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Nitiwarangkul L, Hongku N, Pattanaprateep O, Rattanasiri S, Woratanarat P, Thakkinstian A. Which approach of total hip arthroplasty is the best efficacy and least complication? World J Orthop 2024; 15:73-93. [PMID: 38293261 PMCID: PMC10824060 DOI: 10.5312/wjo.v15.i1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function. Approaches of the hip have been exhaustively explored about pros and cons. The efficacy and the complications of hip approaches remains inconclusive. This study conducted an umbrella review to systematically appraise previous meta-analysis (MAs) including conventional posterior approach (PA), and minimally invasive surgeries as the lateral approach (LA), direct anterior approach (DAA), 2-incisions method, mini-lateral approach and the newest technique direct superior approach (DSA) or supercapsular percutaneously-assisted total hip (SuperPath). AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials (RCTs). METHODS MAs were identified from MEDLINE and Scopus from inception until 2023. RCTs were then updated from the latest MA to September 2023. This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score (HHS), dislocation, intra-operative fracture, wound complication, nerve injury, operative time, operative blood loss, length of hospital stay, incision length and VAS pain. Data were independently selected, extracted and assessed by two reviewers. Network MA and cluster rank and surface under the cumulative ranking curve (SUCRA) were estimated for treatment efficacy and safety. RESULTS Finally, twenty-eight MAs (40 RCTs), and 13 RCTs were retrieved. In total 47 RCTs were included for reanalysis. The results of corrected covered area showed high degree (13.80%). Among 47 RCTs, most of the studies were low risk of bias in part of random process and outcome reporting, while other domains were medium to high risk of bias. DAA significantly provided higher HHS at three months than PA [pooled unstandardized mean difference (USMD): 3.49, 95% confidence interval (CI): 0.98, 6.00 with SUCRA: 85.9], followed by DSA/SuperPath (USMD: 1.57, 95%CI: -1.55, 4.69 with SUCRA: 57.6). All approaches had indifferent dislocation and intraoperative fracture rates. SUCRA comparing early functional outcome and composite complications (dislocation, intra-operative fracture, wound complication, and nerve injury) found DAA was the best approach followed by DSA/SuperPath. CONCLUSION DSA/SuperPath had better earlier functional outcome than PA, but still could not overcome the result of DAA. This technique might be the other preferred option with acceptable complications.
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Affiliation(s)
- Lertkong Nitiwarangkul
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Orthopaedics Surgery, Police General Hospital, Bangkok 10330, Thailand
| | - Natthapong Hongku
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok 10300, Thailand
| | - Oraluck Pattanaprateep
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sasivimol Rattanasiri
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ammarin Thakkinstian
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Patel PV, Giannoudis VP, Palma S, Guy SP, Palan J, Pandit H, Van Duren BH. Doctor when can I drive? A systematic review and meta-analysis of return to driving after total hip arthroplasty. Hip Int 2023; 33:17-27. [PMID: 33736494 PMCID: PMC9827492 DOI: 10.1177/1120700021998028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVE Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons' recommendations range between 4-8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively. METHODS A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis. RESULTS 14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant (p < 0.05).Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients (n = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days). CONCLUSIONS The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.
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Affiliation(s)
- Purva V Patel
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | - Samantha Palma
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | - Stephen P Guy
- Trauma and Orthopaedics Department,
Bradford Royal Infirmary, Bradford, UK
| | - Jeya Palan
- Leeds Institute of Rheumatic and
Musculoskeletal Medicine, University of Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and
Musculoskeletal Medicine, University of Leeds, UK
| | - Bernard H Van Duren
- Leeds Institute of Rheumatic and
Musculoskeletal Medicine, University of Leeds, UK
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3
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Gulbrandsen TR, Muffly SA, Shamrock A, O’Reilly O, Bedard NA, Otero JE, Brown TS. Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:127-136. [PMID: 35821938 PMCID: PMC9210397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background The direct anterior approach (DAA) for total hip arthroplasty (THA) has been popularized as a less invasive technique, however outcomes within the first year of practice after fellowship have not been investigated. The primary aim was to determine differences in complications and outcomes between DAA and posterior approach (PA) in the first year of practice. The secondary aim was to determine if there was a learning curve factor in DAA and PA after fellowship training. Methods THA cases performed by two surgeons during their first year of practice were reviewed. Overall, 181 THAs (91 DAA, 90 PA) in 168 patients, were performed. Intraoperative differences (blood loss, operative time), hospital stay, complications, reoperations, and revisions were compared. Results Overall surgical complications were similar between DAA and PA (11% vs. 9%, p=0.64), but complication profiles were different: dislocation (1% vs. 4%, p=0.17), intraoperative femoral fracture (2% vs. 1%, p=0.32), postoperative periprosthetic fractures (2% vs. 3%, p=0.64). neuropraxia (3% vs. 0%, p=0.08). There was no difference in rate of reoperation (1% vs. 3%, p=0.31). There was a difference in rate of revision at final follow-up (0% vs. 6%, p=0.02). DAA consisted of longer operative time (111 vs. 99 minutes; p<0.001), however was only significant in the first 50 cases (p<0.001), while the subsequent cases were similar (p=0.31). There was no difference in the first 50 cases compared to the subsequent cases for either approach regarding blood loss, complications, reoperations, or revisions. Conclusion DAA and PA for THA performed within the first year of practice exhibit similarly low complication rates, but complication profiles are different. In our series, PA did demonstrate a higher risk of revision at final follow-up. A learning curve is not unique to the DAA. Both DAA and PA THA exhibited a learning curve in the first 50 cases performed at the start of a surgeon's practice. Level of Evidence: III.
