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.

Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases

The direct anterior approach for total hip arthroplasty has gained popularity throughout the last decade. Early reports showed successful results with rapid functional recovery and low dislocation rates. However there is some concern about the high number of complications induced by the technique. The aim of this study was to examine the early radiological outcome and perioperative complications in a consecutive series of 300 total hip arthroplasties performed through a minimal invasive anterior approach with the aid of a positioning table. We observed 9(3%) intra-operative complications : two femoral perforations, 4 calcar fractures and 3 greater trochanter fractures. There were 42 (14%) postoperative complications and 20 (6.7%) patients required a surgical re-intervention. Our major finding was early peri-prosthetic femoral fracture in 5 patients, not noticed during surgery. The dislocation ratio (2 cases, 0.66%) was low. The complication ratio decreased throughout our series, but statistical significance could not be shown (p = 0.26). Surgeons should be aware of the high risk of occult intra-operative fractures when starting with this technique.

Preformed gentamicin spacers in two-stage revision hip arthroplasty: functional results and complications

Two-stage revisions with antibiotic-loaded spacers have gained popularity for treating infected hip-joint arthroplasties. The aim of this prospective study was to assess patient functionality between stages and treatment impact on duration of hospital stay and to describe related complications. Sixty-one consecutive patients with infected hip arthroplasties underwent two-stage revision with preformed spacer implantation. Mean Harris Hip and Merle d'Aubigné scores between the two stages were 39.9 and 7.6, respectively. Forty-six patients (75.4%) were able to leave hospital between stages. Spacer dislocation occurred in 16.4%. No cases of spacer breakage were noted. Preformed cement spacers provide acceptable functional outcome between revision hip arthroplasty stages and facilitate the surgical procedure without increasing mechanical complication rates.