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At least four-year follow-up results of total hip replacement surgery using a direct anterior approach

Year 2023, Volume: 13 Issue: 1, 19 - 26, 16.03.2023
https://doi.org/10.31832/smj.1127792

Abstract

Objective: This study aims to evaluate the clinical and radiological results of patients who were followed for at least 4 years after treatment with total hip arthroplasty, which was performed using a direct anterior approach and to compare the results with different surgical approaches in the literature.
Materials and Methods: The study included 37 patients who underwent total hip replacement using the direct anterior approach. Harris hip scores and lower extremity functional scores were recorded. The correlations between the scores and gender, diagnosis, body mass index, time of walking time, length of hospital stay, and inclination angle were examined.
Results: Of the cases,26(70.3%) were female and 11(29.7%) were male. The mean age was 51.2 (26-76) years. The patients were followed up for an average of 58 (48-72) months. No significant difference was determined between the improvement in Harris hip score and gender, age, body mass index, and length of hospital stay. Postoperative acetabular inclination was 40.8° (35 - 55). The early dislocation was observed in one of our patients. Serous discharge developed in three patients. In three patients, n.cutaneus femoralis lateralis injury developed. The periprosthetic fracture was observed during surgery in five patients.
Conclusion: In our study, it was seen that patients have successful and fast functional results when total hip replacement using a direct anterior approach was performed. Compared to the literature, faster recovery is observed in the early period compared to other approaches; however, no difference is seen between the approaches in the mid- and long term.
Keywords: Direct anterior approach, Total hip arthroplasty, mid-term results

