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International Orthopaedics

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11.05.2020 | Original Paper

Transitioning the total hip arthroplasty technique from posterior approach in lateral position to direct anterior approach in supine position—risk factors for acetabular malpositioning and the learning curve

verfasst von: Constant Foissey, Cécile Batailler, Cam Fary, Francesco Luceri, Elvire Servien, Sébastien Lustig

Erschienen in: International Orthopaedics | Ausgabe 9/2020

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Abstract

Purpose

Cup positioning is important for optimum hip stability, avoiding component impingement and decreasing both bearing surface wear and revision rate. Transitioning from posterior approach in a lateral position to direct anterior approach (DAA) in a supine presents unique challenges for surgeons. The aim of this study was to examine the learning curve when using standard instrumentation that was not specific to DAA.

Methods

A consecutive retrospective series of 537 total hip arthroplasty by DAA from May 2013 to December 2017. Cup positioning was analysed on radiographs and classified whether inside or outside two safe zones (inclination 30–50° and anteversion 10–30°). The demographic data (age, BMI, gender, neck shaft angle (NSA)), surgeon’s dominant side and experience were assessed as risk factors.

Results

Eighty per cent of cups (n = 426) were in the combined safe zones. Eighty-eight per cent (n = 470) were in appropriate anteversion and 87% (n = 463) abduction. Two factors that were significant were identified: Cups of left hips operated by right-handed surgeons were more anteverted (OR = 4.06) and more vertical (OR = 2.23); females had a higher anteversion of the cup (OR = 2.42). Obesity, age and NSA were not risk factors for cup malposition. There was a spike of cups too horizontal at the beginning of the experience (OR = 3.86), and no learning curve was observed in the other orientations.

Conclusion

With our DAA technique using standard instrumentation, there were no risk factors linked to the patient identified for cup malposition. DAA-specific instrumentation is not required to achieve optimum positioning of the cup. Surgeon has to be aware of an excess of abduction at the beginning of his experience and an excess of anteversion and adduction when performing THA on the opposite side of his dominant hand.

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Waddell J, Johnson K, Hein W et al (2010) Orthopaedic practice in total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). Am J Orthop 39:5–13PubMed

Thaler M, Dammerer D, Krismer M et al (2019) Extension of the direct anterior approach for the treatment of periprosthetic femoral fractures. J Arthroplast 34:2449–2453. https://doi.org/10.1016/j.arth.2019.05.015CrossRef

Lewinnek G, Lewis J, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220CrossRef

Moskal JT, Capps SG (2010) Improving the accuracy of acetabular component orientation: avoiding malposition. J Am Acad Orthop Surg 18:286–296. https://doi.org/10.5435/00124635-201005000-00005CrossRefPubMed

Brooks PJ (2013) Dislocation following total hip replacement: causes and cures. Bone Joint J 95-B:67–69. https://doi.org/10.1302/0301-620X.95B11.32645CrossRefPubMed

Melvin JS, Karthikeyan T, Cope R, Fehring TK (2014) Early failures in total hip arthroplasty -- a changing paradigm. J Arthroplast 29:1285–1288. https://doi.org/10.1016/j.arth.2013.12.024CrossRef

Abdel MP, von Roth P, Jennings MT et al (2016) What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position. Clin Orthop Relat Res 474:386–391. https://doi.org/10.1007/s11999-015-4432-5CrossRefPubMed

Reize P, Geiger EV, Suckel A et al (2008) Influence of surgical experience on accuracy of acetabular cup positioning in total hip arthroplasty. Am J Orthop 37:360–363PubMed

Elkins JM, Callaghan JJ, Brown TD (2015) The 2014 Frank Stinchfield Award: the ‘landing zone’ for wear and stability in total hip arthroplasty is smaller than we thought: a computational analysis. Clin Orthop Relat Res 473:441–452. https://doi.org/10.1007/s11999-014-3818-0CrossRefPubMed

10.

Howie DW, Holubowycz OT, Middleton R, Large Articulation Study Group (2012) Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94:1095–1102. https://doi.org/10.2106/JBJS.K.00570CrossRef

11.

Gaillard R, Kenney R, Delalande J-L et al (2019) Ten- to 16-year results of a modern cementless dual-mobility acetabular implant in primary total hip arthroplasty. J Arthroplast 34:2704–2710. https://doi.org/10.1016/j.arth.2019.06.051CrossRef

12.

