Component Placement in Direct Lateral vs Minimally Invasive Anterior Approach in Total Hip Arthroplasty: Radiographic Outcomes From a Prospective Randomized Controlled Trial

Brun, Ole-Christian L.; Sund, Helge N.; Nordsletten, Lars; Röhrl, Stephan M; Mjaaland, Knut Erik

doi:10.1016/j.arth.2019.04.003

Cited by 30 publications

(32 citation statements)

References 61 publications

(44 reference statements)

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“…The role of the surgical approach in obtaining an adequate cement mantle and implant positioning in cemented THA has not been extensively studied. A recent randomized controlled trial demonstrated minor differences in the cement mantle characteristics and implant positioning between 2 groups of patients undergoing cemented THA that was performed through a mini anterior or direct lateral approach [1]. Another randomized controlled trial cadaveric study evaluated the integrity and quality of the cement mantle after implantation of the Exeter stem through the standard anterolateral or mini-invasive anterior approach.…”

Section: Discussionmentioning

confidence: 99%

“…The thinnest part of the cement mantle in each zone was recorded. An adequate cement mantle was defined as at least 2 mm [1,15]. We did not evaluate the thickness of the cement mantle at the region below the tip of the stem because of the regular use of cement restrictors.…”

Section: Radiologic Assessment and Implant And Patient Characteristicsmentioning

confidence: 99%

“…This may be attributed to the surgical approach and the angulated movement of insertion of the stem during the DAA. The access to the hip joint through the DAA is performed through a true internervous and intermuscular plane, limiting the tendon and muscle damage [1]. Opposition to the DAA has been generated out of some studies reporting greater difficulty accessing the femur with higher femoral complications and greater complications during the learning curve [30].…”

Section: Tablementioning

confidence: 99%

“…The direct anterior approach (DAA) is a well-established muscle-sparing approach to the hip joint, which is used increasingly worldwide [ 1 ]. It can be performed with or without use of a traction table in the lateral or supine position [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

et al. 2020

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Background: Limited literature exists concerning the femoral cement mantle quality that can be achieved through an anterior approach in total hip arthroplasty (THA). We radiologically evaluated the quality and thickness of the femoral cement mantle in patients undergoing THA utilizing the direct anterior approach (DAA). Methods: Immediate postoperative anteroposterior and lateral radiographs of 116 consecutive patients who underwent hybrid or fully cemented THA using the DAA and cemented Quadra-C stem (Medacta, International, SA, Switzerland) were assessed by 2 arthroplasty surgeons blinded to the study. Surgical indications were hip osteoarthritis or subcapital hip fracture. The cement mantle and stem alignment were evaluated using the Barrack classification and Khalily methods, respectively. After calibration of radiographs, the thinnest part of the cement mantle per Gruen zone was recorded. Parameters were compared between obese and nonobese patients. Results: Agreement between raters was substantial for the cement quality in anteroposterior (k ¼ 0.707, P .001) and moderate for lateral radiographs (k ¼ 0.574, P 001). The cement mantle was graded A in 39.25%, B in 53.0%, and C in 7.75% of anteroposterior radiographs and similarly for lateral radiographs (40.1% A, 51.75% B, 9.5% C). 93% of stems had neutral alignment. The mean thinnest cement mantle (P ¼ .237) and incidence of inadequate cement mantle (<2 mm) per zone (P ¼ .431) were comparable between Gruen zones. The cement mantle quality (P ¼ .174) and inadequacy (P > .05) and stem alignment (P ¼ .652) were comparable between obese and nonobese patients. Conclusions: DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.

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Section: Discussionmentioning

confidence: 99%

Section: Radiologic Assessment and Implant And Patient Characteristicsmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

et al. 2020

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“…Radiographs were initially reviewed to confirm the previously specified inclusion/exclusion criteria. Subsequently, femoral offset, total offset, and leg length were recorded on each patient on the contralateral hip as described by Brun [14] using TraumaCad (Brainlab, Westchester, IL). Postoperatively, a standing AP pelvis radiograph was obtained with a 25-mm magnification marker ball present again.…”

Section: Radiographic Assessmentmentioning

confidence: 99%

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

2020

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Background: Total hip arthroplasty (THA) has demonstrated excellent results regardless of the surgical approach. However, the approach used may be a factor in final positioning of implants. We hypothesized that the direct anterior approach (DAA) with fluoroscopy would be associated with more anatomic implant positioning than the posterior approach (PA). Methods: A retrospective review of 200 patients was performed. One hundred patients underwent THA utilizing the PA, and 100 patients, with the DAA. All patients had an anterior-posterior pelvis radiograph preoperatively and postoperatively with a magnification marker present to standardize each radiograph. Exclusion criteria included contralateral THA or any pelvic or femoral deformity. Results: Preoperative radiographs demonstrated identical cohorts with respect to leg length, femoral offset, and total offset. Postoperatively, the DAA achieved more accurate anatomic restoration of leg length (1.6 mm vs 5.5 mm; P < .0001), femoral offset (4.8 mm vs 9.3 mm; P < .0001), and total offset (0.5 mm vs 4.7 mm; P < .0001) compared with the PA. Ideal cup abduction and anteversion were significantly superior to the DAA (96% vs 78%, P ¼ .0002, and 69% vs 24%, P < .0001, respectively). Conclusions: This study is the first to compare anatomic implant positioning between patients undergoing THA with these 2 approaches. All parameters were significantly closer to anatomic implant positioning with the DAA. There are at least 2 potential explanations for this: (1) The DAA implant positioning was performed under fluoroscopic guidance, whereas the PA was not. (2) The PA disrupts the posterior capsule and external rotators, and therefore, increased offset or leg length may be necessary to achieve comparable hip stability with the DAA.

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Diagnosing and Managing Complications from the Anterior Approach

Carlson,

Taunton

2022

Anterior Hip Replacement

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Component Placement in Direct Lateral vs Minimally Invasive Anterior Approach in Total Hip Arthroplasty: Radiographic Outcomes From a Prospective Randomized Controlled Trial

Cited by 30 publications

References 61 publications

Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

Diagnosing and Managing Complications from the Anterior Approach

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