Anterolateral Approach In Supine Position Research Articles

Learning curve of minimally invasive anterolateral approach in supine position for total hip arthroplasty

BackgroundTotal hip arthroplasty (THA) using minimally invasive anterolateral approach in the supine position (ALS) is reported to achieve good clinical outcomes including lower dislocation rates and early clinical recovery. However, minimally invasive ALS THA is technically challenging, especially among surgeons who are newly introduced to these techniques. This study aimed to evaluate the learning curves associated with minimally invasive ALS THA. MethodsThis study divided 720 primary THAs with a minimally invasive ALS approach into three groups based on the number of previous procedures per surgeon (A:1–100, B:101–200, C: >201). Surgical time and perioperative complications were compared among the three groups. ResultsPerioperative complications were seen in 8.0% of patients, including periprosthetic fractures (4.2%), surgical site infection (1.3%), stem subsidence (1.0%), nerve palsy (0.6%), dislocation (0.4%), major bleeding (0.4%), and liner malseating (0.1%). The rate of perioperative complications in each group was 8.6% (30 patients), 10.9% (22 patients), and 3.5% (6 patients) in groups A, B, and C, respectively. Group C has a significantly lower rate than other groups. Group B has significantly higher surgical site infection rate than other groups. No statistically significant difference was found in the surgical times among the three groups. ConclusionThe learning curve associated with minimally invasive ALS THA was approximately 200 cases in terms of perioperative complications. Moderately experienced surgeons should always pay careful attention to avoid complications during ALS THA until they perform >200 cases.

Digital templating cementless short stem total hip arthroplasty: is there a difference in planning adherence between the direct anterior approach and minimally invasive anterolateral approach?

PurposeMinimally invasive approaches (MIS) in total hip arthroplasty (THA) show inconsistent findings regarding planning adherence in digital templating. The purpose of this study is to evaluate any difference in planning adherence between the direct anterior approach (DAA) and an anterolateral MIS approach (AL MIS) in cementless short stem THA.MethodsA single surgeon series of 222 THAs in 208 patients with an uncemented short curved stem and a bi-hemispherical acetabular cup were screened for inclusion. A total of 118 THAs were implanted via the DAA and 72 THAs via the AL MIS were included. The planning adherence for the offset option, stem size and the acetabular cup were retrospectively evaluated.ResultsPlanning adherence for cup size (perfect match: p = 0.763; ± 1 size: p = 0.124), offset option (0.125) and stem size (perfect match: p = 0.275; ± 1 size: p = 0.552) did not show any statistical significance. Preoperative diagnosis of avascular necrosis of the femoral head in AL MIS approach (OR 6.045; CI 1.153–31.696) or mild hip dysplasia in the general cohort poses (OR 11.789; CI 1.386–100.293) a significant risk for inadequate prediction of the offset option. Conclusion: digital templating for THA with an uncemented short curved stem and a bi-hemispherical acetabular cup show comparable results between a direct anterior approach and a minimally invasive anterolateral approach in supine position. Surgeons should be aware of a low planning adherence for this type of short stem in minimally invasive approaches.ConclusionDigital templating for THA with an uncemented short curved stem and a bi-hemispherical acetabular cup show comparable results between a direct anterior approach and a minimally invasive anterolateral approach in supine position. Surgeons should be aware of a low planning adherence for this type of short stem in minimally invasive approaches.

Obesity in short stem total hip arthroplasty using a minimally invasive supine anterolateral approach\u2014a risk factor for short-term complications?

