Forgotten Joint Score in THA: Comparing the Direct Anterior Approach to Posterior Approach

Singh, Vivek; Zak, Stephen; Schwarzkopf, Ran; Davidovitch, Roy I.

doi:10.1016/j.arth.2020.04.074

Cited by 16 publications

(12 citation statements)

References 42 publications

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“…This could answer the question why the early stage FJS-12 score in patients undergoing THA via PA is significantly lower than that in patients with DAA in this study. In contrast to our results, Vivek et al [ 21 ] reported that at 1 and 1.75 years postoperatively, although the scores consistently trended in favour of the DAA cohort at all time points, no statistically significant differences in the FJS-12 score were found between the DAA group and the PA group. The authors considered that the approach is not the only factor affecting patient satisfaction and the FJS-12 score.…”

Section: Discussioncontrasting

confidence: 99%

“…This finding may suggest that although patients are able to perform certain motions, those who undergo THA via the PA have a higher likelihood of feeling the prosthesis within 1 month after surgery. This finding is consistent with the results of previous studies [ 21 ]. However, the difference in the HHS between the two groups disappeared gradually within 1 year after surgery ( P = 0.812).…”

Section: Discussionsupporting

confidence: 94%

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Clinical and radiologic outcomes in patients undergoing primary total hip arthroplasty with Collum Femoris Preserving stems: a comparison between the direct anterior approach and the posterior approach

Zhang

Liu

et al. 2022

BMC Musculoskelet Disord

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Background The direct anterior approach (DAA) and posterior approach (PA) are two of the most common surgical approaches used for total hip arthroplasty (THA) worldwide. The curved anatomical collum femoris-preserving (CFP) stem was designed to preserve the bone of the femoral neck and allow physiologic load transfer along the trabecular systems, which may better restore hip biomechanics, improve triplanar stem stability and improve the long-term survival rate. We believe this study will demonstrate whether the DAA is suitable for THA with CFP stems. Methods The data of patients who underwent primary THA with CFP stems from January 2010 to December 2015 were retrospectively analysed. These patients were divided into two groups (group A, DAA; group B, PA). The approach was selected by the surgeon. The demographic characteristics, preoperative diagnoses, preoperative Harris hip score, preoperative range of motion, postoperative complications, and radiologic measurements (neck-shaft angle, coronal alignment, sagittal alignment, stress shielding, anteversion, neck-preserving ratio, acetabular anteversion, acetabular inclination angle, acetabular depth, anterior-posterior offset, lateral offset, difference in leg length) were recorded for all patients. Results In this study, a total of 248 patients (185 male and 63 female) were included. No significant differences were found between group A and group B in terms of general patient information and radiologic measurements. However, the rate of nerve injury in group A (7/5.5%) was significantly higher than that in group B (1/0.8%) (p = 0.037). At 1 month after surgery, we found a significant difference between the two groups in the Harris hip score (HHS) (71.03 ± 8.04 in group A, 68.39 ± 8.37 in group B, P = 0.014) and forgotten joint score (FJS-12) (50.78 ± 7.57 in group A, 47.68 ± 7.34 in group B, P = 0.001). At 1 year after surgery, the mean FJS-12 score in group A (68.78 ± 7.54) was higher than that in group B (58.84 ± 8.91) (P < 0.001). At 5 years after surgery, the mean FJS-12 score in group A (73.38 ± 7.21) was higher than that in group B (67.16 ± 9.12) (P < 0.001). Post hoc analysis of the 1-month, 1-year, and 5-year postoperative FJS-12 scores using multiple linear regression analysis revealed that an excellent HHS led to good patient satisfaction at each time point. Conclusion In summary, unlike a “standard” femoral stem, whose alignment might be affected by the surgical approach, alignment of the CFP stem is independent from the surgical approach. Even though the DAA had a higher nerve injury rate, nerve injury from the DAA did not typically cause severe dysfunction of the lower extremity. Therefore, decisions regarding the surgical approach for patients undergoing THA with CFP stems can be made primarily based on the preference of the surgeon.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 94%

Clinical and radiologic outcomes in patients undergoing primary total hip arthroplasty with Collum Femoris Preserving stems: a comparison between the direct anterior approach and the posterior approach

