Conversion of a Fused or Ankylosed Hip to Total Hip Arthroplasty: Is the Direct Anterior Approach in the Lateral Decubitus Position an Ideal Solution?

Siming Zhang,Lingtong Kong,Chen Zhu,Jiaxing Wang,Xifu Shang,Jiale Dong,Xianzuo Zhang

doi:10.3389/fsurg.2022.819530

Abstract

BackgroundTotal hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). However, few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment.MethodsHere, 127 hips (65 DAA, 62 PLA) were retrospectively evaluated. Early postoperative functional outcomes of DAA and PLA groups were assessed using Harris score and Oxford Hip Score (OHS) and standard anteroposterior hip radiographs. Surgical characteristics, perioperative results, and complications within 6 months postoperatively were recorded.ResultsThough baseline values were similar, Harris and OHS scores were better in the DAA group than in the PLA group at 1 and 3 months postoperatively. The average cup anteversion angle was significantly greater in the DAA group than in the PLA group (12.7° vs. 11.1°). More hips undergoing DAA were successfully orientated in both inclination and anteversion angles (46 vs. 32). Early postoperative hip function predictors were preoperative fused hip position, surgical approach, and range of motion. DAA was associated with reduced postoperative blood loss and shorter hospital stays. Furthermore, 14 vs. 8 complications occurred in the DAA vs. PLA group. Lateral femoral cutaneous nerve injuries were observed in eight hips (12.3%) of the DAA group.ConclusionFor fused or ankylosed hips, THA using DAA in the lateral decubitus position may result in excellent prosthesis positioning and faster postoperative recovery throughout early follow-up vs. PLA.

Highlights

A fused or ankylosed hip may be a late complication of chronic inflammatory disorders or an iatrogenic result of hip fusion [1]
A logistic regression model identified the following risk factors for poor postoperative hip function (Table 3): preoperative fused hip position, surgical approach (OR: 3.11, 95% Confidence interval (CI): 1.42–6.81, p < 0.01), and early postoperative range of motion (ROM) (OR: 1.1, 95% CI: 1.01–1.09, p = 0.02)
Fused or ankylosed hips are highly inconvenient, and studies have shown that total hip arthroplasty (THA) surgery is an effective and economically efficient therapy for affected patients [1, 3, 4]

Summary

Introduction

A fused or ankylosed hip may be a late complication of chronic inflammatory disorders or an iatrogenic result of hip fusion [1]. Total hip arthroplasty (THA) is currently considered the best option due to maintenance of hip function, sparing other joints. The conversion of ankylosed or fused hips to THA has proven successful throughout long-term clinical follow-ups [1, 4], the surgical technique is challenging. The posterolateral approach (PLA) has most often been used, since exposure is clear and extension may be achieved [1, 5, 6]. Total hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). Few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment

Methods

Results

Conclusion