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Affiliation(s)
- Trevor R. Gulbrandsen
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott A. Muffly
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan Shamrock
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Olivia O’Reilly
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Nicolas A. Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jesse E. Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Timothy S. Brown
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Bäcker HC, Krüger D, Spies S, Perka C, Kirschbaum SM, Hardt S. Effect of total hip arthroplasty on brake reaction time and braking force. Hip Int 2022; 32:51-55. [PMID: 32573263 DOI: 10.1177/1120700020936635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The correct moment for return to driving after total hip arthroplasty (THA) remains unclear. Until today no uniform recommendation exists on the ability to perform an emergency brake.The aim of this prospective study was to investigate the braking ability of patients before and after THA implantation based on brake reaction time in milliseconds (BRT) and braking force in N (BF). METHODS In total, 25 patients (15 men, 10 women, mean age 51.3 ± 10.1 years) were treated with THA on the right side. Inclusion criteria consisted of a valid driving licence, frequent road participation and at least 2 years of driving experience. Exclusion criteria were underlying neurological disorders as well as severe complaints in the lumbar spine and the right knee joint. The brake ability was evaluated for emergency braking with a car simulator and a measuring sole. Measurements were performed preoperatively, 6 days, 2, 4 and 6 weeks after surgery. RESULTS Preoperatively, the mean BRT was 671.3 ± 123.5 ms and the BF 455.4 ± 185.0 N. Significant differences were observed at 6 days and 2 weeks after surgery, (BRT 836.4 ± 219.7 ms, respectively, BRT 735.0 ± 186.7 ms, and BF 302.6 ± 154.9 N, respectively, BF 375.5 ± 149.3 N, p < 0.05). Only 4 weeks after, no significant differences were seen compared to pre-operative with a BRT of 647.0 ± 91.9ms (p = 0.354) and BF of 435.9 ± 177.4 (p = 0.843). Furthermore, the BRT improved significantly after 6 weeks (607.4 ± 87.6; p = 0.005). CONCLUSIONS The braking force is significantly reduced, and the brake reaction time is prolonged directly after surgery for at least 2 weeks. After 4 weeks, no statistically significant differences were measured, although special care should still be taken during return to activity.
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Affiliation(s)
- Henrik C Bäcker
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - David Krüger
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Sophie Spies
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Stephanie M Kirschbaum
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
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Understanding the Main Predictors of Length of Stay After Total Hip Arthroplasty: Patient-Related or Procedure-Related Risk Factors? J Arthroplasty 2021; 36:1663-1670.e4. [PMID: 33342668 DOI: 10.1016/j.arth.2020.11.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Removing total hip arthroplasty (THA) from the Centers for Medicare & Medicaid Services (CMS) inpatient-only list allows Medicare to cover outpatient THA, driving hospitals to recommend outpatient surgery for appropriate patients and raising safety concerns over which patients' admissions should remain inpatient. Thus, we aimed to determine the influence of patient-related and procedure-related risk factors as predictors of >1-day Length of Stay (LOS) after THA. METHODS A prospective cohort of 5281 patients underwent primary THA from 2016 to 2019. Risk factors were categorized as patient-related or procedure-related. Multivariable cumulative link models identified significant predictors for 1-day, 2-day, and ≥3-day LOS. Discriminating 1-day LOS from >1-day LOS, we compared performance between two regression models. RESULTS A>1-day LOS was significantly associated with age, female gender, higher body mass index, higher Charlson Comorbidity Index, Medicare status, and higher Hip disability and Osteoarthritis Outcome Physical Function Shortform(HOOS-PS) and lower Veterans RAND12 Mental Component (VR-12 MCS) scores via the initial regression model that contained patient factors only. A second regression model included procedure-related risk factors and indicated that procedure-related risk factors explain LOS more effectively than patient-related risk factors alone, as Akaike information criterion (AIC) increased by approximately 1100 units upon removal from the model. CONCLUSION Although patient-related risk factors alone provide predictive value for LOS following THA, procedure-related risk factors remain the main drivers of predicting LOS. These findings encourage examination of which specific procedural risk factors should be targeted to optimize LOS when choosing between inpatient and outpatient THA, especially within a Medicare population.
