Early Experience of Direct Anterior Approach Total Hip Arthroplasty: Analysis of the First 53 Cases
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Purpose: To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. Materials and Methods: A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. Results: The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27。; 2 cases were out of safety angle. Mean anteversion was 16.18。. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. Conclusion: DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.
Abstract
Purpose: To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. Materials and Methods: A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. Results: The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27。; 2 cases were out of safety angle. Mean anteversion was 16.18。. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. Conclusion: DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.
참고문헌 (24)
- Kurtz S, "Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030", J Bone Joint Surg Am, 89, pp.780~785 (2007)
- De Geest T, "Direct anterior total hip arthroplasty : complications and early outcome in a series of 300 cases", Acta Orthop Belg, 79, pp.166~173 (2013)
- Mears DC, "Development of a two-incision minimally invasive total hip replacement", J Bone Joint Surg Am, 85, pp.2238~2240 (2003)
- Chechik O, "Surgical approach and prosthesis fixation in hip arthroplasty world wide", Arch Orthop Trauma Surg, 133, pp.1595~1600 (2013)
- Kennon RE, "Total hip arthroplasty through a minimally invasive anterior surgical approach", J Bone Joint Surg Am, 4, pp.39~48 (2003)
- Rachbauer F, "The history of the anterior approach to the hip", Orthop Clin North Am, 40, pp.311~320 (2009)
- Sibia US, "The impact of surgical technique on patient reported outcome measures and early complications after total hip arthroplasty", J Arthroplasty, 32, pp.1171~1175 (2017)
- Eto S, "The direct anterior approach is associated with early revision total hip arthroplasty", J Arthroplasty, 32, pp.1001~1005 (2017)
- Spaans AJ, "High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach", Acta Orthop, 83, pp.342~346 (2012)
- Goulding K, "Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty", Clin Orthop Relat Res, 468, pp.2397~2404 (2010)
- Lewinnek GE, "Dislocations after total hip-replacement arthroplasties", J Bone Joint Surg Am, 60, pp.217~220 (1978)
- Tanavalee A, "Early outcomes following minimally invasive total hip arthroplasty using a two-incision approach versus a miniposterior approach", Hip Int, 16(Suppl 4), pp.17~22 (2006)
- Sung-Chan Ki, "Total Hip Arthroplasty Using Two-Incision Technique", Clinics in Orthopedic Surgery, 3(4), pp.268~273 (2011), 대한정형외과학회
- den Hartog YM, "The less invasive anterior approach for total hip arthroplasty : a comparison to other approaches and an evaluation of the learning curve-a systematic review", Hip Int, 26, pp.105~120 (2016)
- Stone AH, "Evaluation of the learning curve when transitioning from posterolateral to direct anterior hip arthroplasty : a consecutive series of 1000 cases", J Arthroplasty, 33, pp.2530~2534 (2018)
- Barnett SL, "Is the anterior approach safe? Early complication rate associated with 5090 consecutive primary total hip arthroplasty procedures performed using the anterior approach", J Arthroplasty, 31, pp.2291~2294 (2016)
- 이상홍, "Perioperative Comparison of Hip Arthroplasty Using the Direct Anterior Approach with the Posterolateral Approach", Hip and Pelvis, 29(4), pp.240~246 (2017), 대한고관절학회[DOI]
- Matta JM, "Single-incision anterior approach for total hip arthroplasty on an orthopaedic table", Clin Orthop Relat Res, 441, pp.115~124 (2005)
- Cheng TE, "A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach", J Arthroplasty, 32, pp.883~890 (2017)
- Hamilton WG, "Comparison of cup alignment, jump distance, and complications in consecutive series of anterior approach and posterior approach total hip arthroplasty", J Arthroplasty, 30, pp.1959~1962 (2015)
- de Steiger RN, "What is the learning curve for the anterior approach for total hip arthroplasty?", Clin Orthop Relat Res, 473, pp.3860~3866 (2015)
- Abdel MP, "What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position", Clin Orthop Relat Res, 474, pp.386~391 (2016)
- Khatod M, "An analysis of the risk of hip dislocation with a contemporary total joint registry", Clin Orthop Relat Res, 447, pp.19~23 (2006)
- Free MD, "Direct anterior approach total hip arthroplasty : an adjunct to an enhanced recovery pathway : outcomes and learning curve effects in surgeons transitioning from other surgical approaches", J Arthroplasty, 33, pp.3490~3495 (2018)