Clinical and Radiographic Outcomes after Direct Anterior Approach Total Hip Arthroplasty Using Two Specialized Surgical Tables

Abstract

Background Specialized tables for direct anterior (DA) approach total hip arthroplasty (THA) have required an unscrubbed assistant for manipulation of the operative limb. A novel surgical table attachment designed for the DA approach is fully surgeon controlled and partially automated. The purpose of this study is to compare the clinical outcomes in patients who underwent THA through a DA approach with an assistant-controlled vs the surgeon-controlled (SC) table. Methods This is a retrospective study of 343 patients who underwent primary THA between January 2017 and October 2017. Two cohorts were established based on the surgical table used. Surgical and clinical data included the surgical time, length of stay, presence of pain (groin, hip, or thigh pain) at latest follow-up, and revision for any reason. Immediate postoperative radiographs were compared with latest follow-up radiographs to assess for leg length discrepancy, stem alignment, and stem subsidence. Results One hundred sixty-seven (48.7%) cases were performed using the assistant-controlled table, and 176 (51.3%) cases were performed using the SC table. The surgical time was significantly greater for surgeries using the SC table (70.2 minutes vs 66.1 minutes, P < .001). Neither group experienced any intraoperative fractures or postoperative dislocations. There were no significant differences in any other clinical or radiographic outcomes. Conclusions Although the surgical time with the self-controlled table was longer by approximately 4 minutes, this discrepancy disappeared with progression through the learning curve. In our experience, the SC table allows for greater autonomy for the operating surgeon and eliminates the need for a full-time employee in the operating room workflow.

Superior Transverse Atraumatic Reconstruction (STAR) approach provides a better-compared outcome to standard Direct Superior Approach (DSA): a matched, prospective comparative single-surgeon study

“…MIS approaches have been associated with a higher complication risk due to obstructed access and the prolonged learning curve [ 13 – 15 ]. STAR and DSA approaches have an outstanding acetabular and femoral view, needing standard instruments when using any implant [ 2 , 9 ].…”

Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study

“…21 The higher risk of complications when using the MIS approach is attributed to impeded acetabular and femoral access, an extended learning curve, and the regular need for unique instrumentation. 22 The main technical aspects of DSA that make this approach distinct from other MIS approaches include the excellent acetabular and femoral view, even for complex primary THAs like dysplastic hips or obese patients, and the reduced damage to SER, minimising the risk of complications. 1 Additional feature include the performance with standard instrumentation either for cemented or uncemented primary THA.…”