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Anterior approach hip replacement

C G Salib, N Reina, K I Perry, M J Taunton, D J Berry, M P Abdel
AIMS: Concurrent hip and spine pathologies can alter the biomechanics of spinopelvic mobility in primary total hip arthroplasty (THA). This study examines how differences in pelvic orientation of patients with spine fusions can increase the risk of dislocation risk after THA. PATIENTS AND METHODS: We identified 84 patients (97 THAs) between 1998 and 2015 who had undergone spinal fusion prior to primary THA. Patients were stratified into three groups depending on the length of lumbar fusion and whether or not the sacrum was involved...
February 2019: Bone & Joint Journal
Gregory R Galakatos
The direct anterior approach to the hip for total joint arthroplasty has been suggested to have several advantages compared to other popular approaches through its use of a natural intramuscular and intra-nervous interval. Recent emphasis on tissue sparing and minimally invasive outpatient joint replacements has given rise to a significant increase in the utilization of direct anterior total hip arthroplasty (DAA). Proponents of this approach cite improved recovery times, lower pain levels, improved patient satisfaction as well as improved accuracy on both implant placement/alignment and leg length restoration...
November 2018: Missouri Medicine
Megan Rutherford, John D O'Connor, Harinderjit S Gill, Janet Hill, David Beverland, Alex B Lennon, Nicholas J Dunne
Orthopaedic surgeons often experience a mismatch between perceived intra-operative and radiographic acetabular cup orientation. This research aimed to assess the impact of pelvic orientation and surgical positioning technique on operative and radiographic cup orientation. Radiographic orientations for two surgical approaches were computationally simulated: a mechanical alignment guide and a transverse acetabular ligament approach, both in combination with different pelvic orientations. Positional errors were defined as the difference between the target radiographic orientation and that achieved...
January 8, 2019: Medical Engineering & Physics
Filippo Randelli, Alessandra Menon, Alessio Giai Via, Manuel Giovanni Mazzoleni, Fabio Sciancalepore, Marco Brioschi, Nicoletta Gagliano
BACKGROUND: Greater Trochanter Pain Syndrome (GTPS) is the main reason for recalcitrant lateral hip pain. Gluteus medius and minimus tendinopathy plays a key role in this setting. An injectable medical compound containing collagen type I (MD-Tissue, Guna) has been produced with the aim to counteract the physiological and pathological degeneration of tendons. In this study we aimed at characterizing the effect of this medical compound on cultured human gluteal tenocytes, focusing on the collagen turnover pathways, in order to understand how this medical compound could influence tendon biology and healing...
December 6, 2018: Cells
Martijn F L Kuijpers, Gerjon Hannink, Liza N van Steenbergen, Berend W Schreurs
BACKGROUND: Total hip arthroplasty (THA) is one of the most successful interventions in medical care. Because of shifting trends in THA and failure rates being higher in younger patients, we aimed to assess trends in implant fixation, bearing type, head diameter, and surgical approach in patients younger than 55 years in the Netherlands using data from the Dutch Arthroplasty Register. METHODS: Trends in the method of implant fixation, bearing type, head diameter, and surgical approach were analyzed over year of surgery (2007-2016) and over age groups (<25, 25-29, 30-34, 35-39, 40-44, 45-49, and 50-54 years)...
August 22, 2018: Journal of Arthroplasty
Hans Gollwitzer
OBJECTIVE OF THE SURGERY: Minimally-invasive implantation of a total hip arthroplasty without damage to or incision of muscles. INDICATIONS: Osteoarthritis, femoral neck fracture, general indications for total hip arthroplasty. CONTRAINDICATIONS: Contraindications for hip arthroplasty. SURGICAL TECHNIQUE: The surgical technique is demonstrated in detail with the help of a video of the surgical procedure, which is available online: positioning on a fracture table with a special leg holder, anterior approach between tensor fasciae latae and rectus femoris muscle, incision of hip capsule and capsular protection, osteotomy of femoral neck in situ, removal of femoral head and acetabular reaming, minimally invasive implantation of acetabular cup, release of pubofemoral ligament and-if necessary-ischiofemoral ligament, external rotation and hyperextension in leg holder with elevation of the proximal femur by a hypomochlion, femoral preparation and implantation of femoral implant, reposition, capsular suture, wound closure...
