Low rate of early periprosthetic fractures in cementless short-stem total hip arthroplasty using a minimally invasive anterolateral approach

Luger, Matthias; Hipmair, Günter; Schopper, Clemens; Schauer, Bernhard; Hochgatterer, Rainer; Allerstorfer, Jakob; Gotterbarm, Tobias; Klasan, Antonio

doi:10.1186/s10195-021-00583-x

Cited by 9 publications

(5 citation statements)

References 33 publications

(59 reference statements)

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“…We could not confirm this finding, since we only found one periprosthetic fracture in the non-obese patient group at the 5-year follow-up. This is in line with a study of Luger et al, in which BMI was not a risk factor for periprosthetic fractures in short stem THA [ 33 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, this can increase the heterogeneity of our study cohort, since patients’ activity levels can differ with age. Nevertheless, the mean age of both cohorts is comparable with other studies investigating the effect of obesity in short stem THA [ 33 , 34 , 36 ]. In addition, the multicenter study design can decrease the homogeneity of the study cohort because of different acetabular cups used and different surgeons who performed the implantation.…”

Section: Discussionsupporting

confidence: 82%

“…However, there are only limited and partly inconclusive data about the effect of obesity in short stem THA, especially on mid-term and long-term outcomes [ 33 – 36 ]. This is why, the purpose of this study was to a investigate the effect of obesity in short stem THA with the optimys implant on operation characteristics, complications, revision surgeries, and clinical outcome, such as postoperative pain, patient satisfaction, and Harris Hip Score.…”

Section: Introductionmentioning

confidence: 99%

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Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

Hinz,

Marsoni,

Mittelstädt

et al. 2023

Arch Orthop Trauma Surg

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Introduction Short stems are a valuable option in young patients undergoing total hip arthroplasty (THA) because of their bone stock preserving properties facilitating revision hip arthroplasty. Although the effect of obesity on conventional THA is well studied, data about short stem THA in obese patients are lacking. Therefore, this study aimed to investigate the influence of obesity on complications, revisions, and outcome after short stem THA. Materials and methods This multicenter, observational cohort study included patients undergoing short stem THA with the optimys prosthesis. Follow-up examinations were performed at specific intervals up to 7 years postoperatively. Operation characteristics, general and specific complications, revisions, VAS rest pain, VAS load pain, VAS patient satisfaction, and Harris Hip Score (HHS) were recorded and statistically compared between obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients. Results Of the 224 patients included with a mean follow-up of 87.2 months (range 81.9–104.0), 69 were assigned to the OB group and 155 to the non-OB group. A minimally invasive approach was significantly less often selected in obese patients (p = 0.049), whereas operating time and length of hospital stay were not significantly different. The rate of general and specific complications did not significantly differ between both groups. Survival of the optimys prosthesis was 99.1% at 7-year follow-up and one patient per group had to undergo revision surgery. VAS rest pain, load pain, and satisfaction improved from preoperatively to postoperatively in both groups without a significant difference between both groups. While the HHS was improved from preoperatively to postoperatively, obese patients showed a significantly lower HHS at the 7-year follow-up (p = 0.01) but still exhibited an excellent scoring above the PASS threshold. Conclusion Short stem THA with the optimys prosthesis is a safe and effective option also in obese patients with an excellent clinical outcome and a low complication rate.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

Hinz,

Marsoni,

Mittelstädt

et al. 2023

Arch Orthop Trauma Surg

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“…Dietrich et al [ 44 ] reported a significantly reduced fracture rate of 1.6% vs 6.8% in 457 DAA with conventional straight stems. Luger et al [ 45 ] reported 0.9% of intraoperative fractures after 1052 DAA- THA with the same straight stem used in our study. In our opinion, the use of short stems with specific instruments for DAA favors the introduction into the femoral canal, decreases the points of conflict with cortices during introduction and decreases the incidence of complications.…”

Section: Discussionsupporting

confidence: 63%

Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review

Rivera¹,

Comba²,

Bardelli³

2022

WJO

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BACKGROUND The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers. AIM To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate. METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification. RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia. CONCLUSION DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.

