High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach

Spaans, Anne J.; Hout, Joost A.A.M. van den; Bolder, Stefan B T

doi:10.3109/17453674.2012.711701

Cited by 219 publications

(211 citation statements)

References 22 publications

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“…Homma et al [7] reported 32 % of lateral femoral cutaneous nerve injury with DAA that correlated to lower FJS-12 scores. Spaans et al [6] reported also a high complication rate in the early experience of DAA THA, with no benefit shown when compared with the posterior approach. High complication rates were also reported by Jewett et al [5] who shown intra-operative complications in 26 out of 800 patients including trochanteric fractures (2.3 %) and femoral perforation (0.37 %).…”

Section: Discussionmentioning

confidence: 99%

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Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Sariali

Catonné

Pascal‐Moussellard

2016

International Orthopaedics (SICOT)

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Purpose The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD). Methods One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up. Results No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved. Conclusions This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure.Level of Evidence: Level IV

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Section: Discussionmentioning

confidence: 99%

“…However, this surgical technique presents a longer learning curve and a higher complications rate, especially on the femoral side including femoral stem malposition [3] and intraoperative femur fractures [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Sariali

Catonné

Pascal‐Moussellard

2016

International Orthopaedics (SICOT)

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“…General health outcome measures, operative time, and surgical complications were similar between groups in our study; to our knowledge, these end points have not been specifically evaluated by other studies comparing the direct anterior and posterior approaches. However, a review of recent literature suggested a remarkably higher complication rate associated with the direct anterior approach, especially in lower-volume settings and during the learning curve of the surgeon [31,33]. It appears that pretraining is critical when embracing a new approach such as the direct anterior approach to minimize complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, some literature has suggested that actual functional recovery may not be better when mini-and conventional posterior procedures are compared [6,9,23,32]. Other studies have identified an increased frequency of complications with MIS THA compared to more traditional approaches [3,[31][32][33]. These complications include, but are not limited to, increased intraoperative blood loss, wound-healing problems, femoral or acetabular fracture, suboptimal implant alignment, dislocation, and early component loosening and subsidence.…”

Section: Introductionmentioning

confidence: 97%

“…These complications include, but are not limited to, increased intraoperative blood loss, wound-healing problems, femoral or acetabular fracture, suboptimal implant alignment, dislocation, and early component loosening and subsidence. The complication rate seems to be higher in low-volume community settings [33] and during the learning curve of the surgeon with a new approach [31].…”

Section: Introductionmentioning

confidence: 99%

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Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?

Rodríguez

Deshmukh

Rathod

et al. 2013

Clin Orthop Relat Res

188

162

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Background Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy. Questions/purposes We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement. Methods In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and go (TUG) test, motor component of the Functional Independence Measure TM

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Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

Yan

Dong

et al. 2023

JAMA Netw Open

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ImportanceEach approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon’s choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and individual patient characteristics.ObjectiveTo assess the efficacy and safety associated with different surgical approaches for THA.Data SourcesA comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022; reference lists of eligible trials; and related reviews.Study SelectionRandomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA.Data Extraction and SynthesisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses.Main Outcomes and MeasuresThe outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle.ResultsOf 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years; median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04; 95% CI, 1.92 to 6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43 to 5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05 to 5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60 to 7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87 to 6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58 to 9.42; high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13 to 2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04 to 1.76; moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, −23.85 minutes; 95% CI, −36.60 to −11.10 minutes; high certainty), DAA (MD, −13.94 minutes; 95% CI, −18.79 to −9.08 minutes; moderate certainty), DLA (MD, −10.50 minutes; 95% CI, −16.07 to −4.94 minutes; high certainty), MIS-ALA (MD, −6.76 minutes; 95% CI, −12.86 to −0.65 minutes; moderate certainty), and SuperPath (MD, −13.91 minutes; 95% CI, −21.87 to −5.95 minutes; moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches.Conclusions and RelevanceIn this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.

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High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach

Cited by 219 publications

References 22 publications

Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?

Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

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