Background Dislocation is a major complication in revision total hip arthroplasties. This study aimed to evaluate the dislocation rate, complications, and functional scores of revision total hip arthroplasty performed through the direct anterior approach. Methods Between January 2014 and March 2020, 84 patients undergoing revision total hip arthroplasty were retrospectively reviewed. All operations were performed through the direct anterior approach. At the final follow-up, incidences of dislocation, reoperation, acute deep infections, periprosthetic fractures and psoas impingement were assessed. The median postoperative Oxford Hip Score was also calculated. Results At revision surgery, the mean age was 66 ± 12 years (range, 28–91). During an average follow-up of 4.2 ± 1.2 years, reoperation rate for major complications in the non-infected revisions was 15% (n = 11), including five acute deep infections (7%), four periprosthetic fractures (5%), one dislocation and one psoas impingement (1%). The median postoperative Oxford Hip Score was 39 (interquartile range = 14). Conclusion In our series, revision total hip arthroplasty through direct anterior approach was associated with a very low dislocation rate, acceptable complication rates and good functional results. Our results suggest that this procedure is safe and reliable. Trial registration Ethical approval for this study was obtained, before enrollment of the first participant, by CUB Erasme's research ethics committee (P2020/323) and C.H.U Ambroise Paré's research ethics committee.
Background: Spine surgery and spinal fusion surgery are rising. Revision rates following initial surgery are between 8 and 45%. Epidural fibrosis is a common response to spine surgery for most patients and increases complications in revision surgery. Previous research suggests using MESNA (Sodium 2-mercaptoethane sulfonate) in combination with mechanical blunt dissection safely reduces surgical complications. MESNA is a mucolytic agent which selectively cleaves disulphide bonds involved in the adherence and strength of fibrosis, meaning cutting instruments are not needed. The Chemically Assisted DISSection (CADISS®) System is an optimised non-cutting surgical device, consisting of a reconstitution cartridge for MESNA preparation, irrigated surgical instruments, and a footswitch to control MESNA release. This is the first study to investigate the use of the CADISS® System in revision spine surgery. Methods: This was a prospective, open label, observational case study. We enrolled 21 patients for revision spine surgery with the CADISS® System at two Belgium sites. The primary assessment was the number of successful removals of epidural fibrosis without cutting. The amount of MESNA used, total dissection and procedure time were recorded. For secondary criterion, the surgeons assessed global satisfaction, facilitation of dissection, quickness of action, usability, bleeding reduction and visualisation of the cleavage plane using an 11-point Likert scale (0-10). Due to the exploratory nature, no formal statistical analysis was planned. We calculated the percentage and confidence interval of successful procedures, the medians and corresponding interquartile range of the Likert criterion, and the mean (±SD) of the amount of MESNA used, CADISS® dissection time and total procedure time. Results: 24 fibrosis dissections were performed in 19 patients and 23 were successful (95.8%, CI: 78.9%; 99.9%). The mean amount of MESNA used, mean dissection time and procedure time were 16 ml (± 4.94), 16.5 minutes (±16.1) and 86.3 minutes (±25.1), respectively. No dural tears were reported. The mean global satisfaction score was 9.0 (8.0-9.0). All other Likert criterion had scores of 8.0 or 9.0, excluding quickness of action, which scored 7.0 (6.0-9.0).Conclusions: The CADISS® System in revision spine surgery has potential to effectively reduce dissection complications. Trial Registration: ClinicalTrials.gov Identifier: NCT05016739 - first registration: 23/08/2021 https://clinicaltrials.gov/ct2/show/NCT05016739
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.