September 2018: Der Orthopäde
Ryan S Patton, Robert P Runner, Riley J Lyons, Thomas L Bradbury
BACKGROUND: Direct anterior total hip arthroplasty (THA) is an increasingly utilized and patient-requested approach for arthroplasty carrying a unique set of complications. Injury to the lateral femoral cutaneous nerve (LFCN) can have a wide range of clinical symptoms ranging from hypesthesia to painful paresthesia. Long-term effects of this injury have not been well studied. We describe duration and severity of these symptoms and correlate their relationship with hip functional scores...
September 2018: Journal of Arthroplasty
R S Camenzind, K Stoffel, N J Lash, M Beck
SURGICAL PRINCIPLE AND OBJECTIVE: The direct anterior approach for total hip arthroplasty is associated with higher complication rates and difficult femoral component positioning. Performing a modified technique in the lateral position allows secure component positioning. INDICATIONS: Primary hip replacement (including femoral neck fracture) and cup revision without bone deficiency. CONTRAINDICATIONS: Destruction/deformities of proximal femur or acetabulum, bone deficiency or malignancy...
August 2018: Operative Orthopädie und Traumatologie
Yawara Eguchi, Satoshi Iida, Chiho Suzuki, Yoshiyuki Shinada, Tomoko Shoji, Kazuhisa Takahashi, Seiji Ohtori
Study Design: Retrospective observational study. Purpose: We examined change in lumbrosacral spine alignment and low back pain (LBP) following total hip arthroplasty (THA) in patients with severe hip osteoarthritis (OA). Overview of Literature: Severe hip osteoarthritis has been reported to cause spine alignment abnormalities and low back pain, and it has been reported that low back pain is improved following THA. Methods: Our target population included 30 patients (29 female, mean age 63...
April 2018: Asian Spine Journal
Andrea H Stone, Udai S Sibia, Ryan Atkinson, Timothy R Turner, Paul J King
BACKGROUND: The direct anterior approach (DAA) for primary hip replacement has been gaining more attention and widespread use in recent years. There are a number of published studies evaluating the learning curve when a surgeon changes technique; these studies typically look at complications during the initial cases. This study examines procedure and total operating room (OR) time along with all complications for a surgeon transitioning from the posterolateral approach (PA) to DAA. METHODS: A retrospective review of a single surgeon series of 1000 initial DAA procedures...
August 2018: Journal of Arthroplasty
Aditya Khemka, Omar Mograby, Sarah J Lord, Zelda Doyle, Munjed Al Muderis
Background: The concept of femoral neck preservation in total hip replacement (THR) was introduced in 1993. It is postulated that retaining cortical bone of the femoral neck offers triplanar stability, uniform stress distribution, and accommodates physiological anteversion. However, data on safety, efficacy and learning curve are lacking. Materials and Methods: We prospectively assessed all patients who were operated for a THR with a short neck preserving stem (MiniHip) between 2012 and 2014...
March 2018: Indian Journal of Orthopaedics
Dirk Pieter Hogerzeil, Imraan Muradin, Eline W Zwitser, Joris A Jansen
Acute compartment syndrome (ACS) of the thigh following primary total hip arthroplasty (THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed...
December 18, 2017: World Journal of Orthopedics
Adrian J Talia, Cassandra Coetzee, Oren Tirosh, Phong Tran
BACKGROUND: Total hip arthroplasty is one of the most commonly performed surgical procedures worldwide. There are a number of surgical approaches for total hip arthroplasty and no high-level evidence supporting one approach over the other. Each approach has its unique benefits and drawbacks. This trial aims to directly compare the three most common surgical approaches for total hip arthroplasty. METHODS/DESIGN: This is a single-centre study conducted at Western Health, Melbourne, Australia; a large metropolitan centre...
