Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Geest, Thomas De; Fennema, Peter; Lenaerts, Gerlinde; Loore, Geert De

doi:10.1007/s00402-015-2258-y

Cited by 75 publications

(59 citation statements)

References 58 publications

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“…The advantages of DAA for total hip arthroplasty (THA) include less soft tissue trauma, less postoperative pain, earlier postoperative functional recovery, and lower dislocation rate compared with other approaches. [1][2][3][4][5] Although DAA for THA has gained popularity in recent years, it has also been associated with some notable complications, 3,[6][7][8][9] one of which is injury to the lateral femoral cutaneous nerve (LFCN). 2,[10][11][12] The LFCN is a pure sensory nerve supplying the cutaneous area of the anterolateral thigh.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous healing of lateral femoral cutaneous nerve injury and improved quality of life after total hip arthroplasty via a direct anterior approach

Ozaki

Homma

Baba

et al. 2017

J Orthop Surg (Hong Kong)

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Purpose: How the symptomatology of lateral femoral cutaneous nerve (LFCN) injury changes after total hip arthroplasty (THA) via direct anterior approach (DAA) is not known. Our hypothesis was that the symptoms of LFCN injury after THA via DAA in longer follow-up periods would resolve spontaneously, leading to an improved quality of life (QOL). The aims of this study were to investigate how the symptom LFCN injury changed after DAA-THA, and how those changes affected QOL. Methods: We investigated the incidence of LFCN injury after DAA-THA using self-reported questionnaires at two time points (initial survey: August 2014, present survey: August 2015). QOL was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, and the Forgotten Joint Score-12 (FJS-12). Types (dysesthesia or hypesthesia) and changes of the symptom were surveyed. Results: About 122 hips at average12.8 months postoperatively (initial survey), and of those, 89 hips at average 26.2 months postoperatively (present survey) were analyzed. The incidence of LFCN injury decreased significantly, from 31.9% to 11.2% (p < 0.001). Spontaneous improvement of symptoms was seen in 96%. The difference of FJS-12 between patients with and without LFCN injury at the initial survey disappeared at the present survey. The dysesthesia group showed significant correlations between rate of improvement in LFCN injury and increase of QOL. Conclusion: Most symptoms of LFCN injury resolved spontaneously with longer follow-up periods. In particular, improvement of dysesthesia as a symptom of LFCN injury was associated with better QOL.

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Section: Introductionmentioning

confidence: 99%

Spontaneous healing of lateral femoral cutaneous nerve injury and improved quality of life after total hip arthroplasty via a direct anterior approach

Ozaki

Homma

Baba

et al. 2017

J Orthop Surg (Hong Kong)

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“…Yi et al [24] reported similar results showing that most complications occurred within the first 32 cases. Although nerve palsy is a common complication of the DAA [6,25], a recent study [16] showed it does not affect hip functionality.…”

Section: Discussionmentioning

confidence: 99%

“…One of the limitations is related to the complications that might occur later in time, although a recent Bayesian metaanalysis study [25] that analysed 38 studies (6485 patients) reported that most complications relative to the approach occur in the early post-operative settings. Moreover, a prospective cohort study of 1104 hip arthroplasties carried out by Ilchmann et al [27] comparing the short and long term risks of infection between the two approaches also reported no increased risk for the DAA.…”

Section: Discussionmentioning

confidence: 99%

“…Given that the DAA has a learning curve defined more by a gradual transition than an exact case number [4,10,18,24,25], embracing the approach is highly dependent on the surgeon's training and ability to cope with a more challenging technique. Therefore, our results might not extrapolate to other low volume hip arthroplasty surgeons, and this is another main limitation of our study.…”

Section: Discussionmentioning

confidence: 99%

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Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

Nistor

Caterev

Bolboacă

et al. 2017

International Orthopaedics (SICOT)

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“…Approximately 10% of patients require contralateral THA within a year of their first THA operation [5]. Anterior minimally invasive surgery (AMIS) for THA has been reported to be a safe and reliable surgical technique [7-10]. Advantages of simultaneous bilateral THA have been described for several surgical approaches [4, 6, 11-14].…”

Section: Introductionmentioning

confidence: 99%

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

Petridis¹,

Nolde²

2017

TOORTHJ

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Background:Sequential bilateral total hip arthroplasty (THA) has the potential advantages of a single operative intervention with a single hospital stay, alongside reduced costs and total rehabilitation times. Its use has been limited, however, by a theoretical increase in perioperative complications.Objective:The purpose of this study was to assess functional outcomes and complications in patients undergoing sequential bilateral THA performed using anterior minimally invasive surgery (AMIS). We hypothesized that sequential bilateral THA yields favorable clinical outcome and is safe to perform.Methods:Two surgical centres conducted a retrospective observational analysis of 130 patients (77 females) with a mean age of 57 (range, 35-77) years, all of whom were treated by one surgeon and followed up for 24 months.Results:The mean length of hospital stay length was 8.4 (range, 6–18) days. The mean operative time was 162 (range, 92–185) minutes, the mean intraoperative blood loss was 499.1ml, and the mean preoperative and postoperative hemoglobin levels were 14.3 g/dl and 11.3 g/dl, respectively. No perioperative complications or deaths were recorded. The Harris Hip Score (HHS) improved from 44.5 ±13.7 preoperatively to 98.9 ± 1.0 at final follow-up. Also the High Activity Arthroplasty Score (HAAS) and the Questions on Life Satisfaction (FLZ) score improved significantly.Conclusion:This retrospective analysis suggests that, in selected patients, sequential bilateral THA via an anterior minimally invasive approach appears to be a valid alternative to two-stage bilateral THA. Further studies are warranted.

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Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Abstract: DAA is a technically demanding procedure, with outcomes possibly indicative of surgeon learning curve. A risk for intra-operative fractures and LCFN is evident, although the risk for other adverse effects is comparable to those with other approaches.

Cited by 75 publications

References 58 publications

Spontaneous healing of lateral femoral cutaneous nerve injury and improved quality of life after total hip arthroplasty via a direct anterior approach

Spontaneous healing of lateral femoral cutaneous nerve injury and improved quality of life after total hip arthroplasty via a direct anterior approach

Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

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