Anterior Approach Group Research Articles

Gait analysis and clinical outcomes of anterior and lateral approach total hip arthroplasty: A prospective randomized study

Objectives: This study compared the lateral and direct anterior approaches (DAAs) for total hip arthroplasty (THA) regarding gait analysis and post-operative outcomes. Methods: Patients undergoing THA for osteonecrosis or primary osteoarthritis were randomized to either the lateral or DAA. Standardized surgical procedures and implants were used. Gait analysis, including temporal distance parameters, kinetics, and kinematics, was conducted at 6 weeks, 3 months, and 18 months. Results: Thirty-four patients (16 lateral, 18 anterior) participated, with comparable demographics. At 6 weeks, the anterior approach group had significantly higher Harris hip scores, improved gait speed, greater hip extension and external rotation moments, higher peak hip abduction angle, and reduced peak hip extension angle. The lateral approach (LA) group showed decreased hip abduction and internal rotation moments. By 3 and 18 months, outcomes were similar between groups. Conclusion: The anterior approach facilitates faster rehabilitation at 6 weeks, but outcomes converge with the LA by 3 and 18 months postoperatively.

Spinal Accessory to Suprascapular Nerve Transfer in Traumatic Brachial Plexus Injury: A Comparative Study of Shoulder Recovery Outcomes in the Anterior versus Posterior Approach and Surgeons' Preference

Problem statementConventionally, neural transfer of SAN to SSN for shoulder abduction in traumatic brachial plexus injury is done via the anterior approach. But important advantages of the posterior approach like the proximity of neural coaptation to the muscle to be reinnervated and negating the effects of a second injury to the suprascapular nerve have made it an alternative option. MethodologyRetrospective data was collected for a total of 30 SAN to SSN transfer patients of brachial plexus injury in two groups of 15 patients each of anterior (Group A) and posterior approach (Group B) over four years. Functional outcome at the shoulder was measured as muscle power and active range of motion (ROM) at 18 months and data on patients’ satisfaction levels and surgeons’ perceptions were also collected. ResultsNo statistical difference was found in the muscle strength achieved in the two groups (p-value = 0.34) but significant recovery was found in the external rotation achieved by group B (p-value = 0.02). Statistical difference was insignificant in the two groups' active ROM during abduction and external rotation. The satisfaction index of patients was 86.7% in the posterior approach compared to 68% in group A. Surgeons’ perspective showed a faster speed of suprascapular nerve exploration as perceived in the posterior approach with better visibility of supraspinatus muscle contraction, and overall surgeons’ preference for a posterior approach. ConclusionExternal rotation at the shoulder is better with the posterior approach but no difference in abduction. Patients with the posterior approach were more satisfied with the recovery, and surgeons preferred the posterior approach.

Comparison of the Efficacy of Different Combined Therapies Based on Modified Core Decompression for the Treatment of Early-stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Clinical Study.

Osteonecrosis of the femoral head (ONFH) is a severe orthopedic disease, which may cause severe hip dysfunction in later stage. Therefore, it is necessary to treat nontraumatic ONFH during the early stages. The aim of this study was to evaluate the clinical efficacy and survival rates of different combined therapies based on modified core decompression (CD) for early-stage nontraumatic ONFH. This retrospective cohort study assessed 397 hips with ONFH who underwent different combined therapies based on modified CD in our institution between January 2010 and December 2017. Patients were classified into six groups based on treatment modalities, and were followed up at 1 year and 5 years postoperatively. Clinical outcomes, including Harris hip score (HHS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC), were compared to evaluate the hip function and quick rehabilitation effect. Radiographic progression of ONFH and the incidence of total hip arthroplasty were analyzed to evaluate the survival rate of ONFH postoperatively. Statistical analyses were mainly performed with Kruskal-Wallis test, chi-square test and Kaplan-Meier method. HHS increased significantly in all groups but showed no significant differences among the six groups in the first years. The nonvascularized allogeneic fibula with bone grafting (NVAF + BG) and percutaneous femoral neck-head fenestration with bone grafting via the direct anterior approach (DAA + BG) groups had significantly higher HHS (p = 0.010; p = 0.025) and WOMAC function score (p < 0.001; p = 0.012) than the CD group 5 years postoperatively. Compared with the CD group, all the other groups showed statistically significant differences in radiographic progression (p < 0.001) and a higher survival rate with no significant difference (p = 0.569). Our study demonstrates the potential use of NVAF + BG and DAA + BG, may serve as a promising combined therapy for the treatment of early-stage nontraumatic ONFH.

