Abstract
ObjectiveTo provide guidelines for surgery and reduce the incidence of fracture, this study analyzed the relationship between femoral fracture and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in the lateral decubitus position.MethodA retrospective series of 273 consecutive patients who underwent THA with the DAA in the lateral decubitus position was analyzed. Each surgery was performed by the same surgeon with a conventional operation bed and femoral stem. The correlations between the incidence of fracture and sex, age, body mass index (BMI), height, osteoporosis, the anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip joint disease were analyzed by univariate analysis and logistic regression analysis.ResultsAmong all hip arthroplasty procedures, 35 hips had femoral fractures, including 30 greater trochanter fractures, 4 proximal femoral splits, and 1 femoral perforation. The incidence of fracture was 12.82%. Univariate analysis showed no significant difference in the incidence of fracture by sex, BMI, or age. However, osteoporosis caused an increase in the incidence of fracture, while the incidence of fracture decreased as height and the ASIS-GTD increased. The incidence of femoral neck fracture was lower in cases of osteonecrosis of the femoral head than in cases of other diseases. Logistic regression showed a significant correlation between osteoporosis, the ASIS-GTD, and fractures. Patients with osteoporosis had a high possibility of fracture (OR = 2.414); the possibility of fracture decreased with increasing ASIS-GTD (OR = 0.938).ConclusionLateral decubitus DAA THA can be successfully performed using a conventional operation bed and stem, effectively saving medical resources. Osteoporosis and a shorter ASIS-GTD were independent risk factors for femoral fracture.
Highlights
Total hip arthroplasty (THA) is one of the most effective operations for the treatment of severe hip disease, and its efficacy has been unanimously recognized by physicians and patients
A total of 261 patients (273 hips) were included in the analysis; among these cases, there were 34 cases (35 hips) of femoral fracture, including 32 cases found during the operation and 2 cases found during the first postoperative X-ray examination
The results showed that there was a significant correlation of the fracture incidence with osteoporosis and the anterior superior iliac spine (ASIS)-GTD (P < 0.05)
Summary
Total hip arthroplasty (THA) is one of the most effective operations for the treatment of severe hip disease, and its efficacy has been unanimously recognized by physicians and patients. Multiple approaches can be used to perform THA, such as the posterior approach, direct lateral approach, and direct anterior approach (DAA). With the development of enhanced recovery after surgery (ERAS) in recent years [3, 4], the DAA has gained increasing attention, and its utilization in the clinic has increased. DAA is performed on the anterior hip joint through the interval between the tensor fascia lata and sartorius muscle [5]. DAA utilizes the neuromuscular interval and has the advantages of reduced intraoperative bleeding, a shorter invasive incision, and improved postoperative recovery [6]. The operative field in the DAA is restricted by the anterior superior iliac spine (ASIS) and greater trochanter (GT), especially on the femoral side, and the risk of femoral fracture is higher than that with the posterior approach [7]. The reliability of lateral DAA THA needs to be further verified [8]
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