Top

Published in:

01-12-2016 | Original Paper

Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series

Authors: Yasuhiro Homma, Tomonori Baba, Hideo Kobayashi, Asuka Desroches, Yu Ozaki, Hironori Ochi, Mikio Matsumoto, Takahito Yuasa, Kazuo Kaneko

Published in: International Orthopaedics | Issue 12/2016

Abstract

Background and purpose

An encouraging result with direct anterior approach (DAA) is attractive for both patients and surgeons. However, the risks associated with beginning to use DAA require further analysis of the learning curve and better countermeasures to ensure safety. We ask whether the complication rate in the DAA by the inexperienced surgeon could be decreased with specific countermeasures. Our hypothesis was that the complication rate would be low even in early phase of the learning curve using the DAA with these particular countermeasures.

Patients and methods

We investigated a consecutive series of 120 primary THA using the DAA with four specific countermeasures; 1) defined exclusion criteria for DAA; 2) no positioning table; 3) use of fluoroscopy as much as required; and 4) having an experienced assistant for DAA (one who has performed the procedure in more than 100 cases). The operative time, the time of fluoroscopic use during the operation, intra and post-operative complications, re-operation for any reason, and cup and stem alignment were investigated.

Results

Although the operation times were similar, the duration of fluoroscopy decreased with surgeons’ experience. There were no intra-operative complications and no re-operations for any reason. One anterior dislocation was observed in one patient. The mean cup inclination and anteversion angle was 39.7° ± 7.6° and 30.3° ± 7.6°; 43.3 % of stems were positioned in flexion, 55.8 % in the neutral position on the lateral view.

Conclusion

We demonstrated a lower complication rate during our early experience with the DAA using four countermeasures. Using these countermeasures for the first 40 cases may be useful for surgeons who are considering DAA.

Hueter C (1883) Funfte abtheilung: die verletzung undkrankheiten des hüftgelenkes, neunundzwanzigstes capitel. In: Hueter C (ed) Grundriss der chirurgie, 2nd edn. FCW Vogel, Leipzig, pp 129–200

Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25:671CrossRefPubMed

Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Nöth U (2012) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36(3):491–498CrossRefPubMed

Oinuma K, Eingartner C, Saito Y, Shiratsuchi H (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19:310–326CrossRefPubMed

Oinuma K, Tamaki T, Miura Y, Kaneyama R, Shiratsuchi H (2014) Total hip arthroplasty with subtrochanteric shortening osteotomy for crowe grade 4 dysplasia using the direct anterior approach. J Arthroplasty 29(3):626–629CrossRefPubMed

Baba T, Shitoto K, Kaneko K (2013) Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 4(2):85CrossRefPubMedPubMedCentral

Chechik O, Khashan M, Lador R, Lador R, Salai M, Amar E (2013) Surgical approach and prosthesis fixation in hip arthroplasty worldwide. Arch Orthop Trauma Surg 133:1595–1600CrossRefPubMed

Akiyama H, Hoshino A, Iida H, Shindo H, Takakura Y, Miura H, Yamamoto K, Yoshiya S, Hasegawa Y, Shimamura T, Kurosaka M, Otsuka H, Kawanabe K, Kawate K, Harada Y, Nakamura T, Implant Committee, Japanese Orthopaedic Association (2012) A pilot project for the Japan arthroplasty register. J Orthop Sci 17(4):358–369CrossRefPubMed

Barton C, Kim PR (2009) Complications of the direct anterior approach for total hip arthroplasty. Orthop Clin N Am 40(3):371–375CrossRef

10.

Jewett BA, Collis DK (2011) High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 469(2):503–507CrossRefPubMed

11.

Woolson ST, Pouliot MA, Huddleston JI (2009) Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplast 24(7):999–1005CrossRef

12.

Den Hartog YM, Mathijssen NM, Peters SJ, Vehmeijer SB (2015) The anterior supine intermuscular approach for total hip arthroplasty: reducing the complication rate by improving the procedure. Hip Int 25(1):28–33CrossRef

13.

