Abstract
BackgroundThe purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table.MethodsThe first experience of consecutive surgeries by a single surgeon using the direct anterior approach with a traction table is described with a two-year follow-up period. Of 121 patients, 100 patients without previous hip surgeries, severe deformity, or cemented implants were divided into two groups comprising the first 50 patients and the second 50 patients.ResultsThe implant survival rate was 99% at the two-year follow-up. Revision surgery was required for periprosthetic femoral fracture in one patient. The complication rate possibly related to the traction table was 5% (5 patients): three anterior dislocations, one periprosthetic femoral fracture, and one intraoperative perforation caused by femoral rasping. The complication rate tended to decrease in the second group compared to the first group (4% versus 6%). Mean surgical time (72.0 minutes versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group.ConclusionThe direct anterior approach with a novel mobile traction table showed a positive learning curve for surgical time, rate of allogeneic blood transfusion, and cup alignment in the safe zone.
Highlights
The purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table
Mean surgical time (72.0 min versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group (Table 2)
The implant survival rate was 99% in the 100 standard patients at the two-year follow-up; one revision surgery was required for a periprosthetic femoral fracture
Summary
The research protocol of this prospective cohort study was in compliance with the Helsinki Declaration, approved by the Institutional Review Boards, and registered with the University Hospital Medical Information Network. The first author had 8 years of surgical experience as an adult hip surgeon He used the direct lateral approach in the lateral decubitus position in 61 patients for the first 2 years, the anterolateral (modified Watson-Jones) approach in the lateral decubitus position in 53 patients the following year and a half, and used the direct anterior approach in the supine position without a traction table in 6 patients. Traction DAA for THA was performed with the patient in a supine position, lying on a novel mobile traction table, ~As You Walk ~ LECURE ® (Surgical Alliance, Tokyo, Japan) (Fig. 1) This table can be set up with a standard orthopedic surgical table, and can hold the leg in hip flexion/extension, internal/external rotation, adduction/abduction, or traction, distraction, or compression (Fig. 2).
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