Conventional Posterolateral Approach Research Articles

Comparison of conjoined tendon-preserving posterior approach and conventional posterolateral approach in hemiarthroplasty for femoral neck fracture in the elderly: A multicenter (TRON group) retrospective study

BackgroundFemoral neck fractures (FNF) are one of the most common traumatic injuries in the elderly. The conjoined tendon-preserving posterior (CPP) approach was developed as a modification of the conventional posterolateral (PL) approach in hemiarthroplasty (HA) for displaced femoral neck fractures (FNF) to reduce postoperative dislocation. We hypothesized that the CPP approach would result in fewer dislocations and similar functional and radiographic outcomes compared to the PL approach. Patients and methodsThis was a retrospective multicenter (TRON group) study. We evaluated the rate of complications, and functional and radiographic outcomes for patients aged >65 years who underwent HA via the PL approach or the CPP approach from 2017 to 2019 and followed up for at least 24 months. To adjust for baseline differences between the groups, a propensity score-matching algorithm was used in a 1:1 ratio. ResultsWe identified 135 patients who underwent HA via the PL approach and 135 patients via the CPP approach. The mean follow-up period was 32.4 ± 14.0 months. The incidence of dislocation was 6 in 135 patients (4.4%) in the PL group and 0 in 135 patients (0%) in the CPP group, and there was significant difference (p = 0.04). Operation time was equivalent between the two groups (73.1 ± 30.4 vs. 71.8 ± 30.0 min; p = 0.72). The rate of varus insertion of stems in the PL group lower than that in the CPP group (19.3% vs. 33.3%; p = 0.01). Postoperative Parker's mobility score was similar between the two groups at 12 months follow-up (6.17 vs. 6.27; p = 0.81). ConclusionThe CPP approach showed a significantly lower dislocation rate, similar functional outcome and more varus stem insertions compared with the PL approach in this retrospective study.

A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach.

The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients. A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined. Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group (P<0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (P=0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14±138.51 mL in the DAA group (P<0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45±4.18 days in the DAA group (P=0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group. Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.

Comparison of postoperative outcomes between bikini-incision via direct anterior approach and posterolateral approach in simultaneous bilateral total hip arthroplasty: a randomized controlled trial

The purpose of this study was to compare an oblique bikini-incision via direct anterior approach (BI-DAA) to a conventional posterolateral approach (PLA) during simultaneous bilateral total hip arthroplasty (simBTHA) in terms of early patient outcomes, postoperative functional recovery, and complications. From January 2017 to January 2020, 106 patients receiving simBTHA were enrolled and randomly allocated to the BI-DAA or PLA group. Primary outcomes were measured using hemoglobin (HGB) drop, transfusion rate, the length of stay (LOS), the visual analog scale (VAS) for pain, the Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and the scar cosmesis assessment and rating scale. Secondary outcomes were the operative time, radiographic measurements, including femoral offset, femoral anteversion, stem varus/valgus angle, and leg length discrepancy (LLD). The occurrence of postoperative complications was also recorded. There were no differences in demographic or clinical characteristics before surgery. Compared to the PLA, the patients in the BI-DAA group had lower HGB drop (24.7 ± 13.3 g/L vs. 34.7 ± 16.7, P < .01) and transfusion rates (9/50 vs. 18/50, P = .04) and a shorter LOS (5.12 ± 1.5 vs. 6.40 ± 2.0 days, P < .01) without increasing the operative time (169.7 ± 17.3 vs. 167.5 ± 21.8 min, P = .58). The BI-DAA group yielded a smaller LLD (2.1 ± 2.3 vs. 3.8 ± 3.0 mm, P < .01) and less variability in component orientation than the PLA group (100% vs. 93%, P = .01). As for the scar, the BI-DAA group produced a shorter incision length (9.7 ± 1.6 vs. 10.8 ± 2.0 mm, P < .01) and higher postoperative recovery satisfaction than the PLA group. Furthermore, the BI-DAA group had a reduced VAS score one week after surgery and had better functional recovery in three months postoperatively. The BI-DAA group had a higher incidence of LFCN dysesthesia (12/100 vs. 0/100 thighs, P < .01), while other complications did not differ significantly between the two groups. For simBTHA, the bikini incision offers early recovery, less variance in components orientation, better postoperative outcomes, and scar healing than the PLA. Therefore, the bikini incision could be a safe and feasible option for simBTHA recipients.