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“…When patients are operated on through DAA, intra-operative femoral fractures and implant malpositioning could occur because of the impingement of the surgical instruments against the adipose tissue [14,16,30]. In order to reduce periprosthetic fracture, specific short stems seem to reduce the risk; in addition, dedicated off-set instrumentation is required to permit a suitable placement of implants without force [31]. Russo et al [14] reported an increased rate of infectious complications in patients with BMI over 30 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

Is the Direct Anterior Approach for Total Hip Arthroplasty Effective in Obese Patients? Early Clinical and Radiographic Results from a Retrospective Comparative Study

et al. 2023

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Background and objectives: Total hip arthroplasty (THA) in obese patients (BMI > 30) is considered technically demanding, and it is associated with higher rates of general and specific complications including infections, component malpositioning, dislocation, and periprosthetic fractures. Classically, the Direct Anterior Approach (DAA) has been considered less suitable for performing THA surgery in the obese patient, but recent evidence produced by high-volume DAA THA surgeons suggests that DAA is suitable and effective in obese patients. At the authors’ institution, DAA is currently the preferred approach for primary and revision THA surgery, accounting for over 90% of hip surgeries without specific patient selection. Therefore, the aim of the current study is to evaluate any difference in early clinical outcomes, perioperative complications, and implant positioning after primary THAs performed via DAA in patients who were divided according to BMI. Material and methods: This study is a retrospective review of 293 THA implants in 277 patients that were performed via DAA from 1 January 2016 to 20 May 2020. Patients were further divided according to BMI: 96 patients were normal weight (NW), 115 were overweight (OW), and 82 were obese (OB). All the procedures were performed by three expert surgeons. The mean follow-up was 6 months. Patients’ data, American Society of Anesthesiologists (ASA) score, surgical time, days in rehab unit, pain at the second post-operative day recorded by using a Numerical Rating Scale (NRS), and number of blood transfusions were recorded from clinical charts and compared. Radiological evaluation of cup inclination and stem alignment was conducted on post-operative radiographs; intra- and post-operative complications at latest follow-up were recorded. Results: The average age at surgery of OB patients was significantly lower compared to NW and OW patients. The ASA score was significantly higher in OB patients compared to NW patients. Surgical time was slightly but significantly higher in OB patients (85 ± 21 min) compared to NW (79 ± 20 min, p = 0.05) and OW patients (79 ± 20 min, p = 0.029). Rehab unit discharge occurred significantly later for OB patients, averaging 8 ± 2 days compared to NW patients (7 ± 2 days, p = 0.012) and OW patients (7 ± 2 days; p = 0.032). No differences in the rate of early infections, number of blood transfusions, NRS pain at the second post-operative day, and day of post-operative stair climbing were found among the three groups. Acetabular cup inclination and stem alignment were similar among the three groups. The perioperative complication rate was 2.3%; that is, perioperative complication occurred in 7 out of 293 patients, with a significantly higher incidence of surgical revisions required in obese patients compared to the others. In fact, OB patients showed a higher revision rate (4.87%) compared to other groups, with 1.04% for NW and 0% for OW (p = 0.028, Chi-square test). Causes for revision in obese patients were aseptic loosening (2), dislocation (1), and clinically significant post-operative leg length discrepancy (1), with a revision rate of 4/82 (4.87%) during follow-up. Conclusions: THA performed via DAA in obese patients could be a solid choice of treatment, given the relatively low rate of complications and the satisfying clinical outcomes. However, surgical expertise on DAA and adequate instrumentation for this approach are required to optimise the outcomes.

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Low rate of early periprosthetic fractures in cementless short-stem total hip arthroplasty using a minimally invasive anterolateral approach

Cited by 9 publications

References 33 publications

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review

Is the Direct Anterior Approach for Total Hip Arthroplasty Effective in Obese Patients? Early Clinical and Radiographic Results from a Retrospective Comparative Study

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