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The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases

Introduction: The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain...

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Autores principales: Heinz, Tizian, Vasilev, Hristo, Anderson, Philip Mark, Stratos, Ioannis, Jakuscheit, Axel, Horas, Konstantin, Holzapfel, Boris Michael, Rudert, Maximilian, Weißenberger, Manuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299585/
https://www.ncbi.nlm.nih.gov/pubmed/37373635
http://dx.doi.org/10.3390/jcm12123941
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author Heinz, Tizian
Vasilev, Hristo
Anderson, Philip Mark
Stratos, Ioannis
Jakuscheit, Axel
Horas, Konstantin
Holzapfel, Boris Michael
Rudert, Maximilian
Weißenberger, Manuel
author_facet Heinz, Tizian
Vasilev, Hristo
Anderson, Philip Mark
Stratos, Ioannis
Jakuscheit, Axel
Horas, Konstantin
Holzapfel, Boris Michael
Rudert, Maximilian
Weißenberger, Manuel
author_sort Heinz, Tizian
collection PubMed
description Introduction: The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain to be determined. Methods: A total of 188 cases of CP (100 cases) and PA (88 cases) hips undergoing primary THA via the DAA were retrospectively analyzed. Surgical and radiographic parameters were evaluated and potential complications were assessed. Finally, successful implantation was defined if surgical and radiographic parameters were well within established values of non-complex primary THA. Results: In 159 hips, the medial border of the acetabular component was transferred laterally to the ilioischial line, corresponding to a fully treated acetabular protrusion. In 23 (12.23%) cases, mild, and in 5 (2.66%) cases, moderate residual acetabular protrusion remained after THA. Postoperatively, 11.40% (PA group) and 9.00% (CP group) had a leg length discrepancy (LLD) greater than 10 mm. The mean operative time was significantly less than 60 min. A linear relationship between the BMI and operative time was observed, with an additional 0.9 min of operative time per BMI unit. Overall, complications were rare and did not differ between the two groups. Conclusion: The results of this study suggest that the DAA is a suitable approach for primary THA in patients with coxa profunda and acetabular protrusion if performed by experienced surgeons familiar with the DAA. Obese patients with acetabular protrusion may pose a significant limitation to the DAA and caution should be advised in cases of obesity.
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spelling pubmed-102995852023-06-28 The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases Heinz, Tizian Vasilev, Hristo Anderson, Philip Mark Stratos, Ioannis Jakuscheit, Axel Horas, Konstantin Holzapfel, Boris Michael Rudert, Maximilian Weißenberger, Manuel J Clin Med Article Introduction: The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain to be determined. Methods: A total of 188 cases of CP (100 cases) and PA (88 cases) hips undergoing primary THA via the DAA were retrospectively analyzed. Surgical and radiographic parameters were evaluated and potential complications were assessed. Finally, successful implantation was defined if surgical and radiographic parameters were well within established values of non-complex primary THA. Results: In 159 hips, the medial border of the acetabular component was transferred laterally to the ilioischial line, corresponding to a fully treated acetabular protrusion. In 23 (12.23%) cases, mild, and in 5 (2.66%) cases, moderate residual acetabular protrusion remained after THA. Postoperatively, 11.40% (PA group) and 9.00% (CP group) had a leg length discrepancy (LLD) greater than 10 mm. The mean operative time was significantly less than 60 min. A linear relationship between the BMI and operative time was observed, with an additional 0.9 min of operative time per BMI unit. Overall, complications were rare and did not differ between the two groups. Conclusion: The results of this study suggest that the DAA is a suitable approach for primary THA in patients with coxa profunda and acetabular protrusion if performed by experienced surgeons familiar with the DAA. Obese patients with acetabular protrusion may pose a significant limitation to the DAA and caution should be advised in cases of obesity. MDPI 2023-06-09 /pmc/articles/PMC10299585/ /pubmed/37373635 http://dx.doi.org/10.3390/jcm12123941 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Heinz, Tizian
Vasilev, Hristo
Anderson, Philip Mark
Stratos, Ioannis
Jakuscheit, Axel
Horas, Konstantin
Holzapfel, Boris Michael
Rudert, Maximilian
Weißenberger, Manuel
The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases
title The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases
title_full The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases
title_fullStr The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases
title_full_unstemmed The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases
title_short The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases
title_sort direct anterior approach (daa) as a standard approach for total hip arthroplasty (tha) in coxa profunda and protrusio acetabuli? a radiographic analysis of 188 cases
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299585/
https://www.ncbi.nlm.nih.gov/pubmed/37373635
http://dx.doi.org/10.3390/jcm12123941
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