Can a target zone safer than Lewinnek's safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls

Reina, Nicolas; Putman, Sophie; Desmarchelier, Romain; Ali, E. Sari; Chiron, Philippe; Ollivier, M.; Jenny, Jean–Yves; Waast, D.; Mabit, C.; Thomasson, E. de; Schwartz, Camille; Oger, Philippe; Gayet, L.-É.; Migaud, Henri; Ramdane, Nassima; Fessy, Michel‐Henri

doi:10.1016/j.otsr.2017.05.015

Cited by 69 publications

(26 citation statements)

References 27 publications

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“…These authors believe that such consistency in implant positioning may be the result of a lack of external soft-tissue forces during preparation and implantation and the SuperPath approach using a lateral position. Recent studies have pointed out that the Lewinnek "safe zone" does not really represent a safe area, and there is still a risk of dislocation in this area [40][41][42][43]. They point out the ideal cup location for some patients may be outside the Lewinnek safe zone and more advanced analysis is needed to determine the correct target in this subgroup [40,44].…”

Section: Discussionmentioning

confidence: 99%

Comparison The Early Clinical Efficacy of SuperPath Approach Versus The Modified Hardinge Approach In Total Hip Arthroplasty For Femoral Neck Fractures In Elderly: A Randomized Controlled Trial

Shen

et al. 2021

Preprint

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Purpose: Femoral neck fracture is a common form of hip fracture in the elderly. Minimally invasive surgery is very popular in recent years. This study was to investigate the clinical efficacy and advantages of the SuperPath approach to total hip arthroplasty in the treatment of femoral neck fractures in the elderly. Methods: From February 2018 to March 2019, 120 patients were random divided into two groups with 60 patients each: the SuperPath group and conventional group. The results evaluated the general operation situation, Serum markers, blood loss, pain score, hip function and prosthesis location analysis.Results: There was no difference demographically between two groups. Compared with the conventional group, the SuperPath group had a shorter operation time (78.4 vs 93.0 min), smaller incision length (5.8 vs 12.5 cm), less intraoperative blood loss (121.5 vs 178.8 ml), shorter hospitalization time (8.0 vs 10.8 day) and less drainage volume (77.8 vs 141.2 ml). The creatine kinase (CK) in the SuperPath group was significantly lower, while there was no difference in the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The visual analog scale (VAS) was lower in one month and Harris Hip Score (HHS) were higher in three months in the SuperPath group. There was no difference in the cup abduction angle and anteversion angle of the two groups.Conclusion: We found the better clinical efficacy after the SuperPath approach with less muscle damage, less postoperative pain and better postoperative function compared with the modified Hardinge approach.Trial registration: Retrospectively registered. The randomized clinical trial was retrospective registered at Chinese Clinical Trial Registry on December 31, 2020 (ChiCTR-2000041583, http://www.chictr.org.cn/showproj.aspx?proj=57008).

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Section: Discussionmentioning

confidence: 99%

Comparison The Early Clinical Efficacy of SuperPath Approach Versus The Modified Hardinge Approach In Total Hip Arthroplasty For Femoral Neck Fractures In Elderly: A Randomized Controlled Trial

Shen

et al. 2021

Preprint

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“…Extrapolating the results from our electronic survey to our study cohort would result in an additional 2.7 dislocations for our entire cohort of 2151 hips, resulting in an overall short-term dislocation rate of 2.2%, similar to the rate reported by other large cohort studies. 7,16,20 Not only femoral head size is a significant predictor for revision due to dislocation, 21 but implant positioning is also seen as an important factor for dislocation risk, 22,23 although the existence of a so called 'safe zone' for implant positioning is debated. 24,25 Of the 45 short-term dislocations in our study cohort, 21 either had a steep cup inclination angle or minimal femoral offset.…”

Section: Discussionmentioning

confidence: 99%

“…Not only femoral head size is a significant predictor for revision due to dislocation, 21 but implant positioning is also seen as an important factor for dislocation risk, 22,23 although the existence of a so called ‘safe zone’ for implant positioning is debated. 24,25 Of the 45 short-term dislocations in our study cohort, 21 either had a steep cup inclination angle or minimal femoral offset.…”

