Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

Nistor, Dan Viorel; Caterev, Sergiu; Bolboacă, Sorana D.; Cosma, Dan; Lucaciu, Dan; Todor, Adrian

doi:10.1007/s00264-017-3480-8

Cited by 48 publications

(83 citation statements)

References 27 publications

(72 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Careful selection and weigh of benefits versus risks should be applied, even with the use of patient reported outcomes [6,7]. Most postoperative complications are found among diabetic, elderly and obese patients and are proportional to the extent of injury or surgery [8][9][10][11].…”

Section: Resultsmentioning

confidence: 99%

Blood Loss of Pedicle Subtraction Osteotomy for Sagittal Imbalance Spinal Deformity

Abu-Awwad¹,

Prejbeanu²,

Vermeşan³

et al. 2019

Rev. Chim.

View full text Add to dashboard Cite

Pedicle subtraction osteotomies (PSO) have been used in the treatment of multiple spinal conditions involving a fixed sagittal imbalance. It is a complex, extensive surgery most often performed in the revision settings. The aim of our study is to review the major complications of this surgical technique with a focus on blood loss. Twenty patients were included, treated using PSO for sagittal imbalance, out of 255 corrective surgeries. Of the 12 female patients included in the study, the mean age was 64.33. Of the 8 male patients included in the study, the mean age was 51.85. For female patients, the mean blood loss was 2122.5 mL in comparison with male patients, with mean blood loss 1737.5 mL. The female patients had an operating time of 357.25 minutes in comparasion with male patients with an 328.5 minute operating time. Eight (5 female and 3 male) had postoperative neurological deficits and 6 (5 female and 1 male) had pseudarthrosis of adjacent levels.

show abstract

Section: Resultsmentioning

confidence: 99%

Blood Loss of Pedicle Subtraction Osteotomy for Sagittal Imbalance Spinal Deformity

Abu-Awwad¹,

Prejbeanu²,

Vermeşan³

et al. 2019

Rev. Chim.

View full text Add to dashboard Cite

show abstract

“…At 8, 24, and 48 h after surgery, blood hemoglobin (Hb), serum levels of creatine kinase (CK), lactate dehydrogenase (LDH), and myoglobin (MYO), as well as postoperative drainage from the wound drains [13], were recorded and later compared between the two groups. In addition, we used a VAS scale to score pain at 8, 24, and 48 h after surgery.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Whether DAA is actually superior to other surgical approaches, however, remains controversial. Due to some concerns of less adequate exposure caused by difficulty elevating of proximal femur, some complications can occur during the operation, such as contusion of periarticular muscles, injury to the anterolateral femoral cutaneous nerve, and fractures around the prosthesis [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…Inadvertent injury to the muscle can increase bleeding and postoperative pain, lead to abnormalities in gait, and overall poorer recovery for patients. Meanwhile, excessive stimulation of muscles causes irreversible injuries, such as compensatory thickening, hypertrophy, and lipogenesis of muscle fibers [13,14,16,17]. Therefore, avoiding secondary injury to the periarticular muscles caused during THA operations via a DAA is an increasing concern for orthopedic surgeons.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Zhao

Zhu

Jiang

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. Methods: Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue "pad" created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. Results: LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. Conclusions: Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. Trial registration: ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

show abstract

“…Due to some concerns of less adequate exposure caused by difficulty elevating of proximal femur, some complications can occur during the operation, such as contusion of periarticular muscles, injury to the anterolateral femoral cutaneous nerve, and fractures around the prosthesis. [10][11][12][13][14][15] By forming the lateral wall of the surgical wound, the muscle fibers of the tensor fascia lata muscle (TFLM) are often traumatized due to mechanical retraction by surgical instruments. While preparing the acetabulum for the prosthesis, the TFLM is often damaged by the handle of the acetabular reamer.…”

Section: Introductionmentioning

confidence: 99%

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Zhao

Zhu

Jiang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

show abstract

Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

Abstract: The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

Cited by 48 publications

References 27 publications

Blood Loss of Pedicle Subtraction Osteotomy for Sagittal Imbalance Spinal Deformity

Blood Loss of Pedicle Subtraction Osteotomy for Sagittal Imbalance Spinal Deformity

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

Contact Info

Product

Resources

About