J Korean Orthop Assoc.  2019 Jun;54(3):244-253. 10.4055/jkoa.2019.54.3.244.

Comparison of the Outcomes after Primary Total Hip Arthroplasty Using a Short Stem between the Modified Anterolateral Approach and Direct Anterior Approach with a Standard Operation Table

• Park MS
• Yoon SJ
• Choi SM
• Cho HM
• Chung W
• Kang KR

• KMID: 2450144
• DOI: http://doi.org/10.4055/jkoa.2019.54.3.244

Abstract

PURPOSE
Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method.
MATERIALS AND METHODS
From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated.
RESULTS
The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155).
CONCLUSION
The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.

Keyword

total hip arthroplasty; direct anterior approach; anterolateral approach; short femoral stem; operating tables

MeSH Terms

Acetabulum
Arthroplasty, Replacement, Hip*
Femur
Hemorrhage
Hip
Hip Joint
Humans
Leg
Methods
Muscle Strength
Operating Tables*
Retrospective Studies

Figure

• 

  Figure 1 Preoperative and postoperative radiographs of the right hip of a male who was 65 years old at the time of the right primary total hip replacement. (A) Preoperative anteroposterior radiograph demonstrating osteoarthritis of the hip with partial loss of the joint space and formation of osteophytes. (B, C) Anteroposterior radiographs at 2 years after total hip replacement with use of a cementless short stem (Minima stem, 131° neck-shaft angle; Lima Co., Udine, Italy) and ceramic-on-cerami acetabular component (Delta PF cup; Lima Co.). Note the excellent osseointegration and absence of radiolucent lines at the implant-bone interface.

• 

  Figure 2 (A) Preoperative radiograph of the left hip of a male who was 68 years old at the time of the left primary total hip replacement. Anteroposterior radiograph demonstrating avascular necrosis of the femoral head with partial collapse and formation of osteophytes. (B) Postoperative anteroposterior radiograph after total hip replacement using a cementless short stem (Minima stem, 131° neck-shaft angle; Lima Co., Udine, Italy) and ceramic-on-ceramic acetabular component (Delta PF cup; Lima Co.). Greater trochanter tip fracture occurred during femoral stem insertion. (C) Note the excellent osseointegration and absence of radiolucent lines at the implant-bone interface and united greater trochanter tip fracture.

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