Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up

Abstract

Purpose The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD). Methods One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up. Results No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved. Conclusions This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure.Level of Evidence: Level IV

Reproducing Proximal Femur Anatomy with Custom Stems

“…The accuracy for anatomically reconstructing the hip with custom stem technology was judged to be excellent. This accuracy compares well with previously reported results for 3D planningbased off-the-shelf THA [4,11]. However, patients in the custom group had complex hip anatomy, primarily regarding their proximal femoral morphology, and restoration of normal biomechanics would not be achievable with conventional implant designs such as the SPS ® stem (anatomic design).…”

“…Cohort description. [11]. Prior to surgery, patients had a low-dose CT scan [12] and 3D planning using the HIP-PLAN ® software [13] to determine the prosthetic components size and position and to anticipate any surgical difficulties.…”

<p>Dislocation Height Performs Well in Predicting the Use of Subtrochanteric Osteotomy in Crowe Type IV Hips</p>

“…11 Perhaps DGT will exert its function in a three-dimensional pre-operative planning. 17 On the basis of our data, both HGT and HJ almost performed as well as DGT, which were beneficial for predicting the use of subtrochanteric osteotomy before surgery. The former two indicators might contribute more to clinical practice due to their accessibility on plain radiographs.…”

Minimally Invasive Approaches for Total Hip Arthroplasty: Systematic Review

“…5). DAA [1,4,5,6,10,11,17,18,30,31,32,33,35,36,37] 6425 0,1 0,3 0,1 0,1 0,2 0,01 0,2 3,4 0,2 0,04 0,03 0,04 -0,2 0,1 -…”