Minimally Invasive Compared with Traditional Transgluteal Approach for Total Hip Arthroplasty

Pospischill, M.; Kranzl, Andreas; Attwenger, Bernhard; Knahr, K.

doi:10.2106/jbjs.h.01086

Cited by 100 publications

(69 citation statements)

References 26 publications

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“…The area from eleven o'clock to three o'clock illustrates the initial extent of the capsulectomy for the MIS Pospischill et al found no significant differences in range of motion between a minimally invasive modified WatsonJones approach and a transgluteal approach according to Hardinge. Remarkably, the first measurements were performed ten days after surgery and the statistical power was low in this study due to the small number of 20 patients per group investigated [21]. The duration of stay in hospital, however, depends on many different patient-specific variables and can therefore only be used indirectly for comparison.…”

Section: Discussionmentioning

confidence: 96%

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Goebel

Steinert

Schillinger

et al. 2011

International Orthopaedics (SICOT)

152

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Section: Discussionmentioning

confidence: 96%

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Goebel

Steinert

Schillinger

et al. 2011

International Orthopaedics (SICOT)

152

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“…A number of recent studies have compared the newer approaches with traditional lateral and posterior approaches [1,12,15,18,34,49] but there is lack of consensus on whether there is any demonstrable difference in reducing muscle damage, improving postoperative gait, or facilitating earlier rehabilitation [21,29,38,41,42,46].…”

Section: Introductionmentioning

confidence: 99%

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

193

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Background Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. Questions/purposes (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? Methods The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011. Endpoints were septic revisions, aseptic revisions, and dislocations. The exposure of interest was surgical approach (posterior, anterolateral, direct lateral, direct anterior). Patient, implant, surgeon, and hospital factors were evaluated as possible confounders. Survival analysis was performed with marginal multivariate Cox models. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. A total of 42,438 primary THAs were available for analysis of revision outcomes and 22,237 for dislocation. Median followup was 3 years (interquartile range, 1-5 years). The registry's voluntary participation is 95%. The most commonly used approach was posterior (75%, N = 31,747) followed by anterolateral (10%, N = 4226), direct anterior (4%, N = 1851), and direct lateral (2%, N = 667). Results During the study period 785 hips (2%) were revised for aseptic reasons, 213 (0.5%) for septic reasons, and 276 (1%) experienced a dislocation. The revision rate per 100 years of observation was 0.54 for aseptic revisions, 0.15 for septic revisions, and 0.58 for dislocations. There were no differences in adjusted risk of revision (either septic or aseptic) across the different THA approaches. However, the anterolateral approach (adjusted HR, 0.29; 95% CI, 0.13-0.63, p = 0.002) and direct anterior approach (adjusted HR, 0.44; 95% CI, 0.22-0.87, p = 0.017) had a lower risk of dislocation relative to the posterior approach. There were no differences in any of the outcomes when comparing the direct anterior approach with the anterolateral approach. Conclusions Anterior and anterolateral surgical approaches had the advantage of a lower risk of dislocation without increasing the risk of early revision. Level of Evidence Level III, therapeutic study.

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“…Recently some less invasive modifications have been described and compared to the standard approaches such as Kocher-Langenbeck (dorsal), Bauer or Hardinge (lateral), Watson-Jones (anterolateral) and Smith-Peterson (anterior). All of them seem to have several advantages and every modification leads to different new problems [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Biber

Brem

Singler³

et al. 2012

International Orthopaedics (SICOT)

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Purpose Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. Methods We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia® stem with selfcentring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test.Results After a dorsal approach 10.5 % [confidence interval (CI) 7.7-13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7-13.6 %), which was not significantly different (p00.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2-5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0-1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5-8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2-2.2 %). The frequency of the other types of complications did not significantly differ. Conclusions The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.

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Minimally Invasive Compared with Traditional Transgluteal Approach for Total Hip Arthroplasty

Cited by 100 publications

References 26 publications

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

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