Outcomes of direct superior approach and posterolateral approach for hemiarthroplasty in the treatment of elderly patients with displaced femoral neck fractures: A comparative study.

Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty via DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty via DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty via PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group (p < 0.001). However, the duration of the operation and blood loss in the DSA group were longer and higher than those in the PLA group, respectively (p < 0.001). In addition, the DSA group had a shorter hospitalization time than the PLA group (p < 0.001). The visual analog scale score and Harris score 1 month postoperatively in the DSA group were better than those in the PLA group (p < 0.001). Moreover, there were no significant differences between the two groups in Harris score (for assessment dysfunction) 6 months postoperatively (p > 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.

Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases

BackgroundThe Supercapsular percutaneously assisted total hip (SuperPath) technique is a relatively new minimally invasive approach for total hip arthroplasty (THA). Good clinical outcomes related to its use are reported in the literature. Nonetheless, there are still uncertainties about its validity in terms of radiographic outcomes.Main purpose of the study is to evaluate the effectiveness of the SuperPath in acetabular cup positioning through radiographic evaluation of acetabular inclination angle (IA) and acetabular anteversion (AA) angle within the safe zone described by Lewinnek. The leg length discrepancy (LLD), femoral offset (FO), and acetabular offset (AO) were also measured to ascertain the radiographic effectiveness of SuperPath in the acetabular cup placement.MethodsBetween January 2016 and December 2019, all SuperPath cases eligible for the study were included. They were operated by three orthopaedic surgeons with long-standing experience in THA via conventional posterolateral approach and who have performed SuperPath training fellowship. The Mann-Whitney U test was used for statistical assessments (p-value < 0.05). Means ± standard deviation (SD) of the radiographic IA and AA were calculated for each year.ResultsA retrospective analysis of 756 THAs was performed. The average percentage of IA within the Lewinnek’s safe zone was from 80 to 85%, while the average percentage of AA was from 76 to 79%. Both IA and AA showed no statistically significant difference between two consecutive years. Good results, in the ranges of normal values, were also obtained for LLD, FO and AO, with homogeneous outcomes between 1 year and the following one.ConclusionIt is possible to achieve good radiographic values of acetabular cup orientation through the SuperPath within the Lewinnek’s safe zone. These results are similar to those reported in the literature by authors using SuperPath. Low rate (0,3%) of hip dislocations were reported. Therefore, the SuperPath technique represents a good alternative THA approach. Nevertheless, there is not a statistically significant improvement in these radiographic parameters over a four-year time.Level of evidenceLevel IV, retrospective study.

Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach.

BackgroundThe aim of this study was to determine if it was feasible and safe to perform total hip arthroplasty (THA) using the direct anterior approach (DAA) when compared with the conventional posterolateral approach (PA) in patients with femoral neck fractures. The time required to start walking was investigated to identify advantages of the muscle-sparing approach. Safety of the approach was judged based on the incidence and nature of all complications.MethodsWe retrospectively reviewed 67 THA cases due to femoral neck fractures from October 2015 to January 2019. The PA was used in 31 cases, and the DAA was used in 36 cases. The average operative time and amount of bleeding were evaluated. Cup inclination, anteversion, and leg length discrepancy (LLD) were also measured on radiographs. The time to start walking and complications (e.g., intraoperative fracture, infection, and dislocation) were recorded.ResultsThe mean operative time was 84.35 ± 13.95 minutes in PA group and 99.22 ± 20.33 minutes in DAA group (p = 0.010). But after experiencing 20 cases using the DAA, there was no statistically significant difference in the operative time between the groups. The mean volume of bleeding was 428.73 ± 207.26 mL in the PA group and 482.47 ± 150.14 mL in the DAA group. There was no difference in the acetabular cup position between two groups. Ambulation was started at 3.94 days after surgery on average in the PA group and 3.14 days in the DAA group, showing a statistically significant difference. Intraoperative fracture and infection were not observed in either group. The incidence of LLD was 1 in each group. The dislocation rate was 3.2% (1 case) in the PA group and 5.5% (2 cases) in the DAA group.ConclusionsAlthough the DAA for THA was similar to the PA in terms of operative time, volume of bleeding, and complications, the DAA showed a great advantage in early rehabilitation as a muscle-sparing procedure in the elderly with femoral neck fractures.

