Does using the direct anterior approach with a standard table for total hip arthroplasty reduce leg length discrepancies? Comparative study of traction table versus standard table

Moslemi, Aymane; Kierszbaum, Elliott; Descamps, Jules; Sigonney, François; Biau, David; Anract, Philippe; Hardy, Alexandre

doi:10.1016/j.otsr.2020.102752

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…However, there was no significant difference concerning functional outcome (Harris Hip Score) (20). In a comparative study of traction table vs. standard table using DAA for THA, Moslemi et al found no statistically significant difference concerning postoperative leg length (34).…”

Section: Discussionmentioning

confidence: 98%

Minimally Invasive Total Hip Arthroplasty: A Comparison of Restoring Hip Biomechanics With and Without a Traction Table

Lenze

Hinterwimmer

FLECKENSTEIN

et al. 2021

In Vivo

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Background/Aim: The aim of the study was to analyze operative time and restoration of hip biomechanics in total hip arthroplasty (THA) via direct anterior approach (DAA) with and without the use of a traction table. Patients and Methods: We retrospectively compared 97 cases where a traction table was used to 92 cases without a table. Ninetyseven patients received THA with a traction table (AMIS ® technique) and 92 patients with conventional DAA. Postoperative standard radiographs were used to analyze offset parameters and leg length. Furthermore, time for patient positioning and cut-to-suture time were evaluated. Results: Cut-to-suture time was statistically significantly shorter in the traction table group (p=0.001), whereas analysis of offset parameters (acetabular, femoral and combined) was comparable between the two groups (p=0.31, p=0.95, p=0.42). Postoperative leg length was statistically significantly different with and without traction table use (p=0.02). Conclusion: Both methods enable restoration of hip biomechanics with high accuracy. Further studies with prospective study designs and larger sample sizes may be needed to confirm these results.

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Section: Discussionmentioning

confidence: 98%

Minimally Invasive Total Hip Arthroplasty: A Comparison of Restoring Hip Biomechanics With and Without a Traction Table

Lenze

Hinterwimmer

FLECKENSTEIN

et al. 2021

In Vivo

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“…The advantage of the DAA traction table, which can fix patients' lower limbs, reduces the incidence of complications of unequal lower limb lengths [ 13 ]. However, the current literature has raised much controversy about the time efficiency of intraoperative traction table [ 14 , 15 ]. The difficulty in femoral exposure poses a threat to the undersized or malalignmental femoral stem implantation by the direct anterior approach (DAA), resulting in the risk of loosening and subsidence of the femoral stem [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical application of artificial intelligence-assisted three-dimensional planning in direct anterior approach hip arthroplasty

Yang,

Gao,

Liu

et al. 2023

International Orthopaedics (SICOT)

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Purpose The objective of this study was to investigate the efficacy of an artificial intelligence-assisted 3D planning system (AIHIP) in total hip arthroplasty by direct anterior approach and assess the reliability of the AIHIP preoperative program in terms of both interobserver and intraobserver agreement. Methods A retrospective analysis was conducted on patients who underwent unilateral primary THA via direct anterior approach from June 2019 to March 2022. Participants were randomly assigned to receive either the AIHIP system (n = 220) or the 2D template (control group) (n = 220) for preoperative planning. The primary outcome aimed to evaluate the correspondence between the prosthesis selected intro-operation and the one planned preoperatively, as well as to calculate the intraclass correlation coefficient (ICC). Secondary outcomes included operation time, intraoperative blood loss, fluoroscopy times, Harris hip score (HHS), lower limb length difference (LLD), femoral offset (FO), and bilateral femoral offset difference. Results No significant differences were observed in gender, age, body mass index (BMI), aetiology, and American Society of Anesthesiologists (ASA) score between the two groups. Both planning methods exhibited good intraobserver agreement for component planning (ICC: 0.941–0.976). Interobserver agreement for component planning was comparable between the two methods (ICC: 0.882–0.929). In the AIHIP group, the accuracy of acetabular cup and femoral stem prosthetics planning significantly improved, with accuracies within the size range of ± 0 and ± 1 being 76.8% and 90.5% and 79.5% and 95.5%, respectively. All differences between two groups were statistically significant (p < 0.05). Patients receiving AIHIP preoperative planning experienced shorter operation times, reduced intraoperative blood loss, fewer fluoroscopy times, and lower leg length discrepancy (LLD) (p < 0.05). Moreover, they demonstrated a higher Harris hip score (HHS) at three days post-surgery (p < 0.05). However, no significant differences were found in femoral offset (FO), difference of bilateral femoral offsets, and HHS at 1 month after the operation. Conclusion Utilizing AIHIP for preoperative planning of direct anterior approach THA can significantly enhance the accuracy of prosthetic sizing with good reliability, decrease operation time, reduce intraoperative blood loss, and more effectively restore the length of both lower limbs. This approach has greater clinical application value.