January 8, 2018: Trials
Sumit Kumar Jain, Parit Aggarwal, Arun Yadav
Introduction: Traumatic dislocation of the hip with ipsilateral fracture neck femur is a rare injury because of the different mechanism of both these injuries. The management of such injuries is a challenge as the chances of nonunion and avascular necrosis of femoral head are very high with fixation methods. We report a case of obturator dislocation of the hip with ipsilateral fracture neck of the femur which was treated with uncemented total hip replacement. Case Report: A 32-year-old male sustained obturator dislocation with ipsilateral fracture neck femur following road traffic accident...
September 2017: Journal of Orthopaedic Case Reports
David Clinton McNabb, Jason M Jennings, Daniel L Levy, Todd M Miner, Charlie C Yang, Raymond H Kim
BACKGROUND: The fluoroscopically assisted direct anterior approach for total hip arthroplasty has gained interest in recent years. One of the perceived advantages is the use of fluoroscopy to aid in the positioning of implants. The purpose of this study was to measure the radiation entrance surface dose to anatomically important areas of both patients and surgeons during direct anterior approach total hip arthroplasty. METHODS: Radiation dosimetry badges were placed at the sternal notch and pubic symphysis of 50 patients undergoing direct anterior approach total hip arthroplasty...
December 6, 2017: Journal of Bone and Joint Surgery. American Volume
Ole-Christian L Brun, Lukas Månsson, Lars Nordsletten
INTRODUCTION: Introduction of new surgical techniques is normal, but seldom monitored in real time. The purpose of this study was to monitor the learning curve when introducing a new surgical technique to a department. We did a prospective evaluation of the learning curve when introducing the minimally invasive direct anterior approach in total hip arthroplasty. We wish to investigate whether there is a learning curve for the direct anterior minimal invasive approach in total hip replacement and what are the early complications to this approach...
March 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Andrzej Kochman, Adrian Goral, Josef Kozak, Wojciech Marek, Monika Morawska-Kochman, Marek Synder
OBJECTIVES: Correct positioning of the acetabular component is a key factor in minimizing the risk of dislocation after total hip replacement (THR) surgery. A "safe" orientation of the cup is usually defined by 2 angles measured between its geometric axis and the anterior pelvic plane. However, in the current state-of-the-art approach to THR surgery, the intraoperative orientation of the anterior pelvic plane cannot be measured. Even less is known about the functional orientation of the pelvis, which determines the postoperative orientation of the cup during the patient's everyday activities...
April 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Max P L van der Sijp, Inger B Schipper, Stefan B Keizer, Pieta Krijnen, Arthur H P Niggebrugge
BACKGROUND: The Direct Anterior Approach (DAA) is an alternative approach to the currently most used Lateral Approach (LA) for hip replacement in femoral neck fracture patients. Compared to the LA, the DAA minimizes soft tissue damage. Sparing muscle tissue may facilitate early and improved postoperative mobility. It may also be associated with fewer complications, increased quality of life and lower 1-year mortality. The aim of this study is to compare postoperative complications, hip function and patient mobility after hemiarthroplasty via the anterior or lateral approach following a displaced femoral neck fracture...
August 23, 2017: BMC Musculoskeletal Disorders
Ritesh Rathi, Idriss Tourabaly, Alexis Nogier
PURPOSE: In recent times the direct anterior approach for total hip replacement has gained considerable interest among orthopaedic surgeons because of the relative muscle-sparing nature than other surgical approaches. However, critics believe that this approach is associated with steep learning curve and high complication rates, mainly attributed to a more limited exposure to the femur. In order to make femoral access easier and implantation of acetabulum in anatomic plane, we designed a "two incisions anterior approach technique" for total hip replacement...
September 2017: Journal of Orthopaedics
Monika Engdal, Olav A Foss, Kristin Taraldsen, Vigdis S Husby, Siri B Winther
OBJECTIVE: Muscle weakness due to trauma from the surgical approach is anticipated to affect the ability of the patient to undertake daily physical activity early after total hip arthroplasty (THA). The objective of this study was to compare daily physical activity on days 1 to 4 after discharge, in patients following THA performed by 1 of 3 surgical approaches. DESIGN: A cohort study included 60 hip osteoarthritis patients, scheduled for THA, allocated to direct lateral approach, posterior approach, or anterior approach...
July 2017: American Journal of Physical Medicine & Rehabilitation
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