Higher Acetabular Anteversion in Direct Anterior Total Hip Arthroplasty: A Retrospective Case-Control Study

Chen, Antonia F.; Chen, Chi‐Lung; Low, Sara; Lin, Wei-Ming; Chinnakkannu, Karthikeyan; Orozco, Fabio; Ong, Alvin; Post, Zachary D.

doi:10.1007/s11420-016-9488-6

Cited by 19 publications

(23 citation statements)

References 32 publications

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“…Although a total of seven articles 16, 26–31 were involved in surgical site infection including superficial or deep infection, six studies 16, 27–31 were included in the meta‐analysis to evaluate the surgical site infection rate, except for the study of Takada et al 26 . due to that no cases of surgical site infection were reported in both DAA and LA groups.…”

Section: Resultsmentioning

confidence: 99%

“…due to that no cases of surgical site infection were reported in both DAA and LA groups. Among of them, two studies 28, 29 reported superficial infection, one study 27 reported deep infection such as periprosthetic joint infection (PJI), and three studies 16, 30, 31 involved both superficial and deep infection. Fixed effects model was adopted in the meta‐analysis because of small heterogeneity among the included studies ( I 2 = 11%, P = 0.35).…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Fig. 5A, a total of eight studies 15, 16, 26–30, 32 including mentioned dislocation, which was the most common complication of prosthesis. Considering that no dislocation cases occurred in both DAA and LA group in the study of Mjaaland et al 16 .…”

Section: Resultsmentioning

confidence: 99%

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Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis

Huang¹,

Liu²,

Jia

et al. 2021

Orthopaedic Surgery

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The direct anterior approach (DAA) are attracting increasing attention from orthopedic arthroplasty surgeons, due to the less blood loss, mild soft tissue invasion, rapid rehabilitation and shorter length of stay. However, the longer learning curve in DAA can give rise to several complications, such as intraoperative femoral fracture, lateral femoral cutaneous nerve injury, wound‐healing problem, premature revision and so on. This meta‐analysis was performed to compare the rate of postoperative orthopedic complications between the DAA and the lateral approach (LA). All studies involving the comparison of postoperative orthopedic complications after THA between the DAA and LA group were searched in 7 databases prior to October 2020. The odds ratio (OR) with the 95% confidence intervals (CI) for each outcome was calculated by using the RevMan 5.3. The methodological bias of included studies was evaluated and the potential heterogeneity sources were analyzed. Thirteen comparative studies including a total of 24853 hips (9575 hips in the DAA group and 15278 hips in the LA group) were eligible for this meta‐analysis. There was no significant difference in the rate of surgical site infection [2.59% vs 2.14% (OR = 0.98; 95% CI: 0.59‐1.61, P = 0.93)], heterotopic ossification [12.16% vs 26.47% (OR = 0.46; 95% CI: 0.20‐1.07, P = 0.07)] and reoperation [2.70% and 2.11% respectively (OR = 0.93; 95% CI: 0.68‐1.26, P = 0.64)] between the DAA and LA groups. Although a lower rate in prosthesis malposition [36.19% vs 54.86% (OR = 0.50; 95% CI: 0.35‐0.73, P = 0.0003)], leg length discrepancy [1.87% vs 2.37% (OR = 2.35; 95% CI: 1.30‐4.25, P = 0.005)] and Trendelenburg gait [1.68% vs 4.78% (OR = 0.29; 95% CI: 0.13‐0.65, P = 0.003)] was observed in the DAA group, a higher rate in dislocation [0.77% vs 0.18% (OR = 3.73; 95% CI: 2.35‐5.94, P< 0.00001)], periprosthetic fracture [1.05% vs 0.41% (OR = 2.38; 95% CI: 1.58‐3.58, P< 0.0001)], prosthesis loosening [0.61% vs 0.37% (OR = 1.66; 95% CI: 1.05‐2.62, P = 0.03)] and nerve injury [0.95% vs 0% (OR = 7.12; 95% CI: 1.66‐30.48, P = 0.008)] was found in the DAA group. This meta‐analysis demonstrated several evidences indicating that the DAA exhibited the advantages in the accurate prosthesis placement and less damage of surrounding hip musculature. However, a higher rate in dislocation, periprosthetic fracture, prosthesis loosening and nerve injury in the DAA group should be paid more attention, due to the limited exposure and a longer learning curve, compared to the LA.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis

Huang¹,

Liu²,

Jia

et al. 2021

Orthopaedic Surgery

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“…This approach is favored by surgeons, because it utilizes the intermuscular plane, thereby avoiding the need to transect any of the periarticular muscles. Moreover, this approach is favored because it provides adequate exposure of the acetabular side [1][2][3][4][5]. Several studies have reported that DAA decreases the duration of hospital stay and increases the percentage of patients discharged home due to the lesser operative trauma which permits a more rapid recovery [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Zhao

Zhu

Jiang

et al. 2020

BMC Musculoskelet Disord

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Background: The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. Methods: Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue "pad" created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. Results: LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. Conclusions: Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. Trial registration: ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

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“…Moreover, this approach is favored because it provides adequate exposure of the acetabular side. [1][2][3][4][5] Several studies have reported that DAA decreases the duration of hospital stay and increases the percentage of patients discharged home due to the lesser operative trauma which permits a more rapid recovery. [5][6][7][8][9] Whether DAA is actually superior to other surgical approaches, however, remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Zhao

Zhu

Jiang

et al. 2020

Preprint

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Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

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Higher Acetabular Anteversion in Direct Anterior Total Hip Arthroplasty: A Retrospective Case-Control Study

Abstract: There is a tendency to antevert the acetabular cup when performing THAs using the DA approach, and one must be mindful of this when implanting the acetabular component.

Cited by 19 publications

References 32 publications

Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis

Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

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