Single Entry Posterior Parasagittal Approach Radiofrequency Neurotomy of Cervical Medial Branch: A Feasible Alternative to Conventional Approaches in the Treatment of Cervical Facet Pain.

Cervical facet joint pain is an important cause of chronic neck pain. The recommended treatment for this condition is radiofrequency (RF) neurotomy of the medial branch of dorsal rami. There have been attempts to find safe and effective ways to perform this procedure. The objective of this study is to describe the single entry posterior parasagittal approach and to evaluate the efficacy and safety of this approach compared to the conventional posterolateral approach of RF neurotomy of cervical medial branch. The record of all patients with cervical facet pain who were treated with RF neurotomy medial branch of dorsal rami between January 2016 and December 2019 were reviewed retrospectively. Comparisons were made between patients who underwent RF neurotomy with multiple skin entry posterolateral approach and those who underwent RF neurotomy with single entry posterior parasagittal approach. The primary outcome was measured as the mean changes in numerical rating scale (NRS), and the secondary outcomes were duration and complications related to both approaches. Thirty-one patients who underwent RF neurotomy via posterolateral approach were compared with 40 patients who underwent the procedure via posterior parasagittal approach. Both approaches showed a significant decrease in the NRS from baseline values. However, the differences in the NRS lowering effect at 3 and 12 months between these 2 approaches were not statistically significant. The duration of the procedure was significantly shorter with posterior parasagittal approach (44.13 ± 4.72 minutes vs 54.68 ± 7.39 minutes; P < 0.001). There were no serious complications encountered in both approaches. With comparable efficacy and safety profile between the posterior parasagittal and the conventional posterolateral approaches, the former single skin entry approach offers the added advantage of being less time-consuming. Further randomized prospective studies are necessary to validate these findings.

Artificial intelligence assisted total hip arthroplasty for patients with Crowe type Ⅳ developmental dysplasia of the hip

To investigate the early effectiveness of artificial intelligence (AI) assisted total hip arthroplasty (THA) system (AIHIP) in the treatment of patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH). The clinical data of 23 patients with Crowe type Ⅳ DDH who met the selection criteria between May 2019 and December 2020 were retrospectively analyzed. There were 3 males and 20 females, the age ranged from 44 to 74 years, with an average of 52.65 years. The absolute value of the lower limbs discrepancy before operation was (15.17±22.17) mm. The preoperative Harris score was 62.4±7.2. The AIHIP system was used for preoperative planning, and the operations were all performed via conventional posterolateral approach. Thirteen patients with difficulty in reduction during operation underwent subtrochanteric shortening osteotomy (SSOT). The operation time, hospital stay, and adverse events were recorded; Harris score was used to evaluate the function of the affected limb at 1 day before operation and 1 week and 6 months after operation; pelvic anteroposterior X-ray film was taken at 1 day after operation to evaluate the position of the prosthesis. The matching degree of prosthesis was evaluated according to the consistency of intraoperative prosthesis model and preoperative planning. The matching degree of acetabular cup model after operation was 16 cases of perfect matching, 4 cases of general matching (1 case of +1, 3 cases of -1), and 3 cases of mismatch (all of them were +2), the coincidence rate was 86.96%. The matching degree of femoral stem model was perfect matching in 22 cases and general matching in 1 case of -1, and the coincidence rate was 100%. One patient had a periprosthesis fracture during operation, and was fixed with a wire cable during operation, and walked with the assistance of walking aid at 6 weeks after operation; the rest of the patients walked with the assistance of walking aid at 1 day after operation. The operation time was 185-315 minutes, with an average of 239.43 minutes; the hospital stay was 8-20 days, with an average of 9.96 days; and the time of disengagement from the walking aid was 2-56 days, with an average of 5.09 days. All patients were followed up 6 months. All incisions healed by first intension, and there was no complication such as infection, dislocation, refracture, and lower extremity deep venous thrombosis; X-ray films at 1 day and 6 months after operation showed that the acetabular and femoral prostheses were firmly fixed and within the safe zone; the absolute value of lower limbs discrepancy at 1 day after operation was (11.96±13.48) mm, which was not significantly decreased compared with that before operation ( t=0.582, P=0.564). All osteotomies healed at 6 months after operation. The Harris scores at 1 week and 6 months after operation were 69.5±4.9 and 79.2±5.7 respectively, showing significant differences between pre- and post-operation ( P<0.05). At 6 months after operation, the hip function was evaluated according to Harris score, and 13 cases were good, 9 cases were fair, and 1 case was poor. AIHIP system-assisted THA (difficult to reposition patients combined with SSOT) for adult Crowe type Ⅳ DDH has high preoperative planning accuracy, easy intraoperative reduction, early postoperative landing, and satisfactory short-term effectiveness.