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Malahias MA, Gu A, Richardson SS, De Martino I, Ast MP, Sculco PK. Hospital Discharge Within a Day After Total Hip Arthroplasty Does Not Compromise 1-Year Outcomes Compared With Rapid Discharge: An Analysis of an Insurance Claims Database. J Arthroplasty 2020; 35:S107-S112. [PMID: 31785964 DOI: 10.1016/j.arth.2019.10.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As health care costs continue to rise, same-day and rapid discharge have become popular options for total hip arthroplasty (THA). However, it remains unclear if there is a difference between within-a-day discharge and early discharge for 1-year clinical outcomes. METHODS Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007 to 2017, identifying patients receiving a primary THA. Patients were then stratified into three groups: (1) discharge within a day (length of stay [LOS] <24 hours), (2) rapid discharge (LOS: 1-2 days), and (3) traditional discharge (LOS: 3-4 days). The outcomes assessed were all-cause revision surgery, periprosthetic joint infection, prosthetic loosening, prosthetic dislocation, and periprosthetic fracture at 1 year postoperatively. RESULTS In total, 40,038 patients met inclusion criteria. Among those, 754 (1.88%) patients were discharged within a day, 13,670 (34.14%) patients were in the rapid discharge cohort, and 25,614 (63.97%) patients were in the traditional discharge cohort. After multivariate analysis, no significant differences were observed between the within-a-day discharge group and either the rapid discharge or the traditional discharge group. Rapid discharge patients were at decreased risk of periprosthetic joint infection (odds ratios: 0.747, 95% confidence interval: 0.623-0.896) and readmission (odds ratios: 0.778; 95% confidence interval: 0.735-0.824, P < .001) compared with traditional discharge patients. CONCLUSIONS No significant differences were observed in the one-year outcomes of primary THA between within-a-day discharge patients, rapid discharge, and traditional discharge. For those that qualify after careful selection, outpatient THA might be a feasible alternative to the traditional inpatient THA.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Shawn S Richardson
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ivan De Martino
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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7
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Gaillard-Campbell MD, Fowble C, Webb L, Gross TP. Hip resurfacing as an outpatient procedure: a comparison of overall cost and review of safety. Musculoskelet Surg 2020; 105:111-116. [PMID: 31993975 PMCID: PMC7960592 DOI: 10.1007/s12306-020-00637-z] [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: 05/29/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022]
Abstract
Abstract Recent advancements in arthroplasty surgical techniques and perioperative protocols have reduced the duration of hospitalization and length of recovery, allowing surgeons to perform joint replacement as an outpatient procedure. This study aims to evaluate the cost-effectiveness and safety of outpatient hip resurfacing. Two experienced surgeons performed 485 resurfacing surgeries. We retrospectively compared clinical outcomes and patient satisfaction with published outpatient total hip results. Furthermore, we compared average insurance reimbursement with that of local inpatient hip replacement. No major complications occurred within 6 weeks. Of the 39 patients with previous inpatient experience, 37 (95%) believed their outpatient experience was superior. The average reimbursement for hip arthroplasty at local hospitals was $50,000, while the average payment for outpatient resurfacing at our surgery center was $26,000. We conclude that outpatient hip resurfacing can be accomplished safely, with high patient satisfaction, and at a tremendous financial savings to the insurer/patient. Level of evidence III Electronic supplementary material The online version of this article (10.1007/s12306-020-00637-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M D Gaillard-Campbell
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - C Fowble
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
| | - L Webb
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
| | - T P Gross
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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8
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Flevas DA, Tsantes AG, Mavrogenis AF. Direct Anterior Approach Total Hip Arthroplasty Revisited. JBJS Rev 2020; 8:e0144. [DOI: 10.2106/jbjs.rvw.19.00144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Outpatient Joint Arthroplasty-Patient Selection: Update on the Outpatient Arthroplasty Risk Assessment Score. J Arthroplasty 2019; 34:S40-S43. [PMID: 30738619 DOI: 10.1016/j.arth.2019.01.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Outpatient Arthroplasty Risk Assessment (OARA) score was designed to identify patients medically appropriate for same- and next-day discharge after surgery. The purpose of this study was to update and confirm the greater predictive utility of the OARA score in relation to American Society of Anesthesiologists Physical Status (ASA-PS) classification for same-day discharge and to identify the optimal preoperative OARA score for safe patient selection for outpatient surgery. METHODS The perioperative medical records of 2051 primary total joint arthroplasties performed by a single surgeon at an academic tertiary care hospital were retrospectively reviewed. Six statistical measures were calculated to examine OARA score performance in binary classification of successful same-day discharge and preoperative OARA scores equal to 0 to 59 points (yes vs no) vs 0 to 79 points (yes vs no). RESULTS Mean OARA scores increased more sharply in magnitude with increasing length of stay, providing superior discrimination than the ASA-PS classification with respect to same-day discharge. Preoperative OARA scores up to 79 points approached the desired 100% for positive predictive value (98.8%) and specificity (99.3%) and 0% for false positive rates (0.7%). CONCLUSION The OARA score was designed to err in the direction of medical safety, and OARA scores between 0 and 79 are conservatively highly effective for identifying patients who can safely elect to undergo outpatient total joint arthroplasty. The ASA-PS classification does not provide sufficient discrimination for safely selecting patients for outpatient arthroplasty.
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10
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Refai HF, Kassem MS. The minimally invasive total hip replacement via the direct anterior approach: A short term clinical and radiological results. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Helmy Fekry Refai
- Orthopaedic Department, Derriford Hospital, Plymouth Hospitals NHS Trust, UK
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11
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Abdel MP, Chalmers BP, Trousdale RT, Hanssen AD, Pagnano MW. Randomized Clinical Trial of 2-Incision vs Mini-Posterior Total Hip Arthroplasty: Differences Persist at 10 Years. J Arthroplasty 2017; 32:2744-2747. [PMID: 28487089 DOI: 10.1016/j.arth.2017.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A previous randomized clinical trial at our institution demonstrated slower recovery of 35 2-incision total hip arthroplasties (THAs) when compared with 36 mini-posterior THAs at 2 years. The primary aim of the present study was to report concise 10-year follow-up results. METHODS We retrospectively reviewed the 71 patients in the previous randomized clinical trial, comparing clinical outcomes, revisions, reoperations, and implant survivorship between the 2-incision and the mini-posterior THAs. RESULTS At the most recent follow-up, the mean Harris hip score was 85 in the 2-incision group and 87 in the mini-posterior group (P = .4). There were 4 revisions and 2 reoperations (16%) in the 2-incision group vs 1 revision and 3 reoperations (11%) in the mini-posterior group (P = .5). Ten-year survivorship free of aseptic revision or reoperation was 77% in the 2-incision group vs 90% in the mini-posterior group (P = .15). CONCLUSION There were no improvements in early or midterm clinical outcomes with the 2-incision technique. However, there was a clinical trend toward a higher rate of aseptic revisions in the 2-incision THA group.