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“…Challenges related to ergonomic support and consistent patient positioning may compromise visibility, potentially affecting accuracy during acetabular and femoral preparation. This could have implications for leg length discrepancies, impingement, and post-operative stability [ 33 ]. Surgeons operating off the table might face difficulties in achieving the optimal angles and depths required for component insertion, raising concerns about implant longevity and potential complications.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique of Direct Anterior Approach for Primary Total Hip Arthroplasty Using a Leg Positioning Traction System

Bajwa

2023

jocr

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Introduction: Through the use of a natural intramuscular and internervous interval, the direct anterior approach (DAA) for total hip arthroplasty (THA) has been suggested to have several advantages over other popular arthroplasty approaches. The usage of DAA for THA has considerably grown in the West in recent years due to the emphasis on tissue preservation and minimally invasive joint replacements. However, due to the long learning curve, literature on this approach originating from India has been inadequate, suggesting a limited adoption of this surgical technique by the Indian diaspora of practicing surgeons. Technical Description: The DAA for THA is reliable and suitable for all conventional primary and revision THA cases. In the surgical procedure, the patient is positioned supine on the standard operating room (OR) table with the legs positioned in the Leg Positioning Traction System. The OR table may rotate, which enables the surgeon to perform the surgery more conveniently as it covers the majority of the patient’s center of gravity. The incision is made over the tensor fascia lata. After femoral neck osteotomy, the head is removed, and traction is applied to the operative leg followed by acetabular cup insertion. The femoral stem is inserted after releasing soft tissues around the proximal femur using the leg positioning traction system. Using traction, flexion, and internal rotation, the femoral head is pushed into the acetabulum at the same time, and reduction is achieved. Conclusion: DAA for THA technique offers patients the advantage of minimally invasive surgery compared to other approaches. Many authors have published their experiences and technical keys to successfully completing this procedure, and several variations of the procedure have been described. The approach described is implemented utilizing specifically developed instruments, including a specialized table and intraoperative fluoroscopy while employing the standard surgical incision. This article attempts to outline the authors’ technique for performing the DAA in the supine position for a primary THA using a Leg Positioning Traction System, with a focus on technical details in assisting an early DAA convert in making a safe transition. Keywords: Direct anterior approach, surgical technique, total hip arthroplasty, traction table.

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Does using the direct anterior approach with a standard table for total hip arthroplasty reduce leg length discrepancies? Comparative study of traction table versus standard table

Cited by 8 publications

References 29 publications

Minimally Invasive Total Hip Arthroplasty: A Comparison of Restoring Hip Biomechanics With and Without a Traction Table

Minimally Invasive Total Hip Arthroplasty: A Comparison of Restoring Hip Biomechanics With and Without a Traction Table

Clinical application of artificial intelligence-assisted three-dimensional planning in direct anterior approach hip arthroplasty

Surgical Technique of Direct Anterior Approach for Primary Total Hip Arthroplasty Using a Leg Positioning Traction System

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