Abstract
Introduction: There has been an increased interest in minimally invasive direct anterior approach total hip arthroplasty (THA) to provide greater patient satisfaction, improve pain relief, and reduce the duration of hospitalisation. A direct anterior approach hybrid cemented THA, utilising a bikini line incision, can be technically challenging. We aimed to undertake radiological analysis of femoral stem cementation, clinical outcomes, and component survivorship. Methods: Over a 5-year period, 215 primary elective bikini anterior THA conducted by a single surgeon were included. All procedures were performed using a cemented collarless polished stem. The operation was performed on a standard operating table. Patients undergoing posterior approach, revision procedures, and fractured neck of femurs were excluded. Post-operative radiographs were analysed for femoral cementation quality using the Barrack grading system. Harris hip scores (HHS) were determined at 6 weeks, 12 weeks, annually thereafter and the difference in HHS was noted. Results: In total, 215 anterior bikini THA (R = 101, L = 114) were performed in 199 patients (M = 89, F = 110) with a mean age of 77 and mean follow up of 2.9 years (range = 0.5–5). Radiographic analysis of femoral cementation showed 189 femoral stems (88%) were either Barrack A or B cementation grade, suggesting optimal cementation. Lucency in the cement-bone interface occurred mainly in Gruen Zone 1 (43%) and Zone 13(46.9%). At the most recent follow-up (mean 2.9 years), component survivorship was at 99.54% (stem). Significant improvement was noted in Harris hip scores at final follow-up (from 54 preoperatively to 92.7 at 2.9 years postoperatively). Conclusion: Our results suggest that a bikini incision direct anterior approach for total hip arthroplasty can be safely employed to perform cemented femoral stems on a standard operating table.
Highlights
As the incidence of primary and revision total hip arthroplasty (THA) rises, there is renewed clinical interest in factors that may contribute to patient satisfaction including the length of hospital admission, pain control, early resumption of premorbid activities, and surgical revision [1,2,3]
Recent studies have suggested that direct anterior THA results in better pain control, shorter hospital stay, improved gait speed, hip flexion at 3 months, early return to driving, reduced dislocation rate, and earlier discontinuation of assisted ambulatory devices compared to posterior THA [1,2,3,4,5,6]
Cadaveric studies have demonstrated no compromise in the cement mantle during DAA THA, there is currently a lack of clinical data regarding femoral cementation in bikini incision anterior THA and component survivorship [15]
Summary
As the incidence of primary and revision total hip arthroplasty (THA) rises, there is renewed clinical interest in factors that may contribute to patient satisfaction including the length of hospital admission, pain control, early resumption of premorbid activities, and surgical revision [1,2,3]. Recent studies have suggested that direct anterior THA results in better pain control, shorter hospital stay, improved gait speed, hip flexion at 3 months, early return to driving, reduced dislocation rate, and earlier discontinuation of assisted ambulatory devices compared to posterior THA [1,2,3,4,5,6]. Cadaveric studies have demonstrated no compromise in the cement mantle during DAA THA, there is currently a lack of clinical data regarding femoral cementation in bikini incision anterior THA and component survivorship [15]. The primary aim of this study was to determine if femoral cementation and component positioning were satisfactory using a
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