Early effectiveness of robot-assisted total hip arthroplasty via direct superior approach

To evaluate the early effectiveness of the robot-assisted total hip arthroplasty (THA) via direct superior approach (DSA). Between March 2021 and April 2021, 11 patients (11 hips) were treated with a robot-assisted THA via DSA. There were 7 males and 4 females, with an average age of 55 years (range, 26-73 years). There were 5 patients of osteoarthritis secondary to hip dysplasia and 6 patients of osteonecrosis of femoral head. Preoperative hip Harris score was 55.8±6.3. The operation time, volume of blood loss, length of incision, postoperative blood transfusion and hospital stay, and the incidence of surgical complications were recorded. The visual analogue scale (VAS) score and Harris score were used to evaluate hip joint pain and function. The leg length discrepancy (LLD) was measured on the X-ray films. The inclination angle and anteversion angle of the acetabular component were also measured, and the difference between the planned and actual values were compared. One THA was performed via conventional posterolateral approach finally because of poor exposure. The rest of 10 THAs were performed with assistance of robotic arm via DSA. The average operation time was 89 minutes (range, 65-120 minutes); the average length of incision was 10.5 cm (range, 9-13 cm); and the average blood loss was 400 mL (range, 110-740 mL). One patient was given a blood transfusion for 2 unit. All incisions healed by first intention and no neurovascular injury, deep vein thrombosis, or fracture occurred. The length of hospital stay after operation was 2-6 days (mean, 4.4 days). The duration of follow-up was 1-3 months (mean, 2.1 months). The VAS score was 0 in 9 patients and 2 in 1 patient at the day of discharge. At last follow-up, the hip Harris score was 84.9±6.7, showing significant difference when compared with that before operation ( t=-8.717, P=0.000). The inclination and anteversion angles were (37.4±2.0)° and (17.1±4.5)°, respectively, and there was no significant difference when compared with the planned values [(38.2±1.6)°, (16.6±3.7)°] ( t=1.809, P=0.104; t=-1.103, P=0.299). The LLD ranged from -2 to 4 mm. No complication such as dislocation, aseptic loosening, or periprosthetic joint infection occurred. The robot-assisted THA via DSA has encouraged early effectiveness.

Comparative prospective randomized study of minimally invasive transpiriformis approach versus conventional posterolateral approach in total hip arthroplasty as measured by biology markers

BackgroundMinimally invasive surgery is becoming increasingly common, but evidence of the advantages of the minimally invasive transpiriformis approach in total hip arthroplasty is limited. Therefore, our single-centre randomized controlled trial evaluated the benefits of this approach versus the posterolateral approach.MethodsForty-nine patients undergoing the minimally invasive transpiriformis approach and 57 patients undergoing the posterolateral approach total hip arthroplasty were analyzed. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded. In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded.ResultsPatients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs. 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs. 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Serum levels of CRP, IL-6, MB, CK-MB, and CK were also lower. According to the Harris hip score, the minimally invasive transpiriformis group showed significant improvement at one week and one month after surgery.ConclusionCompared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage.

Targeting the safe zones for cup position without fluoroscopic guidance in total hip arthroplasty: does the surgical approach affect the outcomes?

