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Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review

BACKGROUND: The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the o...

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Autores principales: Rivera, Fabrizio, Comba, Luca C, Bardelli, Alessandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048494/
https://www.ncbi.nlm.nih.gov/pubmed/35582154
http://dx.doi.org/10.5312/wjo.v13.i4.388
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author Rivera, Fabrizio
Comba, Luca C
Bardelli, Alessandro
author_facet Rivera, Fabrizio
Comba, Luca C
Bardelli, Alessandro
author_sort Rivera, Fabrizio
collection PubMed
description BACKGROUND: The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers. AIM: To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate. METHODS: All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification. RESULTS: A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia. CONCLUSION: DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.
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spelling pubmed-90484942022-05-16 Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review Rivera, Fabrizio Comba, Luca C Bardelli, Alessandro World J Orthop Retrospective Study BACKGROUND: The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers. AIM: To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate. METHODS: All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification. RESULTS: A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia. CONCLUSION: DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging. Baishideng Publishing Group Inc 2022-04-18 /pmc/articles/PMC9048494/ /pubmed/35582154 http://dx.doi.org/10.5312/wjo.v13.i4.388 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Study
Rivera, Fabrizio
Comba, Luca C
Bardelli, Alessandro
Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
title Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
title_full Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
title_fullStr Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
title_full_unstemmed Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
title_short Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
title_sort direct anterior approach hip arthroplasty: how to reduce complications - a 10-years single center experience and literature review
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048494/
https://www.ncbi.nlm.nih.gov/pubmed/35582154
http://dx.doi.org/10.5312/wjo.v13.i4.388
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