1
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Itou J, Munakata Y, Kuramitsu Y, Madarame H, Okazaki K. Incidence and Distribution of Deep Vein Thrombosis Following Total Hip Arthroplasty Using an Anterolateral Supine Approach. Orthop Res Rev 2023; 15:199-205. [PMID: 37942236 PMCID: PMC10629369 DOI: 10.2147/orr.s430145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose Venous thromboembolism (VTE) is a potential major complication in patients undergoing total hip arthroplasty (THA). However, the incidence of VTE following THA using anterolateral supine approach (ALS) has not been reported. The purpose of this study was to investigate the incidence of perioperative VTE and the distribution and characteristics of deep vein thrombosis (DVT) following ALS THA. Patients and Methods This retrospective single-arm study analyzed the 182 consecutive hips of 164 patients who underwent primary ALS THA. Pharmacological prophylaxis consisted of enoxaparin 20 mg twice daily for approximately 6 days starting 24 h postoperatively until duplex ultrasonography was performed to determine whether postoperative DVT was present. DVT was assessed by whole-leg Doppler ultrasound, and the location and characteristics of any thrombus were recorded. If pulmonary thromboembolism was suspected, contrast-enhanced computed tomography was performed. Results The overall incidence of VTE was 9.9% for DVT (18/182 hips) and 0.5% for pulmonary thromboembolism (1/182 hips). Most DVTs were in the soleal vein on the affected side and showed isoechoic or hypoechoic echogenicity. All thrombi were non-floating. Conclusion Following ALS THA with standard pharmacological prophylaxis and an early weight-bearing protocol, the incidence of perioperative DVT was approximately 10%, mostly occurring in the lower leg.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yutaro Munakata
- Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yujiro Kuramitsu
- Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hiromi Madarame
- Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
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2
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Hasebe Y, Akasaka K, Otsudo T, Hall T, Yamamoto M. Effects of cross-training on motor function and length of stay after total hip arthroplasty: A randomized controlled trial. J Back Musculoskelet Rehabil 2023; 36:163-171. [PMID: 35871319 DOI: 10.3233/bmr-210325] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA). OBJECTIVE To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA. METHODS Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded. RESULTS In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group. CONCLUSIONS Conclusions: Cross trainer exercise commencing 3 days postoperatively improves physical function and walking ability after THA.
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Affiliation(s)
- Yuki Hasebe
- Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Moroyama, Saitama, Japan.,Department of Rehabilitation, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Kiyokazu Akasaka
- Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Moroyama, Saitama, Japan
| | - Takahiro Otsudo
- Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Moroyama, Saitama, Japan
| | - Toby Hall
- Manual Concept, Perth, Australia.,Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Mitsuru Yamamoto
- Department of Rehabilitation, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
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3
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Papalia GF, Zampogna B, Albo E, Torre G, Villari E, Papalia R, Denaro V. The role of patient surgical positioning on hip arthroplasty component placement and clinical outcomes: a systematic re-view and meta-analysis. Orthop Rev (Pavia) 2023; 15:74116. [PMID: 37064045 PMCID: PMC10097590 DOI: 10.52965/001c.74116] [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] [Indexed: 04/18/2023] Open
Abstract
Total Hip Arthroplasty (THA) may be performed through various approaches; however, depending on the surgical position of the patient, the superiority of lateral or supine position is still debated. The aim of this systematic review and meta-analysis was to compare the supine versus lateral position in THA in terms of intraoperative and postoperative outcomes and component placement. The systematic literature search was performed by the use of Cochrane Central, Pub-Med-Medline, and Google Scholar in order to select studies that evaluated clinical outcomes and the outliers of cup alignment for inclination and anteversion between supine and lateral position for hip arthroplasty. Finally, 9 articles were included in this review. The meta-analysis showed no significant differences between the two groups for clinical outcomes, unless for blood loss and VAS (respectively p = 0.05 and p = 0.004 in favour of lateral decubitus). Regarding the number of outliers, the supine decubitus showed significant differences only for the cup anteversion (p = 0.01). However, more prospective studies with a longer follow-up that analyze both clinical and radiological parameters are needed to assess the superiority of supine or lateral patient position for total hip arthroplasty.
