Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

Korth, Moritz J Sharabianlou; Ezzibdeh, Rami; Arora, Prerna; Amanatullah, Derek F.

doi:10.52198/21.sti.38.os1336

Cited by 4 publications

(12 citation statements)

References 28 publications

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“…Most studies use the Lewinnek safe zone (5-25° anteversion, 30-50° inclination) to measure optimal implant positioning 31 . Five studies reported a mean cup inclination and mean cup anteversion within the Lewinnek safe zone 10,20-22,27 . The DSA showed cup inclination and anteversion comparable with the MPA and PLA 10,27 .…”

Section: Resultsmentioning

confidence: 99%

“…Blood loss in ml was recorded in 10 studies 10,12,13,17,[19][20][21][22]25,26 . Three studies compared DSA with PLA blood loss 12,13,26 .…”

Section: Blood Lossmentioning

confidence: 99%

“…One hundred eighty-one studies were excluded after reviewing duplications using EndNote, and 207 articles were screened by title and abstract, of which 52 articles were eligible for full-text screening. Ultimately, 17 qualifying articles were selected [10][11][12][13]17,[19][20][21][22][23][24][25][26][27][28][29][30] (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

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The Direct Superior Approach in Total Hip Arthroplasty

van Dooren,

Peters,

van der Wal-Oost

et al. 2024

JBJS Reviews

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Background: Evolution of the surgical approach for total hip arthroplasty (THA) has led to the development of the minimally invasive direct superior approach (DSA). It is hypothesized that the DSA reduces postoperative pain and hospital length of stay (LOS). We aimed to provide an overview of current evidence on clinical, functional, and radiological outcomes with respect to risk of revision, complications, pain scores, physical function, operative time, LOS, blood loss, radiological outcomes, and learning curve. Methods: A comprehensive search of Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension guidelines, was conducted to identify studies evaluating clinical, functional, and radiological outcomes of the DSA. Quality assessment was performed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. The review protocol was prospectively registered in the International Prospective Registry of Systematic Reviews. Results: Seventeen studies were included, generally of moderate quality. Qualitative synthesis evidenced accurate implant positioning, short LOS, and a short learning curve. Conflicting findings were reported for postoperative complications compared with conventional approaches. Better functional outcomes were seen in the early postoperative period than the posterolateral approach (PLA). Outcomes such as blood loss and operative time exhibited conflicting results and considerable heterogeneity. Conclusion: Based on moderate-certainty evidence, it is uncertain if the DSA provides short-term advantages over conventional approaches such as PLA. There is limited evidence on long-term outcomes post-THA using the DSA. Further studies and ongoing registry monitoring is crucial for continuous evaluation of its long-term outcomes. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

“…Blood loss in ml was recorded in 10 studies 10,12,13,17,[19][20][21][22]25,26 . Three studies compared DSA with PLA blood loss 12,13,26 .…”

Section: Blood Lossmentioning

confidence: 99%

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The Direct Superior Approach in Total Hip Arthroplasty

van Dooren,

Peters,

van der Wal-Oost

et al. 2024

JBJS Reviews

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“…Ein weiterer interessanter Aspekt der zukünftigen Forschung sollte die Beurteilung neuer minimalinvasiver Operationstechniken bezüglich der Prävention einer erworbenen traumatischen heterotopen Ossifikation sein [31,80]. Insbesondere in der Hüftchirurgie sind aktuell viele minimalinvasive Zugänge beschrieben, die einen reduzierten Gewebeschaden versprechen [81,82]. Der Einfluss auf die Prävalenz heterotoper Ossifikationen ist bisher nicht beschrieben.…”

Section: Ausblickunclassified

Heterotope Ossifikationen

Ohlmeier¹,

Korth²,

Stange³

et al. 2023

Orthopädie und Unfallchirurgie up2date

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“…In comparison with the PLA, the DSA should therefore improve implant stability. Outcomes of THA with the DSA have shown that reliable implant positioning can be obtained with a low early complication rate (11)(12)(13). Shorter length of hospital stay and enhanced recovery with higher functional scores were recorded in comparison with the PLA (14)(15)(16)(17)(18)(19).…”

mentioning

confidence: 98%

Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI)

Dooren

Peters

Ettema

et al. 2023

ActaO

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Background and purpose: The direct superior approach (DSA) is a modification of the classic posterolateral approach (PLA) for total hip arthroplasty (THA), in which the iliotibial band and short external rotators are spared. The revision rate of the DSA has not been investigated previously using arthroplasty registry data. We examined the reasons and risk of revision of the DSA, compared with the direct anterior approach (DAA) and PLA.Patients and methods: In this population-based cohort study we included 175,543 primary THAs performed between 2014 and 2020 (PLA, n = 117,576; DAA, n = 56,626; DSA, n = 1,341). Competing risk survival analysis and multivariable Cox proportional hazard analyses, adjusted for potential confounders, were performed.Results: After 3 years, crude revision rates due to any reason were 2.1% (95% confidence interval [CI] 1.3–3.3) for DSA, and 2.9% (CI 2.8–3.0) for PLA. Crude dislocation revision rates were 0.3% (CI 0.1–0.8) for DSA, versus 1.0% (CI 0.9–1.0) for PLA. Dislocation revision rate for DSA did not differ from DAA (0.3% [CI 0.2–0.3]). Multivariable Cox regression analysis demonstrated no overall difference in revision rates for the DSA (HR 0.6 [CI 0.4–1.09) compared with the PLA. Lower risk of revision due to dislocation was found in patients operated on through the DSA (HR 0.3 [0.1–0.9]) compared with the PLA.Conclusion: Early nationwide results suggest that the DSA for total hip arthroplasty seems to show a tendency towards a lower risk of revision for dislocation but no overall reduced revision risk compared with the PLA.

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Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

Cited by 4 publications

References 28 publications

The Direct Superior Approach in Total Hip Arthroplasty

The Direct Superior Approach in Total Hip Arthroplasty

Heterotope Ossifikationen

Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI)

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