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Affiliation(s)
- Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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12
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Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P. Safe Selection of Outpatient Joint Arthroplasty Patients With Medical Risk Stratification: the "Outpatient Arthroplasty Risk Assessment Score". J Arthroplasty 2017; 32:2325-2331. [PMID: 28390881 DOI: 10.1016/j.arth.2017.03.004] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/26/2017] [Accepted: 03/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Current patient selection criteria and medical risk stratification methods for outpatient primary total joint arthroplasty (TJA) surgery are unproven. This study assessed the predictive ability of a medically based risk assessment score in selecting patients for outpatient and short stay surgery. METHODS A retrospective review of 1120 consecutive primary TJAs in an early discharge program was performed. An Outpatient Arthroplasty Risk Assessment ("OARA") score was developed by a high-volume arthroplasty surgeon and perioperative internal medicine specialist to stratify patients as "low-moderate risk (≤59)" and "not appropriate" (≥60) for early discharge. OARA, American Society of Anesthesiologists Physical Status Classification System (ASA-PS), and Charlson comorbidity index (CCI) scores were analyzed with respect to length of stay. RESULTS The positive predictive value of the OARA score was 81.6% for the same or the next day discharge, compared with that of 56.4% for ASA-PS (P < .001) and 70.3% for CCI (P = .002) scores. Patients with OARA scores ≤59 were 2.0 (95% confidence interval [CI], 1.4-2.8) times more likely to be discharged early than those with scores ≥60 (P < .001), while a low ASA-PS score was 1.7 (95% CI, 1.2-2.3) times more likely to be discharged early (P = .001). CCI did not predict early discharge (P ≥ .301). With deliberate patient education and expectations for outpatient discharge, the odds of early discharge predicted by the OARA score, but not the ASA-PS score, increased to 2.7 (95% CI, 1.7-4.2). CONCLUSION The OARA score for primary TJA has more precise predictive ability than the ASA-PS and CCI scores for the same or next day discharge and is enhanced with a robust patient education program to establish appropriate expectations for early discharge. Early results suggest that the OARA score can successfully facilitate appropriate patient selection for outpatient TJA, although consideration of clinical program maturity before adoption of the score is advised.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Mary Ziemba-Davis
- Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Marshall K Ishmael
- Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Alexander L Kuzma
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
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13
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Matsumoto M, Baba T, Ochi H, Ozaki Y, Watari T, Homma Y, Kaneko K. Kerboull-type plate in a direct anterior approach for severe bone defects at primary total hip arthroplasty: technical note. SICOT J 2017; 3:21. [PMID: 28287388 PMCID: PMC5347370 DOI: 10.1051/sicotj/2017006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/08/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction: For cases with extensive acetabular bone defects, we perform surgery combining the Kerboull-type (KT) plate and bone graft through direct anterior approach (DAA) in primary total hip arthroplasty (THA) requiring acetabular reconstruction as minimally invasive surgery. This paper provides the details of the surgical procedure. Methods: The basic structure of the Kerboull-type plate is a cruciform plate. Since the hook of the Kerboull-type plate has to be applied to the tear drop, a space for it was exposed. The tear drop is located in the anterior lower region in surgery through DAA in supine position. It was also confirmed by fluoroscopy as needed. The bone grafting was performed using an auto- or allogeneic femoral head for bone defects in the weight-bearing region of the hip joint. Results: Of 563 patients who underwent primary THA between 2012 and 2014, THA using the KT plate through DAA was performed in 21 patients (3.7%). The mean duration of postoperative follow-up was 31.8 months. The mean operative time was 188.4 min, and the mean blood loss was 770 g. The patients became able to walk independently after 2.4 days on average (1–4 days). On clinical evaluation, the modified Harris Hip Score was 45.6 ± 12.4 before surgery, and it was significantly improved to 85.3 ± 8.97 on the final follow-up. Discussion: DAA is a true intermuscular approach capable of conserving soft tissue. Since it is applied in a supine position, fluoroscopy can be readily used, and it was very useful to accurately place the plate.
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Affiliation(s)
- Mikio Matsumoto
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Taiji Watari
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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DiSilvestro KJ, Santoro AJ, Tjoumakaris FP, Levicoff EA, Freedman KB. When Can I Drive After Orthopaedic Surgery? A Systematic Review. Clin Orthop Relat Res 2016; 474:2557-2570. [PMID: 27492688 PMCID: PMC5085934 DOI: 10.1007/s11999-016-5007-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/25/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures, but the data regarding this topic are diverse and sometimes conflicting. Some studies provide observer-reported outcome measures, such as brake response time or simulators, to estimate when patients can safely resume driving after surgery, and patient survey data describing when patients report a return to driving, but they do not all agree. We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive. QUESTIONS/PURPOSES Based on the available evidence, we sought to determine when patients can safely return to driving after (1) lower extremity orthopaedic surgery and injuries; (2) upper extremity orthopaedic surgery and injuries; and (3) spine surgery. METHODS A search was performed using PubMed and EMBASE®, with a list of 20 common orthopaedic procedures and the words "driving" and "brake". Selection criteria included any article that evaluated driver safety or time to driving after major orthopaedic surgery or immobilization using observer-reported outcome measures or survey data. A total of 446 articles were identified from the initial search, 48 of which met inclusion criteria; abstract-only publications and non-English-language articles were not included. The evidence base includes data for driving safety on foot, ankle, spine, and leg injuries, knee and shoulder arthroscopy, hip and knee arthroplasty, carpal tunnel surgery, and extremity immobilization. Thirty-four of the articles used observer-reported outcome measures such as total brake time, brake response time, driving simulator, and standardized driving track results, whereas the remaining 14 used survey data. RESULTS Observer-reported outcome measures of total brake time, brake response time, and brake force postoperatively suggested patients reached presurgical norms 4 weeks after right-sided procedures such as TKA, THA, and ACL reconstruction and approximately 1 week after left-sided TKA and THA. The collected survey data suggest patients resumed driving 1 month after right-sided and left-sided TKAs. Patients who had THA reported returning to driving between 6 days and 3 months postoperatively. Observer-reported outcome measures showed that patients' driving abilities often are impaired when wearing an immobilizing cast above or below the elbow or a shoulder sling on their dominant arm. Patients reported a return to driving on average 2 months after rotator cuff repair procedures and approximately 1-3 months postoperatively for total shoulder arthroplasties. Most patients with spine surgery had normal brake response times at the time of hospital discharge. Patients reported driving 6 weeks after total disc arthroplasty and anterior cervical discectomy and fusion procedures. CONCLUSIONS The available evidence provides a best-case scenario for when patients can return to driving. It is important for observer-reported outcome measures to have normalized before a patient can consider driving, but other factors such as strength, ROM, and use of opioid analgesics need to be considered. This review can provide a guideline for when physicians can begin to consider evaluating these other factors and discussing a return to driving with patients. Survey data suggest that patients are returning to driving before observer-reported outcome measures have normalized, indicating that physicians should tell patients to wait longer before driving. Further research is needed to correlate observer-reported outcome measures with adverse events, such as motor vehicle accidents, and clinical tests that can be performed in the office. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | - Adam J Santoro
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Fotios P Tjoumakaris
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric A Levicoff
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin B Freedman
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
- Rothman Institute, Department of Orthopaedic Surgery, 825 Old Lancaster Road, Suite 200, Bryn Mawr, PA, 19010, USA.