Section: Discussionmentioning

confidence: 99%

It is safe to use minimal restrictions following posterior approach total hip arthroplasty: results from a large cohort study

et al. 2019

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Background: To prevent early postoperative dislocation following a total hip arthroplasty (THA) procedure, patients must adhere to restrictions. Restrictive protocols are common if THA surgery is performed using the posterior approach, but scientific evidence form larger studies that supports these restrictions are scarce. In this large cohort study we compare the <90-days dislocation rate between patients receiving posterior approach THA managed with minimal versus extensive restrictions. Methods: Prospective cohort ( n = 1049) of consecutive elective primary hip replacement surgery procedures (September 2014–July 2017) managed with minimal postoperative restrictions. Hospital charts were prospectively reviewed for patient demographics, risk factors and any hip dislocation. Control ( n = 1102) consecutive primary elective THAs (January 2011–August 2014) managed with a traditional restrictive protocol. A posterior surgical approach was used in all procedures. Results: Minimal restrictions group: 17 dislocations <90 days (1.6%); Restricted group: 28 (2.5%), chi-square p = 0.1. Testing the hypothesis of inferiority by a minimum of 1% increase in ⩽90 days dislocation risk: p = 0.14 (test for difference) and p < 0.001 (non-inferiority test), allowing us to discard the null hypothesis (absolute increase in risk of ⩾1% with minimal restrictions). The proportion of surgeries performed with a femoral head size ⩾32 mm was higher in the minimal restrictions group. Conclusions: Patients can be managed safely with minimal restrictions following posterior approach THA if combined with frequent use of larger femoral heads.

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“…This type of assistance allows more direct and consistent control of the acetabular reaming and positioning of implants during the surgical procedure. Targeted goals are reduction of outliers of the different defined safe zone position [5,9,21] and improvement of clinical outcomes. This overview includes the principles of robotic assistance in hip arthroplasty surgery, its evolution, and actual results concerning its potential advantages and disadvantages reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

Current concepts in robotic total hip arthroplasty

Kouyoumdjïan

Mansour

Assi

et al. 2020

SICOT-J

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Introduction: Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been established throughout the previous years and all of the technologies target accuracy and reliability to reduce complications, and enhance clinical outcomes. Materials and methods: An overview is proposed over the principles of robotic assistance in hip arthroplasty surgery. Accuracy, reliability, management of the bone stock, clinical outcomes, constraints and limits of this technology are reported, based on recent literature. Results: Potential advantages regarding pre-operative planning accuracy, cup positioning, maintenance of the center of rotation, preservation of an adequate bone stock nay clinical short- and mid-term outcomes are balanced with some reported disadvantages and limits like hip anatomical specificity, cost-effectiveness, engineering dependence. Discussion: The use of robotic-assisted THA presents clear and evident benefits related to accurate implant positioning and maintenance of a minimal bone while allowing. For some authors, an early improvement in functional results and patient’s recovery. This technology demonstrated a shorter surgical time and a short learning curve required to optimize its use and this technology presents promising outcomes and results and potential use in routine clinical application but its limitation of use is still present especially the cost of the robot, the need for the presence of an engineer during the surgery, its availability of use in all hospitals as well as the difficulty presented in dysplastic or dysmorphic hip joints.

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Can a target zone safer than Lewinnek's safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls

Abstract: III case-control study.

Cited by 69 publications

References 27 publications

Comparison The Early Clinical Efficacy of SuperPath Approach Versus The Modified Hardinge Approach In Total Hip Arthroplasty For Femoral Neck Fractures In Elderly: A Randomized Controlled Trial

Comparison The Early Clinical Efficacy of SuperPath Approach Versus The Modified Hardinge Approach In Total Hip Arthroplasty For Femoral Neck Fractures In Elderly: A Randomized Controlled Trial

It is safe to use minimal restrictions following posterior approach total hip arthroplasty: results from a large cohort study

Current concepts in robotic total hip arthroplasty

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