875 Comparison of Anterior Versus Posterior Approaches for Management of Cervical Trauma: A National Database Study

INTRODUCTION: Cervical spine injuries are a major cause of long-term disability, accounting for almost 65% of all spinal injuries. They often result in major motor and sensory deficits and chronic pain. Prompt surgical intervention is often required to prevent further neurological deterioration and instability, yet there is no definitive evidence for the optimal operative approach. METHODS: The National Trauma Data Bank was queried from 2017 to 2019 for all patients with cervical trauma who underwent subsequent spinal fusion surgery with anterior or posterior approaches. Patients receiving combination management were excluded. Paired Student’s t-tests and Pearson’s Chi-squared analyses were used to compare differences in patient demographics, in-hospital complications, and lengths of stay between the two groups. Relative risks for the in-hospital complications were also calculated. Alpha was set to 0.05. RESULTS: A total of 10,593 patients meeting the inclusion criteria were identified, with 6,803 patients undergoing fusion with an anterior approach and 3,226 patients with a posterior approach. Patients with a posterior approach were significantly older, had a higher proportion of white and female patients, and a lower total GCS score (p &lt; 0.05 for all). They also had higher rates of comorbidities such as hematologic disorders, COPD, CHF, Hypertension, PAD, MI, and renal disease (p &lt; 0.05 for all). After surgery, the anterior approach group had a shorter hospital stay and a significantly lower risk of developing SSI, requiring unplanned reoperation, and experiencing MI (p &lt; 0.05 for all). CONCLUSIONS: To our knowledge, this is the largest study assessing differences in in-hospital morbidities between surgical approaches for cervical trauma. Our findings suggest that the anterior approach has a lower risk of short-term complications, emphasizing its clinical advantage. Further research is needed to elucidate the long-term effects.

Laparoscopic Versus Open Surgical Management of Hydrocele of the Canal of Nuck: A Retrospective Analysis of 20 Cases.

Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling.The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery. The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed. The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score amongpatients of Group A at all intervals (p-value< 0.001, p-value = 0.005, p-value = 0.005, p-value< 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison. The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.

Comparison of early clinical outcomes between SuperCap and direct anterior approaches for total hip arthroplasty

To compare the short-term clinical efficacy of SuperCap approach and direct anterior approach in total hip arthroplasty. Clinical data of 70 patients who underwent minimally invasive SuperCap approach and DAA THA in January 2016 to June 2017 were retrospective analyzed. These patients were divided into two groups:SuperCap approach group(SuperCap group) and direct anterior approach group(DAA group). There were 15 males and 15 females in SuperCap group, aged from 45 to 71 years old, and the follow-up time ranged from 24 to 30 months. There were 24 males and 16 females in Group B, aged from 51 to 76 years and the follow-up time ranged from 24 to 36 months. Hemoglobin level of the 3rd day after operation, transfusion rate, acetabular abduction angle, anteversion angle and creatine kinase level of the 3rd day after operation, Harris score of 3 months and the last time, VAS score of 1 week and the last time were recorded and compared. Complications were recorded at the final follow-up. All patients were followed up, the follow-up time of SuperCap group ranged from 24 to 30 months, that of DAA group ranged from 24 to 36 months. No significant differences were found in hemoglobin level on the 3rd day after operation, transfusion rate, Harris score or VAS score between two group (P>0.05). There was no significant difference in Harris score between 3 months after operation and the final follow-up in both groups (P>0.05). There were no significant difference in VAS scores of 6 weeks after operation and on the final follow-up neither(P>0.05). The level of creatine kinase in SuperCap group was significant lower than that in DAA group(P<0.05). Until the final follow-up, there was no significant difference in the incidence of complications between the two groups(P>0.05). The clinical effect of minimally invasive SuperCap approach after total hip arthroplasty is comparable to that of DAA approach with less soft tissue injury. Patients can recover rapidly after operation and it is a safe and effective surgical approach for surgeons with short learning curve.