Proper acetabular cup positioning is crucial for achieving implant longevity and stability in total hip arthroplasty (THA). One of the elements that may affect the accuracy and precision of the positioning of the cup is the type of surgical approach used. This study compares the accuracy and the precision of conventional free-hand acetabular cup positioning relative to different "safe zones" in two groups of patients operated with THA using two different surgical approach. Retrospective radiological comparative matched-pair controlled study of two groups of patients operated with primary THA: the first group was operated in supine decubitus with a mini-invasive direct anterior approach (DA group), the second group was operated in lateral decubitus with a conventional posterolateral approach (PL group). Cup inclination and anteversion were assessed using the digital planning software TraumaCad. Cup position in the two groups were compared in terms of accuracy and precision. Forty four patients were enrolled for each group. The DA group showed a less inclined and less anteverted cup compared to the PL group (respectively 38.5 ± 5.2 vs. 49.6 ± 5.6 and 16.2 ± 3.6 vs. 22.9 ± 6.4; p < 0.01). The DA group showed a significantly higher percentage of cups within the "safe zone" in 4 out of 6 reference zones and a significantly lower variance in anteversion (12.96 vs. 40.96, p < .01). There was no difference in the variance for inclination. Our study found greater accuracy and precision in the positioning of the cup when surgery was performed through a direct anterior approach compared to the posterolateral approach due to the supine position of the patient which allows greater stability of the pelvis during surgery and makes it easier to target the desired angular references for cup positioning.

Comparison of total hip arthroplasty with minimally invasive SuperPath approach vs. conventional posterolateral approach in elderly patients: A one-year follow-up randomized controlled research

ObjectiveTo compare difference between SuperPath approach and conventional posterolateral approach in total hip arthroplasty (THA) in elderly patients. MethodsThe present prospective randomized controlled single blinded study enrolled a total of 96 elderly patients who received THA in our hospital during April 2015 to December 2018. All patients were randomly divided into the SuperPath group and the conventional group. General demographic characteristics and intraoperative data, as well as hospitalization time were recorded. Harris scores were used for measurement of hip function and visual analogue scale (VAS) was used for pain measurement. Serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and creatine phosphokinase (CK) were measured before and 24 h after surgery. Gait analysis was conducted by the method of footprints. ResultsThe mean surgical time was remarkably longer, the mean blood loss and incision length were significantly lower and the hospitalization time was also shorter in the SuperPath group compared with the conventional group. Both levels of CRP and CK were remarkably lower in the SuperPath group. At time points of 7 d and 1 mon after surgery, the VAS scores were significantly lower, and at 7 d, 1 mon and 3 mon the Harris scores were markedly higher in the SuperPath group compared with the conventional group. The step length and stride speed were significantly larger in the SuperPath group at 7 d and 1 mon after surgery than the conventional group. Joint dislocation was found in 2 cases of patients in the conventional group and no dislocation case was found in the SuperPath group. The angles of anteversion showed no significant difference, while the angles of abduction were significantly lower in the SuperPath group. ConclusionPatients with SuperPath approach had lower levels of CRP, ESR and CK, better hip function and less pain, as well as better gait condition than patients with conventional posterolateral approach in elderly patients.

Case-control studies on modified anterolateral approach with modified postmedial approach for the treatment of trimalleolar fractures