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15
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Jelsma J, Pijnenburg R, Boons HW, Eggen PJMG, Kleijn LLA, Lacroix H, Noten HJ. Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study. J Orthop 2016; 14:53-58. [PMID: 27822002 DOI: 10.1016/j.jor.2016.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/16/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Since years a discussion is held on the best approach to perform total hip replacement (THR). Risk of dislocation, abductor weakness and a possible difference in rehabilitation are mentioned. We performed this study to objectify that the use of the direct anterior approach (DAA) results in a faster rehabilitation after THR compared to the non-DAA (posterolateral and anterolateral) approach. METHODS A single centre prospective cohort study was conducted. Pre- and 16-weeks postoperative completed PROMs like the VAS, PSC, GPE and HOOS were analyzed. A leg press and power test were performed. Functional capacity was determined by the TUG and the 6MWT. RESULTS A total of 119 patients were included for analysis: 87 in the DAA group, 32 in the non-DAA group. There were no differences in general baseline characteristics. The length of stay was significant (p = .000) shorter in the DAA group. At 16 weeks, the DAA group showed a significant greater improvement with respect to the VAS and HOOS. Also significant differences for all strength, power and functional capacity parameters between the pre- and postoperative measurements were found. A subgroup analysis at 6-weeks postoperative showed significant improvements in the TUG (p = .009) and 6MWT (p = .009) in the DAA group, but not in the non-DAA group. CONCLUSION PROMs, strength, power and functional capacity tests show significant improvement in all approaches after THR. There seems to be a small advantage in favour of the DAA, in particular directly postoperative and the first postoperative weeks.
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Affiliation(s)
- Jetse Jelsma
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Rik Pijnenburg
- Physiotherapy Jeurissen & van Ingh, Fabriekstraat 24, 5753 AH Deurne, The Netherlands
| | - Harm W Boons
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Peter J M G Eggen
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Lucas L A Kleijn
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Herman Lacroix
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Hub J Noten
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
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16
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Barnett SL, Peters DJ, Hamilton WG, Ziran NM, Gorab RS, Matta JM. Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach. J Arthroplasty 2016; 31:2291-4. [PMID: 26897487 DOI: 10.1016/j.arth.2015.07.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/29/2015] [Accepted: 07/06/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few publications have raised concern with the safety of the anterior approach (AA) to total hip arthroplasty (THA). The purpose of this study is to report the early complications with AA THA in a combined, multicenter patient population from three different institutions. METHODS The study cohort consisted of 5090 consecutive primary procedures in 4473 patients who had undergone THA utilizing the anterior approach between August 2006 and July 2013. Surgeries were performed by five surgeons at three sites that maintain prospective databases. Preoperative, intraoperative, and postoperative data were recorded on all patients. Demographic data including age, gender, and BMI were queried, as well as all intraoperative and postoperative complications in the first 90 days. RESULTS The 5090 patients had a mean body mass index of 27.5, and mean age of 63.6 years. The overall 90-day complication rate was 1.9%. There were 41 intraoperative femur fractures including 29 calcar fractures, 9 greater trochanter fractures and 3 femoral shaft fractures. There were 7 postoperative femur fractures including 3 greater trochanter fractures, 2 calcar fractures, and 2 femur fractures. Other complications included 15 superficial infections, 5 deep infections, 12 dislocations, 8 hematomas, 3 cases of cellulitis, 2 sciatic nerve palsies, 1 peroneal nerve palsy, and intrapelvic bleed. The nonsurgical complication rate was 1.4%. Deep vein thrombosis occurred in 0.3% of cases. CONCLUSION This large multicenter study of consecutive AA THAs demonstrates an acceptable risk profile within the first 90 days after surgery.
