5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis.

Ali Darwich,Sascha Gravius,Marcel Betsch,Mohamad Bdeir,Andreas Ottersbach,Kim Pankert

doi:10.3390/jcm11020346

Abstract

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

Highlights

The direct anterior approach (DAA) is thought to be a less invasive surgical approach for total hip arthroplasty (THA) [1], since this muscle-sparing approach requires shorter incisions and less soft-tissue dissection [2]
Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence
29% of the patients were type A according to the Dorr classification [8], 63% were classified as type B and 8% as type C

Summary

Introduction

The direct anterior approach (DAA) is thought to be a less invasive surgical approach for total hip arthroplasty (THA) [1], since this muscle-sparing approach requires shorter incisions and less soft-tissue dissection [2]. It reduces the risk of dislocations and is associated with less postoperative pain, earlier recovery, and a lower rate of surgical complications [3]. One of the most common complications in DAA is the increased rate of undersized femoral stems due to insufficient exposure of the femur leading to early subsidence of the femoral stem Another complication is the associated soft tissue damage and intraoperative femoral fractures WHILE trying to improve proximal femur exposure [4]. In order to prevent these complications, some authors recommend using collared cementless stems that have shown lower complication rates in comparison with collarless stems in THA with DAA [5]

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