To compare clinical effect of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures. From January 2015 to August 2017, 108 patients with trimalleolar fractures were enrolled and randomly divided into modified approaches (experimental group) and conventional approaches(control group). There were 53 patients in experimental group including 31 males and 22 females aged from 18 to 67 years old with an average of(40.2±16.4) years old; 19 patients on the left side and 34 patients on the right side; 39 patients were supination external rotation and 14 patients were pronation-external rotation; preoperative waiting time ranged from 6 to 14 d with an average of(9.6±3.1) d; performed operation through modified anterolateral approach combined with modified posteromedial approach. There were 55 patients in control group, including 34 males and 21 females aged from 19 to 69 years old with an average of (42.1±15.3) years old; 18 patients on the left side and 37 patients on the right side; 42 patients were supination external rotation and 13 patients were pronation-external rotation; preoperative waiting time ranged from 7 to 16 d with an average of (10.3±3.4) d; performed operation through conventional posterolateral approach combined with medial-aided. Operation time, intraoperative blood loss, postoperative drainage volume, cases of incision complications and excellent-good reduction, fracture healing time, cases of nerve injury and muscular flexor contracture, cases of incision complications between two groups were compared; AOFAS score were used to evaluate clinical efficacy at 1 year after operation. All patients were followed up from 12 to 24 months with an average of (16.4 ±7.5) months. Operation time, intraoperative blood loss, postoperative drainage volume and incision complication in experimental group were (95.3±22.6) min, (114.7±68.7) ml, (127.5±87.8) ml and 1 case, respectively; while in control group were (112.5±53.8) min, (155.2±79.6) ml, (178.4±73.8) ml and 3 cases respectively; the data in experimental group were better than that of control group. In experimental group, 36 cases got excellent results, 14 good and 3 poor on the quality of reduction, while 30 patients got excellent results, 15 good and 10 poor in control group; the experimental group was better than control group. Fracture healing time in experimental group were(5.5±1.6) months, 2 patients occurred incision complications, while(6.7±2.1) months, 12 patients in control group; the experiment group were better than control group. Postoperative AOFAS score at 12 months in experimental group was 92.9±18.4, and better than control group 80.3±38.3; 32 patients got excellent results, 17 good, 3 moderate and 1 poor in experimental group; 25 patients got excellent results, 18 good, 8 moderate and 4 poor in control group; there was statistical difference between two groups. Both of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures could receive good clinical effect. While compared with conventional posterolateral approach combined with medial-aided, modified anterolateral approach combined with modified posteromedial approach is more fit for blood supply of local soft tissue, and has advantages of less trauma, safety operation and clearly exposure.

Comparison of early outcomes of minimally invasive SuperCap approach and conventional posterolateral approach for femoral head replacement

Comparison of early outcomes of minimally invasive SuperCap approach and conventional posterolateral approach for femoral head replacement

Randomized controlled trial of comparison between the SuperPATH and posterolateral approaches in total hip arthroplasty

To evaluate the effectiveness of SuperPATH approach in total hip arthroplasty (THA) compared with conventional posterolateral approach. Between March 2017 and May 2017, 24 patients who planned to have a unilateral THA were enrolled in the study and randomized into 2 groups. Twelve patients were treated with SuperPATH approach (SuperPATH group) and 12 patients with posterolateral approach (control group). There was no significant difference in gender, age, body mass index, the type of disease, complicating diseases, and American Society of Anesthesiologists grading between 2 groups ( P>0.05). The operation time, length of stay, length of incision, and perioperative complications related to operation were recorded. The hemoglobin and hematocrit were recorded; the total blood loss and intraoperative blood loss were calculated. The inflammatory response indicators (C-reactive protein, erythrocyte sedimentation rate) and muscle damage index (creatine kinase) were recorded in both groups. The range of motion, functional score (Harris score), visual analogue scale (VAS) score, and prosthesis position were recorded. Patients in both groups were followed up 1 year. Compared with the control group, the operation time of the SuperPATH group was longer ( t=4.470, P=0.000), and the incision was shorter ( t=-2.168, P=0.041). There was no significant difference in length of stay between 2 groups ( t=0.474, P=0.640). Periprosthetic fracture occurred in 1 case of the SuperPATH group. No other complications, such as infection or deep vein thrombosis, occurred in both groups. There was no significant difference in intraoperative blood loss, total blood loss, hemoglobin and hematocrit before operation and at 1 and 3 days after operation, and C-reactive protein and erythrocyte sedimentation rate before operation and at 1, 3, and 14 days between 2 groups ( P>0.05). For creatine kinase, SuperPATH group at 1 and 3 days were lower than control group ( P<0.05), while no significant difference was found between 2 groups before operation and at 14 days after operation ( P>0.05). For flexion and abduction activity, SuperPATH group at 1 and 3 days after operation were better than the control group ( P<0.05), while no significant difference was found between 2 groups at 14 days, 3 months, 6 months, and 1 year after operation ( P>0.05). The Harris and VAS scores of SuperPATH group at 1 and 3 days after operation were better than those of control group ( P<0.05). There was no significant difference in anteversion and abduction between 2 groups ( P>0.05) according to the X-ray film at 1 year. During the follow-up, no loosening or migration was observed. Compared with the posterolateral approach, the SuperPATH approach can reduce muscle damage, relieve early pain, promote recovery, and obtain the similar short-term effectiveness.