References

  • Referans 1. Lee SH, Kang SW, Jo S. Perioperative Comparison of Hip Arthroplasty Using the Direct Anterior Approach with the Posterolateral Approach. Hip & Pelvis. 2017;29(4):240. doi:10.5371/hp.2017.29.4.240
  • Referans 2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. The Lancet. 2007;370(9597):1508-1519. doi:10.1016/S0140-6736(07)60457-7
  • Referans 3. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does Surgical Approach Affect Total Hip Arthroplasty Dislocation Rates? Clinical Orthopaedics & Related Research. 2006;447:34-38. doi:10.1097/01.blo.0000218746.84494.df
  • Referans 4. Nistor DV, Caterev S, Bolboacă SD, Cosma D, Lucaciu DOG, Todor A. 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? International Orthopaedics. 2017;41(11):2245-2252. doi:10.1007/s00264-017-3480-8
  • Referans 5. Jelsma J, Pijnenburg R, Boons HW, et al. Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study. Journal of Orthopaedics. 2017;14(1):53-58. doi:10.1016/j.jor.2016.10.025
  • Referans 6. Wang Z, Hou J zhao, Wu C hua, et al. A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. Journal of Orthopaedic Surgery and Research. 2018;13(1):229. doi:10.1186/s13018-018-0929-4
  • Referans 7. Parvizi J, Restrepo C, Maltenfort MG. Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome. Orthopedic Clinics of North America. 2016;47(3):497-504. doi:10.1016/j.ocl.2016.03.003
  • Referans 8. Zawadsky MW, Paulus MC, Murray PJ, Johansen MA. Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty: 150 Consecutive Cases. The Journal of Arthroplasty. 2014;29(6):1256-1260. doi:10.1016/j.arth.2013.11.013
  • Referans 9. Bremer AK, Kalberer F, Pfirrmann CWA, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement. The Journal of Bone and Joint Surgery British volume. 2011;93-B(7):886-889. doi:10.1302/0301-620X.93B7.25058
  • Referans 10. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of Minimally Invasive Direct Anterior Versus Posterior Total Hip Arthroplasty Based on Inflammation and Muscle Damage Markers. Journal of Bone and Joint Surgery. 2011;93(15):1392-1398. doi:10.2106/JBJS.J.00557
  • Referans 11. Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle Damage During MIS Total Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2006;453:293-298. doi:10.1097/01.blo.0000238859.46615.34
  • Referans 12. Barrett WP, Turner SE, Leopold JP. Prospective Randomized Study of Direct Anterior vs Postero-Lateral Approach for Total Hip Arthroplasty. The Journal of Arthroplasty. 2013;28(9):1634-1638. doi:10.1016/j.arth.2013.01.034
  • Referans 13. Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis. The Journal of Arthroplasty. 2015;30(3):419-434. doi:10.1016/j.arth.2014.10.020
  • Referans 14. Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. The Journal of Arthroplasty. 2015;30(9):94-97. doi:10.1016/j.arth.2014.12.038
  • Referans 15. Berend KR, Lombardi A v., Seng BE, Adams JB. Enhanced Early Outcomes with the Anterior Supine Intermuscular Approach in Primary Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2009;91(Supplement_6):107-120. doi:10.2106/JBJS.I.00525
  • Referans 16. Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A Clinical Comparative Study of the Direct Anterior With Mini-Posterior Approach. The Journal of Arthroplasty. 2009;24(5):698-704. doi:10.1016/j.arth.2008.04.012
  • Referans 17. Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective Randomized Study of Two Surgical Approaches for Total Hip Arthroplasty. The Journal of Arthroplasty. 2010;25(5):671-679.e1. doi:10.1016/j.arth.2010.02.002
  • Referans 18. Mayr E, Nogler M, Benedetti MG, et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: A gait analysis study. Clinical Biomechanics. 2009;24(10):812-818. doi:10.1016/j.clinbiomech.2009.07.010
  • Referans 19. Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement. EFORT Open Reviews. 2018;3(4):130-135. doi:10.1302/2058-5241.3.170031
  • Referans 20. Martin CT, Pugely AJ, Gao Y, Clark CR. A Comparison of Hospital Length of Stay and Short-term Morbidity Between the Anterior and the Posterior Approaches to Total Hip Arthroplasty. The Journal of Arthroplasty. 2013;28(5):849-854. doi:10.1016/j.arth.2012.10.029
  • Referans 21. Gala L, Kim PR, Beaulé PE. Natural history of lateral femoral cutaneous nerve neuropraxia after anterior approach total hip arthroplasty. HIP International. 2019;29(2):161-165. doi:10.1177/1120700019827201
  • Referans 22. Goulding K, Beaulé PE, Kim PR, Fazekas A. Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2010;468(9):2397-2404. doi:10.1007/s11999-010-1406-5
  • Referans 23. Matta JM, Shahrdar C, Ferguson T. Single-incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table. Clinical Orthopaedics and Related Research. 2005;441(NA;):115-124. doi:10.1097/01.blo.0000194309.70518.cb
  • Referans 24. Bhargava T, Goytia RN, Jones LC, Hungerford MW. Lateral Femoral Cutaneous Nerve Impairment After Direct Anterior Approach for Total Hip Arthroplasty. Orthopedics. 2010;33(7). doi:10.3928/01477447-20100526-05
  • Referans 25. Jewett BA, Collis DK. High Complication Rate With Anterior Total Hip Arthroplasties on a Fracture Table. Clinical Orthopaedics & Related Research. 2011;469(2):503-507. doi:10.1007/s11999-010-1568-1
  • Referans 26. Seng BE, Berend KR, Ajluni AF, Lombardi A v. Anterior-Supine Minimally Invasive Total Hip Arthroplasty: Defining the Learning Curve. Orthopedic Clinics of North America. 2009;40(3):343-350. doi:10.1016/j.ocl.2009.01.002
  • Referans 27. Lübbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P. Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis & Rheumatism. 2007;57(2):327-334. doi:10.1002/art.22542

Direk anteriror yaklaşım kullanılarak uygulanan total kalça protez cerrahisinin en az dört yıllık takip sonuçları

Year 2023, Volume: 13 Issue: 1, 19 - 26, 16.03.2023
https://doi.org/10.31832/smj.1127792