Miller LE, Gondusky JS, Kamath AF et al (2018) Influence of surgical approach on complication risk in primary total hip arthroplasty. Acta Orthop 89:289–294. https://doi.org/10.1080/17453674.2018.1438694CrossRefPubMedPubMedCentral

13.

Browne JA, Pagnano MW (2012) Surgical technique: a simple soft-tissue-only repair of the capsule and external rotators in posterior-approach THA. Clin Orthop Relat Res 470:511–515. https://doi.org/10.1007/s11999-011-2113-6CrossRefPubMed

14.

Bergin PF, Doppelt JD, Kephart CJ et al (2011) Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am 93:1392–1398. https://doi.org/10.2106/JBJS.J.00557CrossRefPubMedPubMedCentral

15.

Tsukada S, Wakui M (2015) Lower dislocation rate following total hip arthroplasty via direct anterior approach than via posterior approach: five-year-average follow-up results. Open Orthop J 9:157–162. https://doi.org/10.2174/1874325001509010157CrossRefPubMedPubMedCentral

16.

Trevisan C, Compagnoni R, Klumpp R (2017) Comparison of clinical results and patient’s satisfaction between direct anterior approach and Hardinge approach in primary total hip arthroplasty in a community hospital. Musculoskelet Surg 101:261–267. https://doi.org/10.1007/s12306-017-0478-8CrossRefPubMed

17.

Amlie E, Havelin LI, Furnes O et al (2014) Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1,476 patients 1-3 years after surgery. Acta Orthop 85:463–469. https://doi.org/10.3109/17453674.2014.934183CrossRefPubMedPubMedCentral

18.

Lecoanet P, Vargas M, Pallaro J et al (2018) Leg length discrepancy after total hip arthroplasty: can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D. Orthop Traumatol Surg Res 104:1143–1148. https://doi.org/10.1016/j.otsr.2018.06.020CrossRefPubMed

19.

Batailler C, Fary C, Servien E, Lustig S (2018) Influence of femoral broach shape on stem alignment using anterior approach for total hip arthroplasty: a radiologic comparative study of 3 different stems. PLoS One 13:e0204591. https://doi.org/10.1371/journal.pone.0204591CrossRefPubMedPubMedCentral

20.

Kobayashi H, Homma Y, Baba T et al (2016) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int Orthop 40:1813–1819. https://doi.org/10.1007/s00264-015-3059-1CrossRefPubMed

21.

Deacon M, de Beer J, Ryan P (2016) Radiological analysis of component positioning in total hip arthroplasty using the anterior approach. SA Orthop J 15:38–45. https://doi.org/10.17159/2309-8309/2016/v15n3a5CrossRef

22.

Lustig S (2015) Anterior approach (without specific table) and dual mobility acetabular component. Maitrise Orthop 243:1–5

23.

Batailler C, Fary C, Verdier R et al (2017) The evolution of outcomes and indications for the dual-mobility cup: a systematic review. Int Orthop 41:645–659. https://doi.org/10.1007/s00264-016-3377-yCrossRefPubMed

24.

Widmer K-H (2004) A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplast 19:387–390. https://doi.org/10.1016/j.arth.2003.10.016CrossRef

25.

Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an table. Clin Orthop Relat Res 441:115–124. https://doi.org/10.1097/01.blo.0000194309.70518.cbCrossRefPubMed

26.

Crawford DA, Adams JB, Hobbs GR et al (2019) Surgical approach and hip laterality affect accuracy of acetabular component placement in primary total hip arthroplasty. Surg Technol Int 35:377–385PubMed

27.

Song X, Ni M, Li H et al (2018) Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach? J Orthop Surg Res 13:123. https://doi.org/10.1186/s13018-018-0789-yCrossRefPubMedPubMedCentral

28.

Fessy MH, Putman S, Viste A et al (2017) What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips. Orthop Traumatol Surg Res 103:663–668. https://doi.org/10.1016/j.otsr.2017.05.014CrossRefPubMed

29.

Procyk S (2007) Initial results with a mini-posterior approach for total hip arthroplasty. Int Orthop 31:17–20. https://doi.org/10.1007/s00264-007-0435-5CrossRefPubMedCentral

30.

de Steiger RN, Lorimer M, Solomon M (2015) What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res 473:3860–3866. https://doi.org/10.1007/s11999-015-4565-6CrossRefPubMedPubMedCentral

31.