Super PATH minimally invasive hip arthroplasty for treatment of femoral neck fractures in the elderly

Objective To evaluate the clinical efficacy of super PATH minimally invasive hip arthroplasty for the treatment of femoral neck fractures in the elderly patients. Methods From January 2014 through June 2015, 64 elderly patients with femoral neck fracture underwent hip joint replacement. Of them, 32 (15 men and 17 women with an age of 76.3±8.9 years) were treated by super PATH minimally invasive hip arthroplasty and 32 (14 men and 18 women with an age of 74.3±9.7 years) by conventional hip arthroplasty. All of them were treated through the conventional posterolateral approach. The 2 groups were compared in terms of hospital stay, operation time, change in hemoglobin on the 4th postoperative day, ambulation time, hospitalization costs, visual analogue scale (VAS) and hip Harris scores at different time points postoperatively. Results The minimally invasive group incurred significantly shorter hospital stay (8.4±1.0 d) and postoperative ambulation time (23.4±1.5 h), significantly lower hospitalization costs (48,544.9±12,336.0 yuan), and significantly higher hip Harris scores at 24 hours and one month postoperatively (75.0±5.7 points and 79.4±4.1 points) than the conventional group (10.7±1.1 d, 25.7±2.7 h, 55, 318.9±10, 896.6 yuan, 65.6±6.4 points and 75.5±3.1 points, respectively) (P 0.05). No prosthesis loosening, postoperative dislocation, periprosthetic infection or deep vein thrombosis occurred in either group during follow-up. Conclusion In the treatment of femoral neck fractures in the elderly patients, super PATH minimally invasive hip arthroplasty may be obviously advantageous over conventional replacement surgery in decreased ambulation time and hospital stay, improved short-term hip function, and reduced hospitalization costs. Key words: Arthroplasty, replacement, hip; Femoral neck fractures; Surgical procedures, minimally invasive

Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus

背景与目的非小细胞肺癌合并左房瘤栓病例在局部晚期肺癌中占有一定比例，积极外科手术能否带来获益，以及具体术式选择均存在争议，是目前外科研究的热点。我们报告了单中心接受手术治疗的非小细胞肺癌合并左房瘤栓病例队列，结合预后分析探究合理的诊疗方法。方法自2006年8月-2017年7月共有11例非小细胞肺癌合并左房瘤栓病例在中日友好医院胸外科确诊并行手术治疗，对其临床资料、治疗选择、病理类型、预后情况进行了回顾性研究。结果11例患者中，男性7例，女性4例，平均年龄57.9岁，6例患者接受术前新辅助放化疗。全部患者手术过程顺利，其中行正中开胸体外循环下手术3例，体外膜肺氧合辅助下后外侧切口入路手术1例，常规后外侧切口入路手术6例，胸腔镜辅助小切口入路手术1例。手术达R0切除9例，R1切除2例。手术用时210 min-380 min，平均292 min，出血量100 mL-1, 600 mL，平均436 mL。全组有1例（9.1%）术后90天内死亡病例，另有4例（36.4%）出现心律失常、脑梗、低氧血症等围术期并发症。术后病理诊断鳞癌6例，腺癌4例，肉瘤样癌1例，病理分期pT4N0M0 7例，pT4N1M0 4例。术后对9例患者行辅助化疗，随访期内对2例患者行放射治疗。全组随访时间2个月-53个月，3年无病生存率30.7%，中位无病生存期31个月，3年总体生存率49.1%，中位总体生存期为33个月。结论对有选择的非小细胞肺癌合并左房瘤栓患者，选择合理术式切除肿瘤病灶和肺静脉、左房内瘤栓，加强围术期管理并配合新辅助/辅助化放疗，可能获得满意的预后。

EARLY EFFECTIVENESS COMPARISON OF HEMIARTHROPLASTY BY MINIMAL INVASIVE Supercap APPROACH AND BY CONVENTIONAL APPROACH FOR ELDERLY FEMORAL NECK FRACTURE

