Clinical Trials Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4226-4233
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4226
Dissection and ligation of the lateral circumflex femoral artery is not necessary when using the direct anterior approach for total hip arthroplasty
Gong-Yin Zhao, Yu-Ji Wang, Nan-Wei Xu, Feng Liu
Gong-Yin Zhao, Yu-Ji Wang, Nan-Wei Xu, Department of Orthopedics, The Affiliated Changzhou NO. 2 People’s Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
Feng Liu, Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Author contributions: Liu F designed research; Zhao GY, Wang YJ, and Xu NW performed research; Zhao GY and Wang YJ analyzed data; Zhao GY wrote the paper.
Institutional review board statement: The approval for this study was obtained from the Institutional Review Board committees of the affiliated Changzhou NO. 2 People’s Hospital of Nanjing Medical University.
Clinical trial registration statement: The clinical trial was registered in the affiliated Changzhou NO. 2 People’s Hospital of Nanjing Medical University, with the registration number of 2016-c-06-01.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: We declare that data from this experiment can be shared in a public database.
CONSORT 2010 statement: The design and composition of the clinical trials study conform to the CONSORT2010 statements.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng Liu, MD, PhD, Chief Doctor, Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210000, Jiangsu Province, China. njliuf@163.com
Telephone: +86-15961104432
Received: August 17, 2019
Peer-review started: August 17, 2019
First decision: September 23, 2019
Revised: October 20, 2019
Accepted: November 19, 2019
Article in press: November 19, 2019
Published online: December 26, 2019
Abstract
BACKGROUND

Branches of the lateral circumflex femoral artery (LCFA) stretch across the surgical field during a direct anterior total hip arthroplasty. It is an anatomical marker in direct anterior approach. As an important vessel around the hip joint, this vessel was ligated in most situations. Although ligation of the vascular pedicle of the LCFA is a common, traditional procedure used to decrease bleeding, the ligation of the pedicle of the vessel is tedious and time-consuming.

AIM

To explore whether this ligation is truly necessary in a direct anterior approach to total hip arthroplasty.

METHODS

This single-center, single-surgeon, prospective study was performed to compare patients’ bleeding undergoing ligation of the branches of the LCFA pedicle (group A) vs those treated with electrocautery from the branches of the LCFA (group B). In both groups, the pedicles were identified in the intermuscular plane between the tensor fasciae lata and the rectus femoris muscles. In group A, the pedicles were ligated with a silk ligature. In group B, the branches coming off the LCFA were controlled with electrocautery. We compared preoperative vs postoperative changes in blood hemoglobin levels, intraoperative blood loss, operative time, rates of transfusion, re-bleeding, and hematoma between the two groups.

RESULTS

The reduction of hemoglobin in group A was 20.9 ± 7.0, and in group B it was 21.2 ± 4.9. There was no statistically significant difference between the two groups (P > 0.05). The actual calculated blood loss in group A was 784 ± 125 mL, and in group B it was 722 ± 153 mL. There was a trend in group A having more blood loss (P = 0.078). The estimated blood loss in group A was 344 ± 88 mL, and in group B it was 346 ± 73 mL. There was no statistically significant difference between the two groups (P = 0.883). In addition, there were no significant differences in the rates of postoperative transfusion (10% vs 6.7%, P > 0.05), postoperative hematomas (6.7% vs 13.3%, P > 0.05), or re-bleeding (13.3% vs 20%, P > 0.05) between the two groups.

CONCLUSION

Ligation of the pedicle of the LCFA has no advantage in preventing or decreasing bleeding during or after a total hip arthroplasty using the direct anterior approach. Ligation of the pedicle of the vessel is a cumbersome, unnecessary procedure and can be replaced by electrocautery control of the branches off this artery that course through the surgical field.

Keywords: Total hip arthroplasty, Direct anterior approach, Lateral circumflex femoral artery, Ligation, Blood loss, Electrocautery

Core tip: Most surgeons ligate the ascending branch of the lateral circumflex femoral artery during direct anterior total hip arthroplasty, but it may not be necessary. In our study, ligation of the lateral femoral circumflex artery does not reduce bleeding in direct anterior total hip arthroplasty and can be replaced by electrocautery.