Zhang

Liu

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…Since its introduction, many clinical workers have used it as an important indicator of the maximum satisfaction and surgical success of patients after hip replacement surgery [8,9] . Previous studies have shown that compared to PA, DAA can achieve better FJS, but the conclusions of different studies are not consistent [10][11][12][13][14][15][16] . Currently, there is no evidence from systematic reviews on this aspect.…”

Section: Introductionmentioning

confidence: 99%

Systematic evaluation of joint amnesia in patients after total hip replacement surgery with comparison between anterior and posterior approaches

Zhang

Yang

et al. 2023

Preprint

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Aims A comparison of joint amnesia in patients undergoing total hip arthroplasty with direct anterior approach (DAA) and posterior approach (PA) was conducted through systematic evaluation. Methods Searched for literature on FJS in patients undergoing DAA and PA THA comparison surgery from the establishment of PubMed, EMbase, Web of Science, Cochrane Library, CBM,Wanfang, and VIP databases to February 13, 2023. After two researchers independently searched, screened literature, extracted data, and evaluated the quality of included studies according to the inclusion criteria, a meta-analysis was conducted using RevMan 5.3. Results A total of 1 RCT and 6 cohort studies were included. Meta-analysis results showed that at 1 month postoperatively [MD = 2.08, 95% CI (0.20, 3.96), P = 0.03], 3 months [MD = 10.08, 95% CI (1.20, 18.96), P = 0.03], and 1 year [MD = 6.74, 95% CI (1.30, 12.19), P = 0.02], DAA total hip arthroplasty had better FJS than PA, but there was no statistical significance in FJS scores between the two groups at 5 years postoperatively [MD = 1.35, 95% CI (-0.58, 3.28), P = 0.17]. Conclusion Current evidence shows that early FJS after THA with DAA is better than PA, and there is no significant difference between the two in long-term follow-up. However, due to the limited number of literatures included in this study, the above conclusions need to be further confirmed by the inclusion of more high-quality studies.

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“…Although Tauton et al [ 47 ] provided evidence that patients who underwent DAA THA discontinued walking aids sooner, the functional recovery scores cast doubt as to whether this difference is beneficial or yields superior clinical outcomes. In a previous study performed at our institution, Singh et al [ 48 ] compared the DAA to the posterior approach using the Forgotten Joint Scores (FJS). Although our initial data suggest that patients who underwent the DAA achieved higher FJS at 12 weeks, we found that this difference dissipated when the data were normalized to account for surgeon experience with their respective surgical approaches.…”

Section: Introductionmentioning

confidence: 99%

The direct anterior approach to the hip: a useful tool in experienced hands or just another approach?

et al. 2022

Self Cite

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The direct anterior approach (DAA) to the hip was initially described in the nineteenth century and has been used sporadically for total hip arthroplasty (THA). However, recent increased interest in tissue-sparing and small incision arthroplasty has given rise to a sharp increase in the utilization of the DAA. Although some previous studies claimed that this approach results in less muscle damage and pain as well as rapid recovery, a paucity in the literature exists to conclusively support these claims. While the DAA may be comparable to other THA approaches, no evidence to date shows improved long-term outcomes for patients compared to other surgical approaches for THA. However, the advent of new surgical instruments and tables designed specifically for use with the DAA has made the approach more feasible for surgeons. In addition, the capacity to utilize fluoroscopy intraoperatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons during their learning curve. An understanding of its limitations and challenges is vital for the safe employment of this technique. This review summarizes the pearls and pitfalls of the DAA for THA in order to improve the understanding of this surgical technique for hip replacement surgeons.

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Forgotten Joint Score in THA: Comparing the Direct Anterior Approach to Posterior Approach

Cited by 16 publications

References 42 publications

Clinical and radiologic outcomes in patients undergoing primary total hip arthroplasty with Collum Femoris Preserving stems: a comparison between the direct anterior approach and the posterior approach

Clinical and radiologic outcomes in patients undergoing primary total hip arthroplasty with Collum Femoris Preserving stems: a comparison between the direct anterior approach and the posterior approach

Systematic evaluation of joint amnesia in patients after total hip replacement surgery with comparison between anterior and posterior approaches

The direct anterior approach to the hip: a useful tool in experienced hands or just another approach?

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