Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D

Lecoanet, Paul; Vargas, Morgane; Thelen, Thomas; Ribes, Christopher; Fabre, Thierry

doi:10.1016/j.otsr.2018.06.020

Cited by 46 publications

(33 citation statements)

References 25 publications

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“…1 paper was identified and added manually. 26 There were 25 standard table studies including 6 RCTs, 2 prospective cohorts, 9 retrospective cohorts and 8 case series ( Table 2). There were 19 traction table studies including 5 RCTs, 1 prospective cohort, 3 case-controls, 4 retrospective cohorts, and 6 case series ( Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…14,33,37,40,44,45,48 In comparison, intraoperative fluoroscopy was used in 96.9% (10,870/11,220) of patients in the 16 traction table studies that reported it. 5,7,9,11,[50][51][52][55][56][57][58][59][60][61][62][63] In 15 standard table studies reporting specific implants (n = 4130), there were 54 (1.3%) cemented femoral implants used 26,42 and 4076 (98.7%) cementless femoral implants used. 14,26,29,33,[36][37][38][39][40][41][42][43][44][45]48 In 11 traction table studies that reported specific implants (n = 7189), there were 76 (1.0%) cemented femoral implants 9,54,59 and 7351 (99.0%) cementless femoral implants used.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

et al. 2020

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Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. Methods: The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Results: Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table ( n = 4402) and 100.1 ± 32.6 minutes for traction table ( n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard ( n = 2992) and 531.7 ± 364.3 mL for traction table ( n = 2675). Intra-operative fracture rate was 1.3% for standard table ( n = 3940) and 1.7% for traction table ( n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Conclusion: Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

et al. 2020

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“…Several surgeons modified their approach with or without a traction table [2]. It is described as an anatomical approach [3] leading to a rapid recovery [4,5], less dislocation [6] allowing a good control of the leg length discrepancy (LLD) [7]. Publications report a lack of evidence for these benefits and significant learning difficulties associated with DAA [8,9].…”

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Foissey

Fauvernier

Fary

et al. 2020

SICOT-J

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Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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“…The center of the femoral head is used as landmark for LLD measurement in the full-length standing anteroposterior radiographs [7][8][9]. However, the center of the femoral head in the operative side may be affected by the position of the acetabular shell.…”

Section: Discussionmentioning

confidence: 99%

“…Radiographic LLD detected in the full-length standing anteroposterior radiographs is the objective LLD, and the surgeon tend to focus on the importance of radiographic LLD, whereas perceived LLD is subjective LLD, and the patients pay close attention to the signi cance of their own perception. In many studies, the distance between the center of femoral head and the midpoint of tibial plafond was used as the leg length (CH-TP) [7][8][9], they found that perceived LLD had poor correlation and reliability, low sensitivity and speci city when compared with radiographic LLD [8,9]. However, the position of the acetabular shell will affect the length of the leg, and the distance between the center of femoral head and the midpoint of tibial plafond does not represent the true functional leg length.…”

Section: Introductionmentioning

confidence: 99%

Patient’s perception on leg length discrepancy after total hip arthroplasty in patients with unilateral Crowe type IV developmental dysplasia of the hip

Shen

Sun

et al. 2020

Preprint

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Background: The study assessed the correlation among the patients’ perception on leg length discrepancy (LLD) after total hip arthroplasty (THA) in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH) and the four methods of measuring the leg length in the full-length standing anteroposterior radiographs. Methods: 60 patients with unilateral Crowe type IV DDH were recruited in this retrospective study between January 2012 and January 2019. Four methods of measurement were used: (1) TD-TP: distance between the inferior aspect of teardrop and the midpoint of tibial plafond (TP). (2) CH-TP: distance between the center of femoral head or acetabular cup and the TP. (3) GT-TP: distance between the apex of greater trochanter and the TP. (4) FL + TL: the sum of femoral length and tibial length. Results: Association was found among the patients’ perception on LLD with difference in TD-TP (OR, 1.157), and the difference in FL + TL (OR, 1.166). The area under the curve of the difference in FL + TL and the difference TD-TP (0.704 and 0.679) was significantly higher than those of the difference in CH-TP and the difference in GT-TP (0.564 and 0.483). With the calculated threshold of LLD set at 9.0 mm, the sensitivity and specificity of the difference in TD-TP and the difference in FL + TL were 57.7%, 79.4% and 61.5%, 79.4%, respectively.Conclusion: Patients’ perception on LLD had good correlation and reliability on the difference of FL + TL and the difference of TD-TP.

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Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D

Cited by 46 publications

References 25 publications

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Patient’s perception on leg length discrepancy after total hip arthroplasty in patients with unilateral Crowe type IV developmental dysplasia of the hip

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