Reichert JC, Volkmann MR, Koppmair M, Rackwitz L, Lüdemann M, Rudert M, Nöth U (2015) Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty. Int Orthop 39(12):2309–2313CrossRefPubMed

14.

Spaans AJ, van den Hout JA, Bolder SB (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83(4):342–346CrossRefPubMedPubMedCentral

15.

De Geest T, Fennema P, Lenaerts G, De Loore G (2015) Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg doi: 10.1007/s00402-015-2258-y

16.

Marconi D, Lee GC (2015) Complications following direct anterior hip procedures: costs to both patients and surgeons. J Arthroplasty doi:10.1016/j.arth.2015.03.043

17.

Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217CrossRefPubMed

18.

Widmer KH (2004) A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplast 19(3):387–390CrossRef

19.

Min BW, Song KS, Bae KC, Cho CH, Kang CH, Kim SY (2008) The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplast 23(3):418–423CrossRef

20.

Abe H, Sakai T, Takao M, Nishii T, Nakamura N, Sugano N (2015) Difference in stem alignment between the direct anterior approach and the posterolateral approach in total hip arthroplasty. J Arthroplast doi:10.1016/j.arth.2015.04.026

21.

Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P (2015) Total hip arthroplasty for failed internal fixation after femoral neck fracture versus that for acute displaced femoral neck fracture: a comparative study. J Arthroplasty doi: 10.1016/j.arth.2015.02.037

22.

Masonis J, Thompson C, Odum S (2008) Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics 12(Suppl. 2) [pii:orthosupersite.com/view.asp?rID=37187]

23.

Judet J, Judet H (1985) Voie d’abord antérieure dans l’arthroplastie totale de la hanche. Presse Med 14:1031–1033PubMed

24.

Matta J, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124CrossRefPubMed

25.

Rathod PA, Bhalla S, Deshmukh AJ, Rodriguez JA (2014) Does fluoroscopy with anterior hip arthoplasty decrease acetabular cup variability compared with a nonguided posterior approach? Clin Orthop Relat Res 472(6):1877–1885CrossRefPubMedPubMedCentral

26.

Ji W, Stewart N (2015) Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach. Int Orthop doi:10.1007/s00264-015-2803-x

27.

The Anterior Total Hip Arthroplasty Collaborative, Bhandari M, Matta JM, Dodgin D, Clark C, Kregor P, Bradley G, Little L (2009) Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study. Orthop Clin N Am 40:329, 299pCrossRef

28.

Kobayashi H, Homma Y, Baba T, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2015) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int Orthop. doi:10.1007/s00264-015-3059-1

29.

Christensen CP, Karthikeyan T, Jacobs CA (2014) Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty 29(9):1839CrossRefPubMed

30.

Homma Y, Baba T, Sano K, Ochi H, Matsumoto M, Kobayashi H, Yuasa T, Maruyama Y, Kaneko K (2015) Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. Int Orthop. doi:10.1007/s00264-015-2942-0

Title: Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series
Authors: Yasuhiro Homma
Tomonori Baba
Hideo Kobayashi
Asuka Desroches
Yu Ozaki
Hironori Ochi
Mikio Matsumoto
Takahito Yuasa
Kazuo Kaneko
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3159-6

At a glance: The STEP trials

Springer Medicine

Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series

Abstract

Background and purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2016

History of traction for treatment of lower limb fractures

Is tibial cut navigation alone sufficient in medial unicompartmental knee arthroplasty? Continuous series of fifty nine procedures

Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more

Drain use in total knee arthroplasty is neither associated with a greater transfusion rate nor a longer hospital stay

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature

Post-operative retransfusion of unwashed filtered shed blood reduces allogenic blood demand in hip hemiarthroplasty in traumatic femoral neck fractures—a prospective randomized trial