Comparison of Outcomes in Patients with Cervical Spine Metastasis After Different Surgical Approaches: A Single-Center Experience

ObjectivesIn patients undergoing cervical spine surgery for metastatic spine disease, we sought to: 1) compare perioperative and oncologic outcomes among three different operative approaches, 2) report fusion rates, and 3) compare different types of anterior vertebral body replacement. MethodsA single-center, retrospective cohort study of patients undergoing extradural cervical/cervicothoracic spine metastasis surgery between 02/2010-01/2021 was conducted. Operative approaches were: anterior-alone, posterior-alone, or combined anterior-posterior, and the grafts/cages used in the anterior fusions were: cortical allograft, static cage, or expandable cage. All cages were willed with autograft/allograft. Outcomes included perioperative/postoperative variables, along with fusion rates, functional status, local recurrence (LR), and overall survival (OS). Results61 patients underwent cervical spine surgery for metastatic disease, including 11(18.0%) anterior, 28(45.9%) posterior, and 22(36.1%) combined. New postoperative neurologic deficit was the highest in the anterior approach group (p=0.038), and dysphagia was significantly higher in the combined approach group (p=0.001). LR (p>0.999), OS (p=0.655), and time to both outcomes (log-rank test: OS p=0.051, LR p=0.187) were not significantly different. Of the 51 patients alive at 3-months, only 19/51(37.2%) obtained imaging≥3-months. Fusion was seen in 11/19(57.8%) at a median(IQR) of 8.3(4.6-13.7)months. Among the anterior corpectomies, the following graft/cage were used: 6(54.5%) allograft, 4(36.3%) static cage, and 1(9.0%) expandable cage, with no difference was found in outcomes among the three groups. ConclusionThe only discernible differences between operative approaches were that patients undergoing an anterior approach had higher rates of new postoperative neurologic deficit, and the combined approach group had higher rates of postoperative dysphagia.

Ease of Internal Jugular Venous Cannulation by Anterior V/S Posterior Approach: A Randomized Interventional Study

Background: Percutaneous cervical central venous cannulation is now common practice during Perioperative care in major surgical procedures, critically ill patients in intensive care units for long term hyperalimentation and for rapid restoration of blood volume in cases of acute blood loss. Proper route of insertion is essential for its success. The objective of this study is to compare procedural parameters and complications associated with anterior and posterior approaches for Internal Jugular Venous cannulation.&#x0D; Methods: Our study was conducted as a prospective randomized interventional trail in 60 patients undergoing scheduled cardiac surgeries requiring Right internal jugular venous cannulation in a tertiary level hospital after obtaining clearance from ethics committee, patients were randomly allocated into two groups either Anterior approach (Group A; n=30) or Posterior Approach (Group B; n=30). Number of attempts, time for identification of IJV, duration of cannulation, ease of insertion, complications were compared in both the groups.&#x0D; Results: The number of attempts (p value 0.036), mean time taken for vein identification (p value 0.0003), catheterization time (p value &lt;0.001), incidence of arterial puncture and hematoma are less with posterior approach, ease of threading is comparable among both the group. There were no statistically significant intergroup differences with respect to the Age, Sex, ASA grade.&#x0D; Conclusion: The posterior approach is better than anterior approach for Internal Jugular Vein Cannulation, as it improves the success rate, permits easy threading of catheter, reduces access time and duration of cannulation, complications like arterial puncture, hematoma, pneumothorax are lesser in posterior approach.

Posterior Calot's Triangle Approach First Would Be a Better Choice for Chronic Atrophic Cholecystitis: A Retrospective Controlled Study.

