA overall. The RI for dislocation was low (0.6 %; 95 % CI: 0.4-0.9 %) compared with the reported literature.

CONCLUSIONS

DAA is a technically demanding procedure, with outcomes possibly indicative of surgeon learning curve. A risk for intra-operative fractures and LCFN is evident, although the risk for other adverse effects is comparable to those with other approaches.

Low body mass index and blood loss in primary total hip arthroplasty: results from 236 consecutive ankylosing spondylitis patients

Objective. To evaluate the effect of low body mass index (BMI) on blood loss during primary total hip arthroplasty (THA) in ankylosing spondylitis (AS) patients. Methods. Two hundred seventy-seven consecutive AS patients who underwent primary THA were retrospectively studied. The patients were divided by BMI into an underweight group (BMI < 18.5 kg/m²) and a normal weight group (18.5 kg/m² < BMI < 25 kg/m²). Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, surgical complications, hospitalization cost, and length of stay (LOS) were collected and analyzed. Results. Of 277 AS patients, 236 were eligible for inclusion in the study. A total of 91 (39%) patients were underweight. The hidden blood loss, transfusion rate, transfusion reactions, and hospitalization cost in the underweight group were significantly higher than those in the normal weight group. Conclusions. For AS patients, BMI appears to be correlated with blood loss during primary THA. Compared with patients of normal weight, low BMI patients have the potential to suffer more postoperative hidden blood loss and to require a higher transfusion rate.

Complex primary total hip arthroplasty

Although total hip arthroplasty is now a classic procedure that is well controlled by orthopedic surgeons, some cases remain complex. Difficulties may be due to co-morbidities: obesity, skin problems, muscular problems, a history of neurological disease or associated morphological bone deformities. Obese patients must be informed of their specific risks and a surgical approach must be used that obtains maximum exposure. Healing of incisions is not a particular problem, but adhesions must be assessed. Neurological diseases may require tenotomy and the use of implants that limit instability. Specific techniques or implants are necessary to respect hip biomechanics (offset, neck-shaft angle) in case of a large lever arm or coxa vara. In case of arthrodesis, before THA can be performed, the risk of infection must be specifically evaluated if the etiology is infection, and the strength of the gluteal muscles must be determined. Congenital hip dysplasia presents three problems: the position and coverage of the cup, placement of a specific or custom made femoral stem, with an osteotomy if necessary, and finally lowering the femoral head into the cup by freeing the soft tissues or a shortening osteotomy. Acetabular dysplasia should not be underestimated in the presence of significant bone defect (BD), and reconstruction with a bone graft can be proposed. Sequelae from acetabular fractures presents a problem of associated BD. Internal fixation hardware is rarely an obstacle but the surgical approach should take this into account. Treatment of acetabular protrusio should restore a normal center of rotation, and prevent recurrent progressive protrusion. The use of bone grafts and reinforcement rings are indispensible. Femoral deformities may be congenital or secondary to trauma or osteotomy. They must be evaluated to restore hip biomechanics that are as close to normal as possible. Fixation of implants should restore anteversion, length and the lever arm. Most problems that can make THA a difficult procedure may be anticipated with proper understanding of the case and thorough preoperative planning.