Abstract

Amaç: Bu çalışmanın amacı, direk anterior yaklaşım kullanılarak uygulanan ve en az 4 yıl takip edilen total kalça artroplastisi ile tedavi edilmiş hastaların klinik ve radyolojik sonuçlarının değerlendirilmesi, elde edilen sonuçların literatürdeki farklı cerrahi yaklaşımlar ile karşılaştırılmasıdır.
Gereç ve Yöntem: Direk anterior yaklaşım kullanılarak total kalça protezi uygulanan 37 hasta çalışmaya alındı. Harris kalça skorları ve alt ekstremite fonksiyonel skorları kaydedildi. Elde edilen skorlar ile cinsiyet, tanı, vücut kitle indeksi, yürüme zamanı, yatış süreleri ve inklinasyon açısı arasındaki ilişki araştırıldı.
Bulgular: Olguların 26’sı kadın (%70,3), 11’i erkek (%29,7) olup ortalama yaş 51.2(26-76) idi. Hastalar ortalama 58 (48-72) ay takip edildi. Harris kalça skorundaki düzelme ile cinsiyet, yaş, vücut kitle indeksi ve yatış süreleri arasında anlamlı bir fark görülmedi. Ameliyat sonrası grafilerde asetabular inklinasyon ortalama ortalama olarak 40,8°(35 - 55)ölçüldü. Hastalarımızın birinde erken dönem dislokasyon görüldü. Üç hastada seröz akıntı gelişti. .Üç hastada n.cutaneus femoralis lateralis hasarı gelişti. Beş hastada ameliyat sırasında periprostetik kırık görüldü.
Sonuç: Yaptığımız çalışmada, direk anterior yaklaşım kullanarak uygulanan total kalça protezi, uygun endikasyon ve cerrahi teknikle yapıldığında hastalarda başarılı ve hızlı fonksiyonel sonuçlar elde edildiği görülmektedir. Literatür ile karşılaştırıldığında erken dönemde diğer yaklaşımlara göre daha hızlı iyileşme görülmekte fakat orta ve uzun dönemde yaklaşımlar arasında fark görülmemektedir.
Anahtar kelimeler:Direk anterior yaklaşım,kalça artroplasitisi, orta dönem sonuçlar