Objective: Compare the clinical efficacy of anterior and posterior Calot's triangle approach in laparoscopic cholecystectomy (LC) for chronic atrophic cholecystitis, to find out which approach is much safer and more reliable. Patients and Methods: From June 2020 to June 2022, 102 patients with chronic atrophic cholecystitis underwent LC in our hospital. They were divided into anterior Calot's triangle approach group and posterior Calot's triangle approach group. In addition, their clinical data, intraoperative conditions, surgical results, and postoperative recovery were analyzed. Results: LC was performed in 41 females and 28 males by the anterior Calot's triangle approach, and in 20 females and 13 males by the posterior Calot's triangle approach. There were no differences in age, gender, and body mass index between the two groups (P > .05). The probability of rupture of cystic artery between both groups was not significantly different (P = .549), and the intraoperative blood loss was more in the anterior group (P = .014). The operative time of the posterior approach appeared to be shorter (P = .013). Bile duct injury and conversion to open cholecystectomy revealed no significant difference (P > .05). The recovery time of gastrointestinal function, wound infection, white blood cell count, liver function, and postoperative hospital stay time were found to be not significantly different (P > .05). Conclusion: By the posterior Calot's triangle approach, LC is a convenient and feasible surgical procedure for chronic atrophic cholecystitis with less blood loss and can become easier without increasing the risk of surgery.

Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients

BackgroundWith the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery.MethodsA total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77).ResultsGroup A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041).ConclusionThe use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.

Computed Tomography-Guided Percutaneous Stylomastoid Foramen Puncture and Radiofrequency Thermocoagulation for Treatment of Hemifacial Spasm via Mandibular Angle Approach

BACKGROUND: Hemifacial spasm (HFS) is characterized by progressive, paroxysmal, and involuntary convulsions on one side of the face. We have conducted in-depth exploration on the puncture approach through the mandibular angle, which is an important supplement to the first 2 approaches (i.e., premastoid approach and the postmastoid approach), especially for patients who cannot find a suitable way before and after the mastoid process. OBJECTIVES: To investigate the effect of computed tomography (CT)-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through the stylomastoid foramen in treating HFS. STUDY DESIGN: A retrospective, observational study. SETTING: Pain Department, Jiaxing and Hangzhou, China. METHODS: A total of 89 patients with HFS who underwent CT-guided RFT in the Pain Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and the Pain Department of Jiaxing First Hospital, from June 2020 to June 2022, were retrospectively analyzed, including 29 men and 60 women, aged 34~88 (59.8 ± 11.1). They were divided into 3 groups: anterior mastoid approach group (Group A, n = 38), posterior mastoid approach group (Group P, n = 26), and mandibular angle approach group (Group M, n = 25), according to the different puncture approaches. Puncture time, minimum stimulating current triggering facial muscle twitches, temperature at the end of RFT and duration time of RFT at this temperature, and total treatment time, as well as degree of facial paralysis and complications one-day postoperation, were compared among the 3 groups. RESULTS: The puncture times (mean ± SD) of Group A, Group P, and Group M were (30.63 ± 4.88), (31.35 ± 5.89), and (35.08 ± 5.76), respectively, and the differences were statistically significant (P = 0.006). The puncture time of Group M was longer than that of Groups A and P (P &lt; 0.05). The minimum stimulating current triggering facial muscle twitches in the 3 groups were (0.49 ± 0.16), (0.43 ± 0.14), and (0.28 ± 0.09), respectively, with a statistically significant difference (P = 0.000). The minimum stimulation current in Group M was less than that in Groups A and P (P &lt; 0.05). The temperature at the end of RFT of the 3 groups was (78.29 ± 7.91), (76.54 ± 8.10), and (66.60 ± 8.00), respectively, and the differences were statistically significant (P &lt; 0.001). The temperature of Group M was lower than Groups A and P (P &lt; 0.05). There were no significant differences among the 3 groups in the total operation time or the degree of facial paralysis one-day postoperation (P &gt; 0.05). No hematoma, infection, hearing impairment, or other complications were reported in any patients. LIMITATIONS: The nonrandomized nature, small sample size, and retrospective design are limitations of this study. CONCLUSIONS: CT-guided RFT through the stylomastoid foramen is an effective treatment of HFS. Compared to the poster and anterior mastoid approaches, the mandibular angle approach was found to be more effective in terms of reduced minimum stimulating current and reduced-end RFT temperature, which means fewer potential complications to the patient postsurgery. KEY WORDS: Hemifacial spasm, radiofrequency thermocoagulation, stylomastoid foramen, CT-guided

