The Impact of Surgical Technique on Patient Reported Outcome Measures and Early Complications After Total Hip Arthroplasty

Sibia, Udai S.; Turner, Timothy R.; MacDonald, James; King, Paul J.

doi:10.1016/j.arth.2016.10.031

Cited by 37 publications

(32 citation statements)

References 21 publications

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“…The improved postoperative recovery seems to favourably affect the percentage of patients discharged to their homes versus a rehabilitation facility in the DAA patients. In the largest series to date comparing discharge destination between DAA and PA patients, Ponzio et al 26 and Sibia et al 20 report significantly higher percentages of DAA THA patients being discharged home compared to PA THA patients. The same trend is seen in the literature 13,27–31 without reaching statistical significance in series with smaller numbers of patients.…”

Section: Advantagesmentioning

confidence: 99%

“…Large samples of patients are usually found in the retrospective studies, such as the one from Sibia et al 20 comparing 1457 DAA THA patients with 1241 PA patients, concluding that the anterior approach demonstrated significantly higher HHS and pain relief at the three to six-month follow-up but not at one year postoperatively. Malek et al, 21 on the other hand, compared 265 DAA with 183 PA THA patients, finding no significant difference in outcomes at a median follow-up of 18 months.…”

Section: Advantagesmentioning

confidence: 99%

“…In the majority of studies the length of hospitalization of patients undergoing hip arthroplasty through an anterior approach is significantly reduced compared with their posterior approach counterparts. 11–15,20,21,26–32 Results are shown in Figure 2.…”

Section: Advantagesmentioning

confidence: 99%

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Total hip arthroplasty through an anterior approach

2018

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Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients.Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay.No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches.Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes.Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

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Section: Advantagesmentioning

confidence: 99%

Section: Advantagesmentioning

confidence: 99%

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Total hip arthroplasty through an anterior approach

2018

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“…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%

“…27,29,31,33,35,[36][37][38][39]44,45,[47][48][49] Mean operative time across 10 traction table studies was 100.1 ± 32.6 mins (n = 3518). 5,9,[50][51][52]54,58,61,63 A total of 8 standard table studies (n = 2992) reported estimated blood loss (EBL) as an outcome with a mean EBL of 382.3 ± 246.4 mL. 29,31,33,37,39,43,47,49 Blood loss was reported in 7 traction table studies (n = 2675) with a mean EBL of 531.7 ± 364.3 mL.…”

Section: Perioperative Outcomesmentioning

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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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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