Advantages of an Anterior-Based Muscle-Sparing Approach in Transitioning From a Posterior Approach for Total Hip Arthroplasty: Minimizing the Learning Curve

Kagan, Ryland; Greber, Eric M.; Richards, Stephen M.; Erickson, Jill; Anderson, Mike B.; Peters, Christopher L.

doi:10.1016/j.arth.2019.07.009

Cited by 18 publications

(18 citation statements)

References 32 publications

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“…There were nearly no statistically significant differences in the demographic characteristics of the patients in our meta-analysis. In addition, none of the studies were learning cases, which prevented this factor from influencing the results [35]. However, there was still high heterogeneity among most outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis

Peng

Zeng

et al. 2020

BMC Musculoskelet Disord

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Background: The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes. Methods: We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants met the inclusion criteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I 2 = 93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD =-0.65, 95% CI − 0.91 to − 0.38, p < 0.00001, I 2 = 0%), VAS score at 2 days postoperatively (MD =-0.67, 95% CI − 1.34 to − 0.01, p = 0.05, I 2 = 88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD = 6.05, 95% CI 1.14 to 10.95, p = 0.02, I 2 = 52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected.

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Section: Discussionmentioning

confidence: 99%

Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis

Peng

Zeng

et al. 2020

BMC Musculoskelet Disord

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“…Comparing supine ABMS with the DL approach, George et al 5 reported markedly lower opioid consumption during postoperative days 1 and 2 and 1.91 times less likelihood of experiencing postoperative abductor insufficiency in the ABMS cohort relative to the MMH. Kagan et al 11 found no notable differences in surgical time, EBL, or immediate postoperative complications but did find slightly shorter LOS for the ABMS approach compared with the PL approach. They reported no difference in the adjusted mean change in patient-reported outcomes.…”

Section: Discussionmentioning

confidence: 94%

“…More recently labeled the anterior-based muscle-sparing (ABMS) approach, it has risen in popularity because of its reported early functional recovery and excellent clinical results. 4,[9][10][11][12][13][14][15][16] Although the ABMS approach is believed to reduce the risk of sciatic nerve injury and dislocation rates, it can damage the GM muscle during manipulation, causing abductor weakness. 8,9 The ABMS approach can be successfully done in both the lateral 8,9,[11][12][13]16,17 and supine positions.…”

mentioning

confidence: 99%

“…4,[9][10][11][12][13][14][15][16] Although the ABMS approach is believed to reduce the risk of sciatic nerve injury and dislocation rates, it can damage the GM muscle during manipulation, causing abductor weakness. 8,9 The ABMS approach can be successfully done in both the lateral 8,9,[11][12][13]16,17 and supine positions. 5,10,15,17 However, it remains unclear whether the supine ABMS approach offers any advantage over other approaches.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of the Supine Anterior-based Muscle-sparing Approach for Primary and Revision Hip Arthroplasty

Pan

Mehta²,

Mason³

2022

JAAOS Glob Res Rev

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Introduction: Risks and outcomes of total hip arthroplasty (THA) are believed to vary relative to the surgical approach. This study compares the supine anterior-based muscle-sparing (ABMS) approach with its modern-day counterparts. Methods: A retrospective review was done on 550 patients undergoing primary or revision THA from 2016 to 2018. Surgical modalities included direct anterior (DAA), ABMS, posterolateral, and Mu ¨ller modified Hardinge approaches. Surgical data were collected, and clinical outcomes were measured by the Hip Disability and Osteoarthritis Outcome Score, Modified Harris Hip Score, UCLA, and VR-12 Mental/Physical scores preoperatively and compared clinical outcomes among approaches. Results: A total of 550 patients were included (447 primaries, 103 revisions). The average age was 64 years (231 men, 319 women). Approaches included 79 DAA (14%), 212 ABMS (39%), 180 modified Mu ¨ller-Hardinge (33%), and 79 posterolateral (14%). The incidence of lateral femoral cutaneous nerve injury was more common with the DAA (P = 0.008), but no other clinically significant differences were noted among the groups. Conclusion:The results of this study showed no clinically notable differences between the supine ABMS and other approaches. The supine ABMS approach is an acceptable approach in modern day THA when used by an experienced surgeon well-versed in the approach.T otal hip arthroplasty (THA) is considered one of the most effective orthopaedic procedures for relieving pain, restoring function, and improving the quality of life in patients with hip osteoarthritis. Modern improvements in THA have yielded shorter hospital stays, better functional outcomes, and higher patient satisfaction scores. [1][2][3] Although some suggest that a surgical approach is an independent predictor of an early postoperative Tommy Pan, BA

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“…There was nearly no statistical significance about the demographic characteristics of patients in our meta-analysis. Besides, All the studies were not learning cases avoiding being influenced [35] . But there was still a high heterogeneity among most outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

Peng

Zeng

et al. 2020

Preprint

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Background: The purpose of this systematic review and meta-analysis was to compare the clinical, functional and radiographic outcomes of primary total hip arthroplasty between the direct anterior approach and posterior approach. Methods: We searched the PubMed, EMBASE databases and Cochrane library from the inception dates to November 1, 2019. And we also searched for the meta-analysis which was published in the past for randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants fulfilled the inclusion criteria. Among these, 301 and 299 patients were in the DAA and PA groups, respectively. DAA was associated with a longer surgery time by a mean of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). Postoperative early functional outcomes were significantly better in the DAA group than PA group such as Visual Analogue Scale (VAS) postoperative 1 day (MD=-0.65, 95% CI -0.91 to -0.38,p < 0.00001, I2=0%), VAS score postoperative 2 days (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05,I2=88%) and Harris Hip Score (HHS) postoperative 6 weeks(MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%).There was no significant difference between the DAA and PA groups at length of incision, length of stay(LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups about late functional outcomes such as VAS score postoperative 12 months or HHS scores postoperative 3, 6, 12 months. A significant difference in Radiographic outcomes can not be detected too. Conclusions: DAA needs longer surgery time than PA in primary total hip arthroplasty. The DAA offers better early functional recovery than PA. There is no significant difference between the two groups in terms of other clinical, complication, late functional and radiographic outcomes. The evidence about the superiority of DAA is insufficient, which needs more research.

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Advantages of an Anterior-Based Muscle-Sparing Approach in Transitioning From a Posterior Approach for Total Hip Arthroplasty: Minimizing the Learning Curve

Cited by 18 publications

References 32 publications

Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis

Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis

Outcomes of the Supine Anterior-based Muscle-sparing Approach for Primary and Revision Hip Arthroplasty

Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

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