Comparasion of the anatomic and therapeutic effect of two transsphenoidal approaches under neuroendoscopy

ObjectiveTo compare anatomical parameters, postoperative nasal complications and quality of life of 2 sphenoid sinus approaches (nasal septum approach and transsphenoidal anterior wall approach) via anterior wall by endoscopic surgery. MethodsThe study was anatomic basis research and prospective randomized double-blind (Clinical trials registration number: NFEC-2015-033). Study was performed in 30 dissected heads via 2 approaches. The related anatomic parameters were measured. Another 60 patients with pituitary tumor were randomly divided into 2 groups to receive endoscopic surgery. The selected otolaryngologist and non-operative neurosurgeon common then analyzed preoperative indicators. The therapeutic effect and nasal complications of 2 transsphenoidal approaches were compared by Lund-Kennedy scale, Lund-Mackay scale and SNOT-20 scale. ResultsThe distances between incision and external nostrils of anterior wall in nasal septum approach and transsphenoidal anterior wall approach are 5.19 ± 0.15 versus 6.91 ± 0.14 cm, respectively; maximum angles and ranges of swing in horizontal direction on operative route are 44.77 ± 2.04° versus 38.54 ± 1.40°, and 1.25 ± 0.15 versus 0.59 ± 0.52 cm. The operation time in nasal septum approach group is shorter (61.97 ± 18.123 min) than transsphenoidal anterior wall approach group (89.83 ± 38.515 min); And higher Lund-Kennedy score (2.4737 ± 1.46699 vs 3.8125 ± 1.51520. In addition, 20 Subjective Scoring Scales for Nasal and Paranasal Sinus Outcome (SNOT-20) measurement results indicated nasal septum approach group has less subjective symptoms plague patients' lives. The cerebrospinal fluid leakage, resection of tumor, postoperative endocrine remission rate and postoperative complications occurred in 2 groups have no significant difference. ConclusionEndonasal transsphenoidal via nasal septum-sphenoid sinus approach has characters of less surgery damage, short distance to the outside of the nose, precise location, wider operation space and larger perspective, which is obvious advantages in reducing postoperative nasal complications.

Comparative Study between Anterior and Posterior Approaches in Management of Cervical Spondylotic Myelopathy

Background The best surgical approach for management of degenerative cervical myelopathy remains area of debate between spinal surgeons. The purpose of this study compare between anterior approach (anterior cervical discectomy with fusion) and posterior approach (laminectomy with and without fusion) for treatment of multilevel spondylotic myelopathy according to clinical, radiological outcomes, recovery rates and complications. Material and Methods A total of 20 patients were operated by anterior cervical discectomy and fusion (ACDF) and 20 patients were operated by cervical laminectomy with and without fusion in this study. Preoperative and postoperative clinical assessment were done using modified Japanese Orthopedic Association (mJOA) score and Myelopathy scale (MS). Postoperative complications, recovery rate and intraoperative blood loss are recorded. Preoperative and postoperative radiological analysis were done using Cobb angle measurement (C2-7 angle) and canal diameter assessment by measuring the canal through the center of each vertebra and intervertebral discs (C2–C7) on 10 transverse planes on mid-sagittal T2WI image. Results There was significant decrease in pre-operative mJOA scale in posterior approach group; compared to anterior group (P = 0.41). There was highly significant decrease in duration of symptoms in anterior approach group; compared to anterior group (P &amp;lt; 0.01) and significant decrease in pre-operative MS scale in anterior approach group; compared to anterior group (P &amp;lt; 0.05). There is non-significant difference as regards post-operative mJOA scale and MS scale between anterior and posterior group (p &amp;gt; 0.05). Although recovery rate was higher in anterior group than posterior group (49.5 ± 27.2 vs 39.51 ± 11.30), but finally There was no significant difference as regards postoperative recovery, improvement and complications rates (p &amp;gt; 0.05). postoperative canal diameter change was greater in posterior surgery than anterior group (11.1 ± 1.98 vs 9.5 ± 0.76). Reoperation rate was higher in anterior group. Postoperative C5 palsy and axial neck pain were higher in posterior group. Conclusions Both anterior and posterior approaches were successful to treat multilevel CSM, but no definitive surgical approach was proved for management of CSM and each case should be evaluated carefully for determination of best surgical approach according to preoperative Cobb angle and canal diameter.