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Affiliation(s)
| | | | | | - Navid M Ziran
- Hip & Pelvis Institute at St. John's Center, Santa Monica, California
| | | | - Joel M Matta
- Hip & Pelvis Institute at St. John's Center, Santa Monica, California
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17
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Shah NA, Patil HG, Vaishnav VO, Kathawadia KM. Morbidity index: A score to assess immediate postoperative recovery in TKR patients. J Orthop 2016; 13:235-7. [PMID: 27408484 PMCID: PMC4925723 DOI: 10.1016/j.jor.2015.05.004] [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: 02/03/2015] [Accepted: 05/03/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Every surgical procedure involves certain amount of postoperative morbidity which varies among different surgeries and the same surgery done by different techniques. Minimally invasive surgeries have evolved in all surgical branches and are believed to have a lesser morbidity than the traditional procedures; however there is no score or index to assess the immediate recovery after any surgical procedure in the literature. We tried to devise an immediate postoperative assessment method that takes into account the early recovery phase of patient post total knee arthroplasty (TKA) from day1 to day3. We called it as morbidity index. It consists of a 10 different parameters which could overall assess the patient's postoperative recovery. MATERIALS & METHODS A prospective study was conducted in order to evaluate feasibility of the morbidity index and its usefulness in assessing the immediate postoperative recovery in TKA. We evaluated 50 consecutive TKA patients and scored at day 1, day 2 and day 3 postoperatively by a morbidity index. RESULTS The mean score on day one was 13.88 which decreased to 4.68 by day three indicating morbidity has decreased. CONCLUSIONS The morbidity index can be a tool to assess the immediate postoperative recovery of the patient after TKA and can be used to compare different approaches and procedure.
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Affiliation(s)
| | - Hitendra G. Patil
- Corresponding author. Tel.: +91 022 23825673 (office), +91 9833164740 (mobile).
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18
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Parvizi J, Restrepo C, Maltenfort MG. Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study. Orthop Clin North Am 2016; 47:497-504. [PMID: 27241374 DOI: 10.1016/j.ocl.2016.03.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Studies suggest that total hip arthroplasty (THA) performed through direct anterior (DA) approach has better functional outcomes than other surgical approaches. The immediate to very early outcomes of DA THA are not known. A prospective, randomized study examined the very early outcome of THA performed through DA versus direct lateral approach. The functional outcomes on day 1, day 2, week 6, week 12, 6 months, and 1 year were measured. Patients receiving DA THA had significantly higher functional scores during the early period following surgery. The difference in functional scores leveled out at 6 months.
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Affiliation(s)
- Javad Parvizi
- The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Camilo Restrepo
- The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Mitchell G Maltenfort
- The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA
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19
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Lovald ST, Ong KL, Lau EC, Joshi GP, Kurtz SM, Malkani AL. Patient Selection in Short Stay Total Hip Arthroplasty for Medicare Patients. J Arthroplasty 2015; 30:2086-91. [PMID: 26115979 DOI: 10.1016/j.arth.2015.05.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/16/2015] [Accepted: 05/21/2015] [Indexed: 02/01/2023] Open
Abstract
There is a trend towards shortening inpatient hospital stays following total hip arthroplasty (THA) in an effort to reduce healthcare costs and potentially decrease complications. The purpose of this study was to identify patients who are at risk for readmission, complications, and mortality after short stay THA. The Medicare sample (1997-2011) was used to identify THA patients with 1-2-day (Group A, n=2949) or 3-day (Group B, n=8707) stays. Complication risks were similar between groups, though there was a reduced risk for hospitalization for Group A (adjusted hazard ratio=0.90, P=0.029). These findings suggest that age and comorbidities, particularly diabetes and cardiovascular conditions, have the greatest effect on readmission and event risk after short stay THA.
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Affiliation(s)
| | | | | | - Girish P Joshi
- Dept of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | | | - Arthur L Malkani
- University of Louisville, Dept. of Orthopaedic Surgery, KentuckyOne Health, Louisville, Kentucky
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20
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The Impact of Study Period on Perioperative Outcomes Following Hip Arthroplasty. J Arthroplasty 2015; 30:1167-71. [PMID: 25682207 DOI: 10.1016/j.arth.2015.02.002] [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: 11/17/2014] [Revised: 01/20/2015] [Accepted: 02/03/2015] [Indexed: 02/01/2023] Open
Abstract
We hypothesized that the time period studied would have a greater impact on perioperative outcomes than the hip arthroplasty procedure performed, demonstrating concerns with studies comparing new techniques to "historical" controls. One hundred total hip arthroplasty (THA) and 100 surface replacement arthroplasty (SRA) patients performed between 2004 and 2010 ("historical" period) were matched and compared to 50 THA and 50 SRA patients performed between 2010 and 2012 ("recent" period). Time to discharge was significantly improved for both the THA and SRA groups in the recent versus historical period by 16hours (P<0.001). At both periods, THA patients were discharged earlier by 9hours versus SRAs (P<0.0001). Study time frame had a greater impact than the operative procedure on perioperative metrics.
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21
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Anterolateral intermuscular approach for type A2 intertrochanteric fractures: a cadaveric study. Int Surg 2015; 100:314-9. [PMID: 25692436 DOI: 10.9738/intsurg-d-14-00188.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This cadaveric study was designed to clarify the anatomic basis of using an anterolateral intermuscular approach to repair type A2 intertrochanteric fractures (ITF). The conventional lateral approach to surgery that is used for ITF has several disadvantages that can result in both intraoperative and postoperative complications, especially for type A2 ITF. Previous studies have suggested using minimally-invasive total hip arthroplasty (THA) with an anterolateral approach. The legs of 10 formalin-fixed Asian cadavers were dissected, simulating an anterolateral surgical approach. The distances from the superior gluteal nerve and the lateral femoral circumflex artery branches to the lateral protrusive point of the greater trochanter were measured. The anterolateral intermuscular approach provided excellent exposure of the GT, the lesser trochanter and the femoral neck. The gluteus medius branch of the ascending branch of the lateral femoral circumflex artery (GMB-LFCA) and the most inferior branch of the superior gluteal nerve (MIB-SGN) were found to cross the spatium intermusculare between the gluteus medius and the tensor fasciae latae. The distance from the GMB-LFCA, in the intermuscular plane, to the lateral protrusive point of the GT was (4.04 ± 1.00 cm, range 2.96-6.62 cm); and the distance from the MIB-SGN to the lateral protrusive point of the GT was (5.47 ± 1.61 cm, range 3.68-9.56 cm). The anterolateral intermuscular approach is relatively safe, provides excellent exposure, and causes less soft-tissue damage than the traditional approach, and it represents a promising new method to surgically treat type A2 ITF.
