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A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty

INTRODUCTION: The direct anterior approach (DAA) is suggested to accelerate postoperative recovery and decrease the dislocation risk after primary total hip arthroplasty (THA). However, exposure of the femur can be challenging. Insufficient exposure increases the risk for intraoperative femoral frac...

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Autores principales: Rueckl, Kilian, Springer, Bernhard, Jungwirth-Weinberger, Anna, Bechler, Ulrich, Kasparek, Maximillian F., Boettner, Friedrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522704/
https://www.ncbi.nlm.nih.gov/pubmed/33954812
http://dx.doi.org/10.1007/s00402-021-03919-8
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author Rueckl, Kilian
Springer, Bernhard
Jungwirth-Weinberger, Anna
Bechler, Ulrich
Kasparek, Maximillian F.
Boettner, Friedrich
author_facet Rueckl, Kilian
Springer, Bernhard
Jungwirth-Weinberger, Anna
Bechler, Ulrich
Kasparek, Maximillian F.
Boettner, Friedrich
author_sort Rueckl, Kilian
collection PubMed
description INTRODUCTION: The direct anterior approach (DAA) is suggested to accelerate postoperative recovery and decrease the dislocation risk after primary total hip arthroplasty (THA). However, exposure of the femur can be challenging. Insufficient exposure increases the risk for intraoperative femoral fracture. MATERIALS AND METHODS: Of 435 consecutive anterior THA, the first 102 consecutive THA in 94 patients were treated with an external rotator tendon “release-on-demand” (RoD). The following 311 consecutive patients (333 THA) underwent routine release of the conjoint tendon (CTR) of its bony insertion on the greater trochanter only. Retrospective analysis recorded trochanteric fractures, intraoperative calcar fractures, postoperative periprosthetic fractures, stem subsidence, ossifications, and dislocations. RESULTS: Three (2.9%) fractures of the greater trochanter were recorded in the RoD group, but no (0.0%) fractures occurred in the CTR group (p = 0.002). There was no significant difference in the occurrence of intraoperative calcar fractures (0% (RoD) vs. 1.2% (CTR), p = 0.267), postoperative periprosthetic fractures (0% (RoD) vs. 0.3% (CTR), p = 0.560), stem subsidence (2.0% (RoD) vs. 1.2% (CTR), p = 0.565) or ossifications (2.9% (RoD) vs. 1.6% (CTR), p = 0.344) between these groups. There were no dislocations within a minimum 12 months follow-up period. CONCLUSION: The routine release of the conjoined tendon (CTR group) decreases the shear forces on the tip of the greater trochanter during DAA THA and eliminates the risk of greater trochanter fractures. The routine release of the conjoined tendon did not increase the risk of postoperative dislocations.
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spelling pubmed-95227042022-10-01 A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty Rueckl, Kilian Springer, Bernhard Jungwirth-Weinberger, Anna Bechler, Ulrich Kasparek, Maximillian F. Boettner, Friedrich Arch Orthop Trauma Surg Orthopaedic Surgery INTRODUCTION: The direct anterior approach (DAA) is suggested to accelerate postoperative recovery and decrease the dislocation risk after primary total hip arthroplasty (THA). However, exposure of the femur can be challenging. Insufficient exposure increases the risk for intraoperative femoral fracture. MATERIALS AND METHODS: Of 435 consecutive anterior THA, the first 102 consecutive THA in 94 patients were treated with an external rotator tendon “release-on-demand” (RoD). The following 311 consecutive patients (333 THA) underwent routine release of the conjoint tendon (CTR) of its bony insertion on the greater trochanter only. Retrospective analysis recorded trochanteric fractures, intraoperative calcar fractures, postoperative periprosthetic fractures, stem subsidence, ossifications, and dislocations. RESULTS: Three (2.9%) fractures of the greater trochanter were recorded in the RoD group, but no (0.0%) fractures occurred in the CTR group (p = 0.002). There was no significant difference in the occurrence of intraoperative calcar fractures (0% (RoD) vs. 1.2% (CTR), p = 0.267), postoperative periprosthetic fractures (0% (RoD) vs. 0.3% (CTR), p = 0.560), stem subsidence (2.0% (RoD) vs. 1.2% (CTR), p = 0.565) or ossifications (2.9% (RoD) vs. 1.6% (CTR), p = 0.344) between these groups. There were no dislocations within a minimum 12 months follow-up period. CONCLUSION: The routine release of the conjoined tendon (CTR group) decreases the shear forces on the tip of the greater trochanter during DAA THA and eliminates the risk of greater trochanter fractures. The routine release of the conjoined tendon did not increase the risk of postoperative dislocations. Springer Berlin Heidelberg 2021-05-05 2022 /pmc/articles/PMC9522704/ /pubmed/33954812 http://dx.doi.org/10.1007/s00402-021-03919-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Orthopaedic Surgery
Rueckl, Kilian
Springer, Bernhard
Jungwirth-Weinberger, Anna
Bechler, Ulrich
Kasparek, Maximillian F.
Boettner, Friedrich
A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
title A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
title_full A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
title_fullStr A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
title_full_unstemmed A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
title_short A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
title_sort standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty
topic Orthopaedic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522704/
https://www.ncbi.nlm.nih.gov/pubmed/33954812
http://dx.doi.org/10.1007/s00402-021-03919-8
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