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Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Erika Albo
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Eleonora Villari
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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4
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Xiong A, Li G, Liu S, Chen Y, Xu C, Weng J, Yu F, Gao L, Wang D, Zeng H. Anterolateral approach may be superior to posterolateral approach in controlling postoperative lower limb discrepancy in primary total hip arthroplasty: A single-center, retrospective cohort study. Jt Dis Relat Surg 2022; 34:32-41. [PMID: 36700261 PMCID: PMC9903117 DOI: 10.52312/jdrs.2022.763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/25/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aims to investigate the possible association and comparison between anterolateral approach (ALA) and posterolateral approach (PLA) and postoperative lower limb discrepancy (LLD) in selective total hip arthroplasty (THA). PATIENTS AND METHODS April 2021 and July 2021, a total of 266 consecutive patients (126 males, 140 females; mean age: 46.7±13.6 years; range, 22 to 60 years) who underwent unilateral primary THA via the ALA or the PLA were retrospectively analyzed. The operations were performed by a single surgical team. All patients were divided into two groups according to the approach: ALA group (n=66) and PLA group (n=200). Relevant data were recorded. Diagnosis including hip osteoarthritis, developmental dysplasia of the hip (DDH), aseptic avascular necrosis (AVN), and inflammatory arthritis were noted. Perioperative follow-up radiographs were evaluated and measured to compare the postoperative LLD and offset. The association between two approaches and postoperative LLD and offset was analyzed using the univariate and multivariate linear regression analysis. RESULTS The mean follow-up was 20±3.7 (range, 16 to 25) months. Univariate analysis revealed that the postoperative LLD, the postoperative acetabular offset, and hospital costs were lower in the ALA group than the PLA group (p<0.01). However, the offset and length of stay were comparable between the two groups (p>0.05). Multivariate analysis revealed that the PLA (β=4.71; 95% confidence interval [CI]: 1.78 to 7.64), preoperative LLD (β=0.29; 95% CI: 0.21 to 0.37), DDH (β=5.01; 95% CI: 1.47 to 8.55), and AVN (β=3.81; 95% CI: 0.50 to 7.12) were the main contributors to the postoperative LLD. CONCLUSION Our study results suggest that the ALA may be superior to the PLA in controlling the postoperative LLD among some of the selective unilateral primary THA patients. Both the ALA and the PLA were comparable in terms of the restoration of offset.
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Affiliation(s)
- Ao Xiong
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Guoqing Li
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Su Liu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Yixiao Chen
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Chang Xu
- Intelligent Hospital Research Academy, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Jian Weng
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Fei Yu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Liang Gao
- Sino Euro Orthopaedics Network, Berlin, Germany
| | - Deli Wang
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, 518036 Shenzhen, PR China
| | - Hui Zeng
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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5
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Rivera F, Comba LC, Bardelli A. Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review. World J Orthop 2022; 13:388-399. [PMID: 35582154 PMCID: PMC9048494 DOI: 10.5312/wjo.v13.i4.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/31/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers.
AIM To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate.
METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.
RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.
CONCLUSION DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.
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Affiliation(s)
- Fabrizio Rivera
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
| | - Luca C Comba
- Department of Orthopedic Trauma, Università degli Studi di Torino, Torino 10124, Italy
| | - Alessandro Bardelli
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
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Koto S, Ikeda T, Inoue S, Inoue H, Watanabe M. Differences in preoperative function and outcome of patients with versus without sarcopenia after total hip arthroplasty. J Phys Ther Sci 2022; 34:60-64. [PMID: 35035081 PMCID: PMC8752275 DOI: 10.1589/jpts.34.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Public attention regarding sarcopenia has increased in recent years. Patients
with sarcopenia reportedly show worse return home rates and activities of daily living at
discharge. However, no reports have described the function and outcomes of hip
osteoarthrosis patients with sarcopenia after total hip arthroplasty. This study aimed to
clarify differences in preoperative physical function and outcomes of hip osteoarthrosis
patients with versus without sarcopenia after total hip arthroplasty. [Participants and
Methods] Twenty-five patients with hip osteoarthrosis who underwent total hip arthroplasty
were included. Evaluation items were preoperative skeletal muscle mass of the extremities,
isometric strength of the lower extremities (hip abduction and knee extension), grip
strength, and the 10-m timed gait test results. [Results] The prevalence of sarcopenia was
8% (2/25 patients). The sarcopenic group displayed lower skeletal muscle mass index, grip
strength, and 10-m timed gait test values. The sarcopenic group showed lower muscle mass
in the upper and lower limbs and trunk and lower hip abductor strength than the
non-sarcopenic group. [Conclusion] Eight percent of patients developed sarcopenia after
total hip arthroplasty. Due to the low average age (66.0 ± 9.5 years), the prevalence was
lower than that of other orthopedic diseases.
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Affiliation(s)
- Satoshi Koto
- Department of Physical Therapy, School of Nursing and Rehabilitation, Showa University: 1865 Tokaichiba-cho, Yokohama, Kanagawa 226-8555, Japan.,Department of Rehabilitation, Fujigaoka Hospital, Showa University, Japan.,Research Institute for Sport and Exercise Sciences, Showa University, Japan
| | - Takashi Ikeda
- Department of Physical Therapy, School of Nursing and Rehabilitation, Showa University: 1865 Tokaichiba-cho, Yokohama, Kanagawa 226-8555, Japan.,Research Institute for Sport and Exercise Sciences, Showa University, Japan.,Department of Rehabilitation, Fujigaoka Rehabilitation Hospital, Showa University, Japan
| | - Shunya Inoue
- Department of Rehabilitation, Fujigaoka Rehabilitation Hospital, Showa University, Japan
| | - Hiroyasu Inoue
- Department of Physical Therapy, School of Nursing and Rehabilitation, Showa University: 1865 Tokaichiba-cho, Yokohama, Kanagawa 226-8555, Japan.,Department of Rehabilitation, Fujigaoka Hospital, Showa University, Japan
| | - Minoru Watanabe
- Department of Orthopedic Surgery, Fujigaoka Hospital, Showa University, Japan
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