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22
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Poehling-Monaghan KL, Kamath AF, Taunton MJ, Pagnano MW. Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results. Clin Orthop Relat Res 2015; 473:623-31. [PMID: 25082624 PMCID: PMC4294903 DOI: 10.1007/s11999-014-3827-z] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although some surgeons strongly advocate for one approach over the other, there are few data directly comparing the direct anterior approach with a miniposterior approach for total hip arthroplasty (THA). QUESTIONS/PURPOSES Using the same advanced pain and rapid rehabilitation protocols for both groups, we compared the direct anterior and miniposterior approaches with respect to (1) return to activities of daily living at 2 days, 2 weeks, or 2 months; (2) risk of intraoperative or early postoperative complications; and (3) component position. METHODS Over a 1-year period we identified all consecutive, primary direct anterior and miniposterior THAs performed by two surgeons at our institution, totaling 242 patients. Of those, 20 did not meet inclusion criteria as a result of prior trauma or surgery about the hip. A total of 222 patients, 126 direct anterior and 96 miniposterior, were retrospectively evaluated. All cases were done by one of two surgeons, one of whom performs THA exclusively through the direct anterior approach and the other who only uses the miniposterior approach. Groups did not differ demographically with mean±SD age 64±12 years, mean body mass index 30±5.7 kg/m2, and 50% female. The same rapid rehabilitation protocols were used with no postoperative hip positioning precautions. RESULTS No differences were seen between the two groups in mean length of stay (2.2 days; range, 1-9 days), operative or in-hospital complications, intravenous breakthrough analgesia, stairs, maximum feet walked in-hospital, or percent discharged to home (80% [177 of 222]; all p>0.2). The direct anterior patients had longer mean operative times (114 minutes; range, 60-251 minutes) than the miniposterior patients (mean, 60 minutes; range, 41-113 minutes; p<0.001). The direct anterior group had a higher maximum visual analog scale pain score (5.3 direct anterior; ±2, versus 3.8 MP; ±2; p<0.0001). At 2 weeks, more direct anterior patients required gait aids (92% [116 of 126]) than miniposterior (68% [62 of 96]; p<0.0001). At 8 weeks, direct anterior patients had higher mean Harris hip scores (95 versus 89) but a lower return to work and driving with no difference in their use of gait aids, narcotics, activities of daily living, or walking 0.5 mile. More wound problems occurred in the miniposterior group (p<0.01). With the numbers available, component alignment was not different between the study groups (p>0.05 for all comparisons). CONCLUSIONS There was no systematic advantage of direct anterior THA versus miniposterior THA. Contrary to conventional belief and somewhat surprising were the fewer minor wound problems in the direct anterior group and the higher proportion of patients free of gait aids at 2 weeks and back to driving and working at 8 weeks in the miniposterior group. Factors other than surgical approach, perhaps including attentive pain management, patient selection, surgical volume and experience, careful preoperative templating, and rapid rehabilitation protocols, may be more important in terms of influencing early recovery after THA. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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23
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Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg 2013; 7:18. [PMID: 23721404 PMCID: PMC3681720 DOI: 10.1186/1754-9493-7-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/22/2013] [Indexed: 12/17/2022] Open
Abstract
Background Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. Recently a new option has become available with the minimally-invasive tight rope technique. Whereas clinical studies justify the medical use, risks and benefits remain unclear. Therefore, this study analyzed these facts associated with this procedure and compared them to K-wire fixation. Material and Methods A retrospective analysis was performed of patients surgically treated either with the TightRope™-technique (TR) or K-wires (KW) for a first event isolated Rockwood type III or higher acromioclavicular joint dislocation between 2004 and 2011. Timing for surgery, surgical duration, length of hospital stay, costs, complications and outpatient visits were recorded. Results 41 patients were included (TR: n = 18; KW: n = 23) with comparable demographics and injury severity. A trend towards shorter operation time was seen in the TR group (TR: 64.3 ±19.8 min. vs. KW: 80.9 ±33.7 min., n.s.) A tendency for lower total operation theater costs was seen in the TR group (TR: 474 ±436.5€ vs. KW: 749.1 ±31.2€, n.s.). Patients from the TR group left hospital earlier (TR: 2 ±1d vs. KW: 3.6 ±1.8d, p = 0.002). Severe complications (i.e. a fracture of the clavicle or nerve damage) occurred in neither of the groups. Early loss of reduction (n = 1) and impaired wound healing (n = 2) was seen in the TR group. Migrating K-wires (n = 4), loss of reduction (n = 1) and impingement syndrome (n = 1) were recorded in the KW group. Conclusion Usage of the tight rope technique offered advantages, such as being a safe minimally-invasive technique and showed a tendency towards shorter operation time, and lower physician- and total operation and theater costs. Material costs were significantly higher for this device but patients were discharged earlier. The influence of different clinical long-term results on the financial outcome needs to be evaluated in further studies.