Joint awareness among total hip arthroplasty patients operated through anterior approach versus posterior approach: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to compare joint awareness in patients who underwent total hip arthroplasty (THA) via the anterior approach (AA) versus the posterior approach (PA). The hypothesis was that patients who underwent THA via AA would have better forgetfulness of the artificial joint. A comprehensive search of major literature databases and bibliographic details was conducted to identify studies evaluating the forgotten joint score (FJS-12) in total hip arthroplasty (THA) patients operated through the anterior approach (AA) and posterior approach (PA). Out of 234 studies identified, seven studies met the inclusion criteria for review. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence and the risk of bias in the included studies. The FJS-12 was evaluated at three months, one year, and beyond 2 years. The mean FJS-12 at > 2years was 82.03 in the AA group and 80.32 in the PA group. The forest plot analysis (n = 819 patients) revealed no significant difference in FJS-12 score between these two approaches (MD 2.13, 95% CI [- 1.17, 5.42], p = 0.21; I2 = 60%). However, the joint awareness was significantly lesser in the AA group at 3months (MD 12.56, 95% CI [9.58, 15.54], p < 0.00001, I2 = 0%) and 1year (MD 9.55, 95% CI [7.85, 11.24], p < 0.0001, I2 = 0%). After analyzing the available literature, it was found that THA patients operated through the AA approach have significantly lower joint awareness than those operated through the PA approach in the first year of surgery. However, there is no significant difference in joint awareness between these two approaches after 2years. III.

Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis

BackgroundEastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce.In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared. MethodsA retrospective inverse propensity score-weighted fashion (IPTW) case–control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed. ResultsSurvival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62–1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54–2.6, p = 0.66).After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence. ConclusionAA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.

Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review.

Odontoid fractures account for 15%-20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures. The relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3. Twelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA. AA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.

Surgical outcome of locked facet in distractive flexion injury of the subaxial cervical spine: Single institution retrospective study.

The optimal surgical treatment for patients suffering from distractive flexion injury of the subaxial cervical spine with a locked facet (LF) is unknown. Closed reduction via an anterior or posterior approach is a treatment option for LF. We examined the surgical outcomes of patients treated for locked facet distractive flexion injury (LF-DFI) in this case series, with a particular emphasis on the surgical approach and reduction maneuver. We retrospectively analyzed the patients with distractive flexion injury of the subaxial cervical spine who underwent surgery at our hospital between November 2006 and April 2021. Patients who did not have facet subluxation or dislocation or those who achieved LF reduction prior to skin incision were excluded from this study. The patients were divided into 2 groups based on their initial approach, anterior or posterior approach. Perioperative clinical outcomes, including the American Spinal Cord Injury Association scale score, radiological changes, and complications were analyzed. This study enrolled 12 patients with LF-DFI. Four and 8 patients underwent the anterior and posterior approaches, respectively. The LF was reduced using an anterior approach with traction between the vertebral bodies in the anterior approach group and using a posterior approach with partial facetectomy in the posterior approach group. The preoperative American Spinal Cord Injury Association scale scores were as follows: A, 1 patient; B, 1 patient; C, 3 patients; D, 4 patients; and E, 3 patients. Nine patients showed no neurologic deterioration after surgery, whereas 2 had an aggravated neurologic status. Postoperatively, patients who underwent posterior open reduction did not exhibit worsened neurologic symptoms, whereas 2 patients who underwent the anterior approach showed worsened neurologic symptoms. At the final follow-up, all patients achieved radiological fusion, and no complications other than neurologic deterioration were identified. In terms of worsening postoperative neurologic status, a posterior approach using partial facetectomy for LF reduction is considered a safer surgical technique than an anterior approach. To avoid iatrogenic intraoperative cord injury, we recommend posterior approach in patients with LF-DFI.

