Orthostatic retractor placement reduces operating time and post-operative inflammatory response during the learning curve of anterior approach THA

Abstract

IntroductionHandheld retractor placement (HHRP) is prone to repetitive repositioning. This could lead to muscle damage especially during a procedure with a steep learning curve. In an attempt to minimize retractor repositioning during the learning curve of direct anterior approach (DAA) total hip arthroplasty (THA), we used a table mounted orthostatic retractor placement (ORP) device. PurposeTo investigate whether ORP would reduce the extent of muscle damage, OR-time and post-operative inflammatory response. Materials and methods29 Patients were operated by 2 surgeons who randomly used HHRP or ORP during their learning curve of DAA THA. There were 14 patients in a control group who were operated by an experienced surgeon. Blood levels of Creatine Kinase (CK), C-Reactive Protein (CRP), Hemoglobin (Hb), Lactate Dehydrogenase (LDH) and Erythrocyte Sedimentation Rate (ESR) were measured at 1 h pre- and 24 and 48 h post-operatively. ResultsThe mean OR-time was 67 and 50 min in the HHRP and ORP cohort, respectively (p < 0,001). Post-operative CRP levels were significantly higher in the HHRP cohort at 24 h (HHRP 60.64 mg/L (25.20–143.20); ORP 34.67 mg/L (9.30–71.20)) (p = 0.003) and 48 h post-operatively (HHRP 154.54 mg/L (65.90–369.00); ORP 81.60 mg/L (21.30–219.40) (p = 0.004). The post-operative Hb-levels were significantly lower in the HHRP cohort at 24 h (HHRP 11.11 g/dL (9.10–12.30); ORP 11.37 g/dL (8.80–14.00)) (p = 0.0008) and 48 h (HHRP 10.86 g/dL (9.50–12.00); ORP 11.25 g/dL (8.60–14.10)) (p = 0.03). Post-operative ESR levels were significantly higher in the HHRP cohort 48 h post-op (HHRP 45.21 mm/h (14.00–83.00); ORP 23.73 mm/h (2.00–73.00)) (p = 0.004). No significant differences were found for the CK and LDH levels at any time postoperatively. There were no complications in any group. ConclusionThe use of an orthostatic retractor placement device allows for reducing the OR-time, post-operative blood loss and post-operative inflammatory response during the learning curve of DAA THA.