Hartford JM, Bellino MJ (2017) The learning curve for the direct anterior approach for total hip arthroplasty: a single surgeon’s first 500 cases. Hip Int 27:483–488. https://doi.org/10.5301/hipint.5000488CrossRefPubMed

32.

Kong X, Grau L, Ong A et al (2019) Adopting the direct anterior approach: experience and learning curve in a Chinese patient population. J Orthop Surg Res 14:218. https://doi.org/10.1186/s13018-019-1272-0CrossRefPubMedPubMedCentral

33.

Callanan MC, Jarrett B, Bragdon CR et al (2011) The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 469:319–329. https://doi.org/10.1007/s11999-010-1487-1CrossRefPubMed

34.

Hallert O, Li Y, Brismar H, Lindgren U (2012) The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty. J Orthop Surg Res 7:17. https://doi.org/10.1186/1749-799X-7-17CrossRefPubMedPubMedCentral

35.

Todkar M (2008) Obesity does not necessarily affect the accuracy of acetabular cup implantation in total hip replacement. Acta Orthop Belg 74:206–209PubMed

36.

Atkinson HD, Johal KS, Willis-Owen C et al (2010) Differences in hip morphology between the sexes in patients undergoing hip resurfacing. J Orthop Surg Res 5:76. https://doi.org/10.1186/1749-799X-5-76CrossRefPubMedPubMedCentral

37.

Batailler C, Bonin N, M Wettstein null, et al (2017) Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: retrospective study of 46 patients. Orthop Traumatol Surg Res 103:1147–1153. https://doi.org/10.1016/j.otsr.2017.07.021

38.

Tezuka T, Heckmann ND, Bodner RJ, Dorr LD (2019) Functional safe zone is superior to the Lewinnek safe zone for total hip arthroplasty: why the Lewinnek safe zone is not always predictive of stability. J Arthroplast 34:3–8. https://doi.org/10.1016/j.arth.2018.10.034CrossRef

39.

Reina N, Putman S, Desmarchelier R et al (2017) Can a target zone safer than Lewinnek’s safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls. Orthop Traumatol Surg Res 103:657–661. https://doi.org/10.1016/j.otsr.2017.05.015CrossRefPubMed

40.

Dorr LD, Callaghan JJ (2019) Death of the Lewinnek “safe zone”. J Arthroplast 34:1–2. https://doi.org/10.1016/j.arth.2018.10.035CrossRef

41.

Murphy WS, Yun HH, Hayden B et al (2018) The safe zone range for cup anteversion is narrower than for inclination in THA. Clin Orthop Relat Res 476:325–335. https://doi.org/10.1007/s11999.0000000000000051CrossRefPubMedPubMedCentral

42.

Kamara E, Robinson J, Bas MA et al (2017) Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: is acetabular positioning improved in the learning curve? J Arthroplast 32:125–130. https://doi.org/10.1016/j.arth.2016.06.039CrossRef

43.

Honl M, Dierk O, Gauck C et al (2003) Comparison of robotic-assisted and manual implantation of a primary total hip replacement: a prospective study. J Bone Joint Surg Am 85:1470–1478CrossRef

44.

Snijders T, van Gaalen SM, de Gast A (2017) Precision and accuracy of imageless navigation versus freehand implantation of total hip arthroplasty: a systematic review and meta-analysis. Int J Med Robot 13. https://doi.org/10.1002/rcs.1843

45.

DiGioia A, Hafez M, Jaramaz B et al (2006) Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res 453:272–276. https://doi.org/10.1097/01.blo.0000238862.92356.45CrossRefPubMed

46.

Craiovan B, Renkawitz T, Weber M et al (2014) Is the acetabular cup orientation after total hip arthroplasty on a two dimension or three dimension model accurate? Int Orthop 38:2009–2015. https://doi.org/10.1007/s00264-014-2336-8CrossRefPubMed

Titel: Transitioning the total hip arthroplasty technique from posterior approach in lateral position to direct anterior approach in supine position—risk factors for acetabular malpositioning and the learning curve
verfasst von: Constant Foissey
Cécile Batailler
Cam Fary
Francesco Luceri
Elvire Servien
Sébastien Lustig
Publikationsdatum: 11.05.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 9/2020
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04583-0

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Transitioning the total hip arthroplasty technique from posterior approach in lateral position to direct anterior approach in supine position—risk factors for acetabular malpositioning and the learning curve

Abstract

Purpose

Methods

Results

Conclusion

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Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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