References

  • Referans 1. Lee SH, Kang SW, Jo S. Perioperative Comparison of Hip Arthroplasty Using the Direct Anterior Approach with the Posterolateral Approach. Hip & Pelvis. 2017;29(4):240. doi:10.5371/hp.2017.29.4.240
  • Referans 2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. The Lancet. 2007;370(9597):1508-1519. doi:10.1016/S0140-6736(07)60457-7
  • Referans 3. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does Surgical Approach Affect Total Hip Arthroplasty Dislocation Rates? Clinical Orthopaedics & Related Research. 2006;447:34-38. doi:10.1097/01.blo.0000218746.84494.df
  • Referans 4. Nistor DV, Caterev S, Bolboacă SD, Cosma D, Lucaciu DOG, Todor A. 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? International Orthopaedics. 2017;41(11):2245-2252. doi:10.1007/s00264-017-3480-8
  • Referans 5. Jelsma J, Pijnenburg R, Boons HW, et al. Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study. Journal of Orthopaedics. 2017;14(1):53-58. doi:10.1016/j.jor.2016.10.025
  • Referans 6. Wang Z, Hou J zhao, Wu C hua, et al. A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. Journal of Orthopaedic Surgery and Research. 2018;13(1):229. doi:10.1186/s13018-018-0929-4
  • Referans 7. Parvizi J, Restrepo C, Maltenfort MG. Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome. Orthopedic Clinics of North America. 2016;47(3):497-504. doi:10.1016/j.ocl.2016.03.003
  • Referans 8. Zawadsky MW, Paulus MC, Murray PJ, Johansen MA. Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty: 150 Consecutive Cases. The Journal of Arthroplasty. 2014;29(6):1256-1260. doi:10.1016/j.arth.2013.11.013
  • Referans 9. Bremer AK, Kalberer F, Pfirrmann CWA, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement. The Journal of Bone and Joint Surgery British volume. 2011;93-B(7):886-889. doi:10.1302/0301-620X.93B7.25058
  • Referans 10. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of Minimally Invasive Direct Anterior Versus Posterior Total Hip Arthroplasty Based on Inflammation and Muscle Damage Markers. Journal of Bone and Joint Surgery. 2011;93(15):1392-1398. doi:10.2106/JBJS.J.00557
  • Referans 11. Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle Damage During MIS Total Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2006;453:293-298. doi:10.1097/01.blo.0000238859.46615.34
  • Referans 12. Barrett WP, Turner SE, Leopold JP. Prospective Randomized Study of Direct Anterior vs Postero-Lateral Approach for Total Hip Arthroplasty. The Journal of Arthroplasty. 2013;28(9):1634-1638. doi:10.1016/j.arth.2013.01.034
  • Referans 13. Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis. The Journal of Arthroplasty. 2015;30(3):419-434. doi:10.1016/j.arth.2014.10.020
  • Referans 14. Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. The Journal of Arthroplasty. 2015;30(9):94-97. doi:10.1016/j.arth.2014.12.038
  • Referans 15. Berend KR, Lombardi A v., Seng BE, Adams JB. Enhanced Early Outcomes with the Anterior Supine Intermuscular Approach in Primary Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2009;91(Supplement_6):107-120. doi:10.2106/JBJS.I.00525
  • Referans 16. Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A Clinical Comparative Study of the Direct Anterior With Mini-Posterior Approach. The Journal of Arthroplasty. 2009;24(5):698-704. doi:10.1016/j.arth.2008.04.012
  • Referans 17. Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective Randomized Study of Two Surgical Approaches for Total Hip Arthroplasty. The Journal of Arthroplasty. 2010;25(5):671-679.e1. doi:10.1016/j.arth.2010.02.002
  • Referans 18. Mayr E, Nogler M, Benedetti MG, et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: A gait analysis study. Clinical Biomechanics. 2009;24(10):812-818. doi:10.1016/j.clinbiomech.2009.07.010
  • Referans 19. Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement. EFORT Open Reviews. 2018;3(4):130-135. doi:10.1302/2058-5241.3.170031
  • Referans 20. Martin CT, Pugely AJ, Gao Y, Clark CR. A Comparison of Hospital Length of Stay and Short-term Morbidity Between the Anterior and the Posterior Approaches to Total Hip Arthroplasty. The Journal of Arthroplasty. 2013;28(5):849-854. doi:10.1016/j.arth.2012.10.029
  • Referans 21. Gala L, Kim PR, Beaulé PE. Natural history of lateral femoral cutaneous nerve neuropraxia after anterior approach total hip arthroplasty. HIP International. 2019;29(2):161-165. doi:10.1177/1120700019827201
  • Referans 22. Goulding K, Beaulé PE, Kim PR, Fazekas A. Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2010;468(9):2397-2404. doi:10.1007/s11999-010-1406-5
  • Referans 23. Matta JM, Shahrdar C, Ferguson T. Single-incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table. Clinical Orthopaedics and Related Research. 2005;441(NA;):115-124. doi:10.1097/01.blo.0000194309.70518.cb
  • Referans 24. Bhargava T, Goytia RN, Jones LC, Hungerford MW. Lateral Femoral Cutaneous Nerve Impairment After Direct Anterior Approach for Total Hip Arthroplasty. Orthopedics. 2010;33(7). doi:10.3928/01477447-20100526-05
  • Referans 25. Jewett BA, Collis DK. High Complication Rate With Anterior Total Hip Arthroplasties on a Fracture Table. Clinical Orthopaedics & Related Research. 2011;469(2):503-507. doi:10.1007/s11999-010-1568-1
  • Referans 26. Seng BE, Berend KR, Ajluni AF, Lombardi A v. Anterior-Supine Minimally Invasive Total Hip Arthroplasty: Defining the Learning Curve. Orthopedic Clinics of North America. 2009;40(3):343-350. doi:10.1016/j.ocl.2009.01.002
  • Referans 27. Lübbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P. Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis & Rheumatism. 2007;57(2):327-334. doi:10.1002/art.22542
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Abdülhalim Akar 0000-0002-3153-4799

Ahmet Can Erdem 0000-0002-4763-1112

Necmettin Turgut 0000-0003-4994-5059

Amet Çağrı Uyar 0000-0002-8905-6320

Levent Bayam 0000-0001-5149-0829

Mehmet Erdem 0000-0002-9683-1882

Publication Date March 16, 2023
Submission Date June 9, 2022
Published in Issue Year 2023 Volume: 13 Issue: 1

Cite

AMA Akar A, Erdem AC, Turgut N, Uyar AÇ, Bayam L, Erdem M. At least four-year follow-up results of total hip replacement surgery using a direct anterior approach. Sakarya Tıp Dergisi. March 2023;13(1):19-26. doi:10.31832/smj.1127792

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