Comparative study between anterior and posterior approach in emergent femoral hernia

Objectives/aims Emergency surgery is necessary for incarcerated and/or strangulated femoral hernias. With regard to emergency femoral hernia repair, this study attempted to compare between open anterior and open posterior (preperitoneal) techniques. Methods Patients who underwent emergency femoral hernia repair between October 2020 and October 2022 were included in this single centre retrospective cohort research. They were divided into two groups based on the surgical incisions: the anterior approach group (19 cases) and the posterior approach group (14 cases). Open anterior and posterior methods were compared using patient demographic information, intraoperative findings, operating time, and postoperative outcomes. Results 33 patients in total were included in the current study. 19 patients (57.6%) underwent open anterior approach, whereas 14 patients (42.4%) underwent open preperitoneal approach. Patient features indicated a similarity between the two groups. The posterior approach group experienced considerably shorter mean operative time (53.624 7 min vs 77.936 5 min, P = 0.039) and recovery time (9.24 1days vs 13.36 6days, P = 0.049) before returning to full activity. The posterior approach group had a decreased (7.14%) rate of postoperative complications, such as wound infection, seroma/hematomas, persistent discomfort, and hernia recurrence. Conclusion While it can increase the rate of first-stage tension-free repair of incarcerated femoral hernia and with a lower risk of postoperative complications, the open preperitoneal approach for emergency femoral hernia may be preferable to other procedures.

Prosthetic Hip Dislocations in Direct Anterior Versus Posterior Approach in Patients With Instrumented Lumbar Fusion

BackgroundInstrumented posterior lumbar spinal fusion (IPLSF) has been demonstrated to contribute to instability following total hip arthroplasty (THA). It is unclear whether a supine direct anterior (DA) approach reduces the risk of instability. MethodsA retrospective review of 1,773 patients who underwent THA through either a DA approach or a posterior approach at our institution over a 7-year period was performed. Radiographic and chart reviews were then used to identify our primary group of interest comprised of 111 patients with previous IPLSF. Radiographic review, chart review, and phone survey was performed. Dislocation rates in each approach group were then compared within this cohort of patients with IPLSF. ResultsWithin the group of patients with IPLSF, 33.3% (n = 37) received a DA approach while 66.6% (n = 74) received a posterior approach. None of the 9 total dislocations in the DA group had IPLSF, whereas 4 of the 16 total dislocations in the posterior approach group had IPLSF (P = .78). When examining the larger group of patients, including those without IPLSF, patients undergoing a DA approach had a lower BMI and were likely have a smaller head size implanted (P < .001 for both). Using Fischer’s exact test, fusion was associated with dislocation in the posterior approach group (P < .01), whereas fusion was not associated with dislocation in the anterior approach group (P = 1.0). ConclusionsWhile there was no significant difference in dislocation rates between posterior and anterior approach groups, in patients with IPLSF, the anterior approach had a lower percentage of dislocation events compared to the posterior approach.

Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience.

The aim was the comparison of two different approaches to re-insert the inferior eyelid retractors within addition to lateral tarsal strip at lower eyelid involutional entropion (LEIE) surgical correction. This multicentric retrospective case series involved 233 consecutive patients (195 eyelids) who underwent LEIE repair. All the lids had a lateral tarsal strip (LTS) in addition to the reinsertion of retractors onto the tarsal plate via the anterior approach (group 1) or the posterior approach (group 2). The desired normal position of the eyelids at 6-month follow-up was considered 'surgical successes, while entropion recurrence and overcorrection (ectropion) were considered 'surgical failures'. One-hundred ninety-one (82%) surgeries were included in group 1 and 42 (18%) in group 2. The success rate was 92.1% (176 lids) in group 1 and 85.7% (36 lids) in group 2 (p = 0.188). The recurrence rate was statistically higher for group 2 (14.3%) than for group 1 (3.7%) (p = 0.016). Overcorrection only described in group 1 (3.1%). Both groups had a similar complication rate (p = 0.268), with trichiasis being the most frequent (14, 6%). Ten eyelids (47.6%) from the 21 overall failures were satisfactorily reoperated, and the remaining ones were treated conservatively. The anterior or posterior approach to reinsert lower eyelid retractors to tarsal plate in addition to LTS to correct LEIE can provide a similar outcome. However, the anterior approach achieves a slightly higher success rate with fewer recurrences but with a higher overcorrection rate.