Direct Anterior Research Articles

Direct anterior Hueter approach is a safe and effective approach to perform a bipolar hemiarthroplasty for femoral neck fracture

Background and purpose — The direct anterior (DA) approach in total hip arthroplasty has recently been associated with faster functional recovery than the posterolateral (PL) approach. We hypothesized that the same should hold for the DA approach in bipolar hemiarthroplasty for femoral neck fractures.Patients and methods — 82 patients with a displaced femoral neck fracture and candidates for bipolar hemiarthroplasty were enrolled after IRB approval in this prospective non-randomized comparative study (DA: n = 38; PL: n = 44). The postoperative protocols were similar in both groups. Evaluation included surgical complications, component placement, and early functional outcomes, assessed 6 weeks postoperatively using a timed up-and-go (TUG) test. The incidence of dislocation was assessed by telephone interview at least 1 year after the surgery.Results — The DA-group patients had better results in the TUG test than the PL-group patients 6 weeks after surgery: half were under 19 seconds as opposed to only one third for PL (p = 0.06). We did not record any intraoperative femoral fracture or any lateral femoral cutaneous neuropraxia in the DA group. We observed a significant difference (p = 0.04) in lateral offset between the PL group (4.2 (SD 6.4) mm) and the DA group (−1.6 (SD 8.5) mm). Stem alignment was similar between groups. The dislocation rate for DA patients was lower than for PL patients (1 of 38 cases vs. 9 of 44 cases; p = 0.02).Interpretation — Our findings indicate that relative to the posterolateral approach, the direct anterior approach for bipolar hemiarthroplasty may improve gait in the early postoperative period and decrease the dislocation rate.

Direct anterior approach for revision total hip arthroplasty.

Revision total hip arthroplasty (THA) can be successfully performed through the direct anterior (DA) approach. Patient positioning, the surgical approach and specific instruments are important for obtaining adequate exposure. Acetabular exposure can be facilitated by capsular release and correct placement of retractors. Distal and proximal extension of the incision, as well as a femoral extended trochanteric osteotomy (ETO) can be performed to increase femoral exposure. The purposes of this article are to describe the DA approach, provide surgical techniques for revision THA through this approach, and describe the indications, contraindications and complications of this approach.

Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss?

It is not clear whether type of surgical approach affects the amount of blood loss in one-stage bilateral total hip arthroplasty (THA). This study therefore aims to examine if type of surgical approach can affect peri-operative blood loss and allogeneic blood transfusion in patients undergoing one-stage bilateral THA. Records of 319 patients who underwent one-stage bilateral THA from January 2004 to June 2011 were retrospectively reviewed. Patients were divided into two groups: direct anterior (DA) approach (75 patients) and direct lateral (DL) approach (244 patients). Blood loss was calculated using a previously validated formula. Blood loss and need for allogeneic blood transfusion were compared between the two groups. Additionally, the effects of using cell saver and surgical approach were evaluated in a multivariate analysis. Compared to the DL approach, calculated blood loss was significantly lower in the DA group (2,813.90 ± 804.13 ml vs 3,617.03 ± 1,148.47 ml) and a significantly lower per cent of patients needed allogeneic blood transfusion in the DA group (26.6 vs 52.4%). Intra-operative cell saver was used in 36 patients. Compared to the non-cell saver group, mean blood loss was significantly higher in the cell saver group (4,061.0 ± 1,285.55 ml vs 3,347.71 ± 1,083.85 ml), whereas the difference between the two groups regarding allogeneic blood transfusion was not statistically significant. The DA approach was an independent predictor of lower peri-operative blood loss and allogeneic blood transfusion while using cell saver was not. Our results may be explained by the lower extent of muscular dissection performed in the DA approach. Our findings also indicate that intra-operative cell salvage might not be justified in bilateral THA performed expeditiously.