To compare the early clinical and radiographic outcomes of hemiarthroplasty by a minimal invasive Supercap approach and by a conventional approach for elderly displaced femoral neck fractures. Between January and June 2015, 70 geriatric patients with displaced femoral neck fracture underwent cementless bipolar hemiarthroplasty by minimally invasive Supercap approach (group A, n=35) or by posterolateral approach (group B, n=35). One patient was excluded from the study in group B because of too wide femur cavity. There was no significant difference in gender, age, body mass index, fracture cause, time from fracture to operation, fracture side, fracture classification, and preoperative visual analogue scale (VAS), and hemoglobin-level between the 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, and complications were recorded. The early clinical evaluations included timed up and go test (TUG), hemoglobin-level, VAS score, and satisfaction. The anteroposterior and lateral X-ray films were taken to measure the stem alignment, difference in leg length, and difference in femoral offset. All the patients were followed up 6-11 months (mean, 7.32 months). No patients died during follow-up. There was no significant difference in operation time and intraoperative blood loss between the 2 groups (P>0.05). The incision length of group A was significantly smaller than that of group B (P<0.05). One patient had delayed union of incision in group A (2.86%); 2 patients had deep vein thrombosis in group B (5.88%); and there was no significant difference in the complication rate (χ2=0.764, P=0.512). The postoperative hemoglobin level showed no significant difference between the 2 groups (P>0.05). Group A had lower VAS score and higher subjective satisfaction than group B, showing significant difference at 1, 5, and 14 days after operation (P<0.05). The TUG of group A was significantly shorter than that of group B at 5, 14, and 30 days (P<0.05). There was no significant difference in femoral offset or leg length on the X-ray films (t=1.273, P=0.851; t=0.409, P=0.327). The good rate of stem alignment was 82.86% (29/35) in group A, and was 85.30% (29/34) in group B, showing no significant difference (χ2=0.584, P=0.497). Both minimal invasive Supercap approach and conventional posterolateral approach are effective and safe for elderly displaced femoral neck fractures in hemiarthroplasty. Supercap approach has the advantages of less trauma, pain relief, and improvement of mobility and rapid rehabilitation.

A Novel 'Transfibular Approach' for the Nonunion of a Tibial Shaft Fracture with Poor Anteromedial Soft Tissue Cover.

The need for an ideal approach for the nonunion of the tibial shaft with anteromedial soft tissue scarring has long baffled surgeons. Many different approaches have been suggested in the past, but all those approaches were haggled by a multitude of problems. We have described a novel 'transfibular approach' for this selective situation. An appropriate patient with a mid-shaft tibial non-union was selected. After preoperative workup, the patient underwent an open reduction internal fixation (ORIF) with lateral tibial plating, bone grafting, and partial fibulectomy. In this new approach, the plane between tibialis anterior and extensor hallucis longus was used combined with a conventional posterolateral approach using the same incision. Subsequently, the patient was followed up for adequacy of the fixation and wound-related problems with a convincing outcome.

Ceramic on ceramic hip arthroplasty in fused hips.

Background:Most literature in the field of total hip arthroplasty (THA) for fused hips, until date has reported the results of using metal on polyethylene and ceramic on polyethylene bearings. Results of THA using ceramic on ceramic (CoC) bearings in fused hips have not been published in literature. This study reports the results of cementless THA using CoC articulation perfomed in fused hips.Materials and Methods:Twenty-three patients (25 hips) with fused hips underwent conversion to THA using CoC bearings and were followed up for a mean 5.4 years. The conventional posterolateral approach was used in 15 hips, a modified two incision technique in 7 hips and a direct lateral approach with greater trochanteric osteotomy in 3 hips. Postoperatively, range of motion exercises were encouraged after 2–3 days of bed rest and subsequent gradual weight bearing using crutches was begun.Results:Mean Harris hip score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. In the average 5.4 years (range 2.8-9.1 years) followup there were no cases with osteolysis around acetabular cup and femoral stem. In this study, there was no case of ceramic fracture. There was one case of squeaking.Conclusion:This study suggests that cementless THA performed for fused hips with CoC bearings can provide good early clinical results.