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Affiliation(s)
- Klemens Horst
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Thomas Dienstknecht
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Miguel Pishnamaz
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Richard Martin Sellei
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
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Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty 2013; 28:849-54. [PMID: 23489731 DOI: 10.1016/j.arth.2012.10.029] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/20/2012] [Accepted: 10/29/2012] [Indexed: 02/01/2023] Open
Abstract
The efficacy of the anterior, relative to other operative approaches, in promoting earlier return to function after hip arthroplasty has not been well established. We retrospectively compared 41 anterior and 47 posterior approach cases. Mean hospital stay (2.9 vs. 4 days, p=0.001) and days to mobilization (2.4 vs. 3.2 days, p=0.006) were shorter with the anterior approach. After multivariate regression, the anterior approach remained a significant predictor of early discharge (p=0.009). Lateral femoral cutaneous nerve neuropraxia (17%) and fracture (2%), were more common in the anterior cohort, but all patients recovered without sequela. Overall, the anterior approach patients had earlier discharge and mobilization as compared to patients who received the posterior approach. Neuropraxia and fracture remain a concern, but the clinical significance was low in our cohort.
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Affiliation(s)
- Christopher T Martin
- The Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
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25
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Kipping R. [Current knowledge on minimally invasive hip replacement]. DER ORTHOPADE 2012. [PMID: 23179265 DOI: 10.1007/s00132-012-1995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lloyd JM, Wainwright T, Middleton RG. What is the role of minimally invasive surgery in a fast track hip and knee replacement pathway? Ann R Coll Surg Engl 2012; 94:148-51. [PMID: 22507716 DOI: 10.1308/003588412x13171221590214] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Minimally invasive hip and knee replacement surgery (MIS) continues to receive coverage in both the popular press and scientific literature. The cited benefits include a smaller scar, less soft tissue trauma, faster recovery, reduced hospital stay, decreased blood loss and reduced post-operative pain. These outcomes are highly desirable and consistent with the aims of fast track hip and knee pathways. This paper evaluates the literature and discusses whether performing MIS over conventional surgical techniques offers advantages in a fast track hip and knee pathway. METHODS An English language literature search was performed using the MEDLINE and PubMed databases. Case series, randomised controlled trials and systematic reviews were included in the review. RESULTS The reported improvements in recovery brought about by MIS must be considered multifactorial. In combination with improved clinical pathways, MIS can be associated with quicker recovery and shorter length of hospital stay. CONCLUSIONS There is insufficient evidence to indicate that surgical technique alone makes a significant difference to recovery or reduces soft tissue trauma. No consensus on whether to use MIS techniques in fast track hip and knee replacement pathways can therefore be drawn. This is especially important given that the complication rates of MIS in the low to medium volume surgeon appear unacceptably high compared with standard approaches. It is also too early to assess the long-term effects of MIS on implant survival.
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Affiliation(s)
- J M Lloyd
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, UK.
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Gebel P, Oszwald M, Ishaque B, Ahmed G, Blessing R, Thorey F, Ottersbach A. Process optimized minimally invasive total hip replacement. Orthop Rev (Pavia) 2012; 4:e3. [PMID: 22577504 PMCID: PMC3348691 DOI: 10.4081/or.2012.e3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA) in total hip replacement (THR) in combination with the leg positioner (Rotex- Table) and a modified retractor system (Condor). We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS). All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years), with a mean BMI of 26.5 (17 to 43). The mean time of surgery was 80 min. (55 to 130 min). The blood loss showed an average of 511.5 mL (200 to 1000 mL). No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points) 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/− 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.
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Affiliation(s)
- Philipp Gebel
- Department of Orthopaedics, Hospital of Wallis/Brig, Switzerland
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Ki SC, Kim BH, Ryu JH, Yoon DH, Chung YY. Total hip arthroplasty using two-incision technique. Clin Orthop Surg 2011; 3:268-73. [PMID: 22162788 PMCID: PMC3232353 DOI: 10.4055/cios.2011.3.4.268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/23/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of minimally invasive surgery total hip arthroplasty (THA) using the two-incision technique as described by Mears. METHODS From January 2003 to December 2006, sixty-four patients underwent total hip arthroplasty using the one-incision (group I) and two-incision (group II) technique by one surgeon. There were 34 hips in group I and 30 hips in group II. There was no difference in age, gender, and causes of THA between the two groups. We evaluated the operation time, bleeding amount, incision length, ambulation, hospital stay, and complications between the two groups. RESULTS There was no difference in the bleeding amount between the two groups. Operation time was longer in the two-incision group than in the one-incision group. Operation time of the two-incision technique could be reduced after 15 cases. Patients started ambulation after surgery earlier in group II than group I, and the hospital stay was shorter in group II than in group I. There was no difference in clinical results between the two groups. There was no difference in component position of the acetabular cup and femoral stem between the two groups. Intraoperative periprosthetic fracture occurred in four cases (13.3%) in group II. CONCLUSIONS Two-incision THA has the advantage of rapid recovery and shorter hospital stay. However, longer operation time and a high complication rate compared to one-incision are problems that need to be solved in the two-incision technique.
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Affiliation(s)
- Sung-Chan Ki
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Wellman SS, Murphy AC, Gulcynski D, Murphy SB. Implementation of an accelerated mobilization protocol following primary total hip arthroplasty: impact on length of stay and disposition. Curr Rev Musculoskelet Med 2011; 4:84-90. [PMID: 21755283 DOI: 10.1007/s12178-011-9091-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With improvements in surgical techniques, implant design, and patient caremaps, surgeons have sought to accelerate early rehabilitation after total hip arthroplasty. Many authors have reported results of fundamentally similar protocols to achieve this end. These protocols focus on multi-modal pain management, early therapy, tissue-preserving surgical technique, and careful blood management. We present the implementation and results of such a protocol involving a different surgical approach, and highlight the published literature on this topic.
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Affiliation(s)
- Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3447, Durham, NC, 27710, USA,
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