Anterior-Supine Minimally Invasive Total Hip Arthroplasty: Defining the Learning Curve

205

145

Background Although injury to the lateral femoral cutaneous nerve (LFCN) is a known complication of anterior approaches to the hip and pelvis, no study has quantified its' incidence in anterior arthroplasty procedures. Questions/purposes We therefore defined the incidence, functional impact, and natural history of LFCN neuropraxia after an anterior approach for both hip resurfacing (HR) and primary total hip arthroplasty (THA). Methods We followed 132 patients who underwent an anterior hip approach (55 THA; 77 HR). We administered self-reported questionnaires for sensory deficits of LFCN, neuropathic pain score (DN4), visual analog scale, as well as SF-12, UCLA, and WOMAC scores at one year postoperatively. A subset of 60 patients (30 THA; 30 HR) was evaluated at two time intervals. Results One hundred seven patients (81%) reported LFCN neuropraxia with a mean severity score of 2.32/10 and a mean DN4 score of 2.42/10. Hip resurfacing had a higher incidence of neuropraxia as compared with THA: 91% versus 67%, respectively. No functional limitations were reported on SF-12, WOMAC, or UCLA scores. Of the subset of 60 patients followed over an average of 12 months, 53 (88%) reported neuropraxia at the first followup interval with only three (6%) having complete resolution at second followup. Improvement in DN4 scores was observed over time: 3.6 versus 2.5, respectively. Conclusions Although LFCN neuropraxia was a frequent complication after anterior approach THA, it did not lead to functional limitations in our patients. A decrease in symptoms occurred over time but only a small number of patients reported complete resolution. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty

Goulding

Beaulé

Kim

et al. 2010

205

145

“…Surgical approach for the majority of cases was direct lateral, used in 1815 of the 2020 (90%) hips, including the less invasive variant introduced in 2003 [2] in 1260 (62%), standard incision in 546 (27%) hips [15], and extended variant in nine (0.4%) hips [15]. The anterior supine intermuscular approach was used in 204 (10%) hips [35] and minimally invasive posterior in one (0.05%) hip. Patients were allowed full weightbearing in the immediate perioperative period with the assistance of ambulatory aids.…”

Section: Methodsmentioning

confidence: 99%

Do Large Heads Enhance Stability and Restore Native Anatomy in Primary Total Hip Arthroplasty?

Lombardi¹,

Skeels

Berend

et al. 2011

Self Cite

104

Background Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal-or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages. Questions/purposes We sought to determine (1) if using larger diameter heads has lowered our dislocation rate; and (2) how closely an anatomic metal-on-metal bearing with diameters to 60 mm replicates native femoral head size. Methods We retrospectively reviewed 2020 primary arthroplasties performed with large heads (C 36 mm) in 1748 patients and noted dislocation incidence. In a prospective subset of 89 cases using anatomic heads, native femoral head diameter was measured intraoperatively with calipers by an independent observer and later compared with implanted size. Results One dislocation has occurred in 2020 hips for an incidence of 0.05%. The prosthetic head averaged 0.7 mm larger than the native head with 68 of 89 (76%) reconstructed to within ± 2 mm of native size. Conclusions Larger diameter heads have contributed to lower dislocation rates and large-diameter metal-on-metal articulation can provide close anatomic restoration in primary THA.

“…Numerous authors have reported low dislocation rates and rapid early functional recovery [1,29,31,33,36,40,46] with this approach. However, some studies have shown higher surgical blood loss and complication rates [6,47], particularly for less-experienced surgeons [16,43] or for patients who are obese [39]. Additionally, the distal extension of the approach is less familiar to most surgeons and a recent anatomic study by Grob et al [10] suggested that it may pose a risk to the neurovascular supply to portions of the vastus lateralis.…”

Section: Introductionmentioning

confidence: 99%

Does Surgical Approach Affect Patient-reported Function After Primary THA?

Graves

Dropkin

Keeney

et al. 2016

112

Background Total hip arthroplasty (THA) relieves pain and improves physical function in patients with hip osteoarthritis, but requires a year or more for full postoperative recovery. Proponents of intermuscular surgical approaches believe that the direct-anterior approach may restore physical function more quickly than transgluteal approaches, perhaps because of diminished muscle trauma. To evaluate this, we compared patient-reported physical function and other outcome metrics during the first year after surgery between groups of patients who underwent primary THA either through the direct-anterior approach or posterior approach. Questions/purposes We asked: (1) Is a primary THA using a direct-anterior approach associated with better patient-reported physical function at early postoperative times (1 and 3 months) compared with a THA performed through the posterior approach? (2) Is the direct-anterior approach THA associated with shorter operative times and higher rates of noninstitutional discharge than a posterior approach THA? Methods Between