PurposeObesity is associated with increased risk for surgical complications in total hip arthroplasty (THA). The impact of obesity on short-term complication in minimally invasive (MIS) anterolateral approach is not well known. Therefore, this study was conducted to evaluate the early complications within the first 90 days after THA using a MIS anterolateral approach with a short-curved stem stratified by Body Mass Index (BMI).Patients and methodsA single centre consecutive series of 1052 hips in 982 patients (index surgery 2014–2019) with a short-curved stem and press fit cup implanted using a MIS anterolateral approach in supine position were screened for inclusion. Inclusion criteria were defined as end-stage primary osteoarthritis of the hip. Eventually, 878 implantations in 808 patients were included and stratified by body mass index (BMI). Peri-operative complications, within the first 90 days after surgery, were retrospectively evaluated.ResultsSeverely obese patients (BMI ≥ 35 kg/m2) and morbidly obese patients (BMI ≥ 40 kg/m2) demonstrated a significantly increased operation time (p < 0.001) and a higher risk for general surgical complications (p = 0.015) (odds ratio (OR) = 4.365; OR = 4.985), periprosthetic joint infection (PJI) (p = 0.001) (OR = 21.687; OR = 57.653), and revision (OR = 8.793; OR = 20.708).ConclusionThe risk for early PJI and overall surgical complications in MIS anterolateral approach is significantly increased in severely and morbidly obese patients. This leads to a significantly higher risk for revision surgery after index surgery within the first 90 days. A BMI above 35 kg/m2 is the clear threshold for increased risk of PJI in MIS anterolateral THA with a short curved stem. As the surgical complications are comparable to other approaches, MIS anterolateral short stem THA is also feasible with increasing BMI.

Low rate of early periprosthetic fractures in cementless short-stem total hip arthroplasty using a minimally invasive anterolateral approach

PurposeMinimally invasive (MIS) approaches in combination with short stems have gained popularity in recent years in total hip arthroplasty (THA). A decreased risk for periprosthetic femoral fractures (PFFs) is reported for cementless short-stem THA, but in contrast to other approaches, the risk factors for PFFs for short-stem THA using MIS anterolateral approach in supine position are not described in literature.MethodsA single-center consecutive series of 1052 hips in 982 patients, performed between 2014 and 2019 with a short curved stem and a press fit using an MIS anterolateral approach in supine position, was retrospectively screened for inclusion. Fourteen patients were lost to follow-up. Therefore, 1038 THAs in 968 patients were included. Risk factors for intra- and postoperative PFFs within 90 days were analyzed. We investigated for sex, age, body mass index (BMI), diagnosis, and laterality.ResultsIn total, 18 PFFs (1.7%) occurred. Intraoperative fracture occurred in ten cases ( 0.9%), with another eight cases (0.8%) occurring postoperatively. Increased American Society of Anesthesiologists (ASA) Score was a significant risk factor for PFF (p = 0.026), whereas sex (p = 0.155), age (p = 0.161), BMI (p = 0.996), and laterality (p = 1.000) were not. Seven PFFs (0.7%) required revision arthroplasty.ConclusionCementless short-stem THA using the MIS anterolateral approach is a procedure with a low number of PFFs within 90 days from index surgery. Fracture rates are comparable to other MIS approaches, and comparable femoral short stems are used. Age, sex, and BMI were not identified as risk factors of PFF, while risk for PFF increased with ASA Score.Level of EvidenceLevel IV

Portable imageless navigation system and surgeon's estimate for accurate evaluation of acetabular cup orientation during total hip arthroplasty in supine position.

This prospective study aimed to clarify whether this novel device can evaluate the cup orientation during total hip arthroplasty (THA) more closely to that measured in postoperative computed tomography (CT) compared to the surgeon's estimate using a manual goniometer. We prospectively performed 30 cementless THAs via the anterolateral approach in supine position between October 2018 and July 2019, wherein cup orientation was evaluated by both a portable imageless navigation system (HipAlign) and a manual goniometer during surgeries. Primary outcome was the absolute estimate error [the absolute value of the difference between cup angles measured by postoperative CT and those measured by HipAlign (group H) or surgeon's estimate using the manual goniometer (group S) during surgery]. The number of outliers of the absolute estimate error (> 10°) in each group was also estimated. The absolute estimate error of cup inclination in groups H and S was 3.3° ± 2.7° and 3.0° ± 2.5°, respectively (p = 0.51), whereas that of cup anteversion was 3.8° ± 3.4° and 6.0° ± 3.7°, respectively (p = 0.0008). The number of outliers of the estimate error in groups H and S was one case (3.3%) and six cases (20.0%), respectively (p = 0.04). In all six outlier cases, surgeons underestimated cup anteversion during surgeries. This portable imageless navigation system was a useful method, especially for avoiding incorrect cup anteversion. Underestimation of cup anteversion during THA in the supine position with the conventional alignment assisting device should be given attention.