SciELO - Scientific Electronic Library Online

 
vol.15 issue3Amputation rate following tibia fractures with associated popliteal artery injuriesLower limb deep vein thrombosis as a complication of posterior dislocation of a total hip replacement: A case report author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Article

Indicators

Related links

  • On index processCited by Google
  • On index processSimilars in Google

Share


SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

Abstract

DEACON, M; DE BEER, J  and  RYAN, P. Radiological analysis of component positioning in total hip arthroplasty using the anterior approach. SA orthop. j. [online]. 2016, vol.15, n.3, pp.38-45. ISSN 2309-8309.  http://dx.doi.org/10.17159/2309-8309/2016/v15n3a5.

BACKGROUND: The direct anterior approach for total hip replacement is gaining popularity among surgeons and patients alike, as it is a minimally invasive technique, and a true muscle-sparing operation. Reported advantages of this approach include decreased post-operative pain, faster post-operative mobilisation and a low incidence of hip dislocation. Optimal component positioning is vital for the longevity of total hip replacements. Poor positioning leads to increased dislocation rates, accelerated bearing wear, limited range of motion and higher rates of revision surgery. Minimally invasive surgery strives for smaller incisions, and muscle-sparing dissection. This may result in poor acetabular exposure, and subsequent sub-optimal component positioning. The direct anterior approach is generally done supine on a traction table with/without the use of intra-operative fluoroscopy. This study describes the surgical technique performed with the patient in the lateral decubitus position, without the use of traction, and without intra-operative imaging. We then report on the radiographic outcomes and complications using this approach. METHODS: We retrospectively reviewed 150 patients who had total hip replacements done via the direct anterior approach. Clinical notes were evaluated for patient demographics, body mass index, and post-operative complications. The post-operative radiographs were analysed for acetabular component position inclination and anteversion. RESULTS: The radiographic analysis showed a mean cup inclination of 41.1° (range 27.9-61.1°) and anteversion of 18.33° (range 11.2-25.3°). A total of 95.97% (95% CI) of the components were within the safety zones, as described by Lewinnek, (inclination 40 ± 10°, anteversion 15 ± 10°).23 There were five outliers with regard to cup inclination. Three had excessively abducted cups, which were noted to be in patients with increased BMI >35 kg/ m2. The remaining two were excessively adducted. There were no outliers with regard to cup anteversion There were no dislocations, deep infections or femoral nerve palsies. Two patients required re-operation: one for a periprosthetic fracture and another for a greater trochanter fracture with late displacement. There were six cases of thigh swelling which resolved on discontinuation of oral anti-coagulation, four episodes of soft tissue inflammation responding to physiotherapy, four clinically observed leg length discrepancies, two minor stitch abscesses, and two transient lateral cutaneous nerve palsies. CONCLUSION: The direct anterior approach, done in the familiar lateral decubitus position, as described in this study, is safe and reliable, with an acceptable complication rate. The radiographic results for acetabular component placement are comparable to other surgical approaches, as well as to the direct anterior approach using a fracture table and intraoperative imaging.

Keywords : anterior approach; total hip arthroplasty; component positioning.

        · text in English     · English ( pdf )

 

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License