Posterolateral Approach Group Research Articles

Effect of improved posterolateral minimally invasive approach combined with modular femoral head prosthesis in treatment of femoral neck fractures in elderly patients

Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femo- ral neck fractures （ 26 males and 44 females ; at age range of 67-95 years, mean 78.3 years） treated from October 2008 to June 2010. There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures （2-4 months post-injury）, all of whom were type Ⅲor Ⅳ fractures according to the Garden＇ s classification. All surgeries were completed by the same operation group. The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females. The two groups were compared in aspects of incision size, operative time, perioperative complications, prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks （range, 12-18 weeks）. The differences between the two groups were significant regarding the incision length, perioperative blood loss, and blood product transfusio amount （ P 〈 0.01 ） , but insignifi- cant in operative time （ P 〉 0.05 ）. All patients were able to take weight-bearing walk six weeks postoperatively. The two groups showed significant difference in the hip joint function by Charnley＇s criteria six weeks postoperatively （ P 〈 O. 05 ）, but insignificant difference in the hip joint function by Harris＇ s crite- ria at the last follow-up （P 〈 0.05 ）. Conclusion The modified posterolateral minimally invasive ap- proach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients, for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time. Key words: Femoral neck fractures ; Surgical procedure, minimally invasive; Arthoplasty,replacement, hip; Modular femoral head

Anterolateral minimally-invasive total hip arthroplasty: a clinical comparative study of 110 cases

To explore the indications and key points of anterolateral minimally-invasive total hip arthroplasty. 110 baseline indexes matched patients admitted for unilateral total hip arthroplasty were randomly assigned to 2 equal groups to undergo surgery through a short anterolateral incision of < or = 10 cm or a standard posterolateral incision. All operations were done by the same surgeon. The demographic data, perioperative indexes, and postoperative function indexes were recorded and statistically analyzed. No significant differences were detected with respect to operation time, abduction angle, anteversion angle, stem alignment, and stem fixation between these 2 groups. The incision length, blood loss, perioperative transfusion, and 100 - mm visual analogue pain scale (VAS) score at the first 24 hours of the anterolateral approach group were (7.49 +/- 0.86) cm, (376.18 +/- 168.30) ml, (410.09 +/- 136.46) ml, and (30.76 +/- 21.77) respectively, all significantly shorter, less, or lower than those of the standard posterolateral approach group [(15.2 +/- 1.8) cm, (605.0 +/- 225.1) ml, (629.5 +/- 232.9) ml, and (50.3 +/- 13.7) respectively, all P < 0.01]. The Harris hip score and Barthel index 3 months after operation of the anterolateral approach group were (83.80 +/- 5.64) and (93.45 +/- 6.37) respectively, both significantly higher than those of the standard posterolateral approach group [(75.0 +/- 7.5) and (94.6 +/- 7.5) respectively, both P < 0.01)], however, there were not significant differences in the Harris hip score and Barthel index 3 years after operation between these 2 groups. Fewer traumas, less blood loss and rapid recovery can be obtained through this new total hip arthroplasty approach. But experienced doctors and special instruments are prerequisite.

Prosthesis survival after total hip arthroplasty—does surgical approach matter? Analysis of 19,304 Charnley and 6,002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register

Background and purpose Controversies still exist about whether there is any effect of operative approach on survival of hip prostheses. We compared long-term survival of primary total hip arthroplasties in a welldefined study population from a national prospective population-based registry with regard to the three most commonly used surgical approaches.Methods We assessed prosthesis survival according to surgical approach (the lateral with or without trochanteric osteotomy, and the posterolateral) for 19,304 Charnley and 6,002 Exeter total hip arthroplasties performed from 1987 to 2004.Results For Charnley total hip arthroplasties, lateral approach with trochanteric osteotomy had a lower probability of revision than lateral approach without trochanteric osteotomy (RR = 0.6, 95% CI: 0.5–0.8). The lower revision rate was due to fewer revisions for aseptic loosening and dislocation. The differences had declined in the latest time period (1995–2004). We observed no differences between lateral approach without trochanteric osteotomy and posterolateral approach, except that there were more revisions due to dislocation in the posterolateral approach group (RR = 1.9, 95%CI: 1.1–3.2). No statistically significant differences were observed for Exeter total hip arthroplasties.Interpretation For Charnley prostheses, the lateral approach with trochanteric osteotomy gave a reduced revision risk compared to the other approaches, which was due to fewer revisions for dislocation, and in the first time period also fewer revisions due to aseptic loosening.

Comparison of complications after transtrochanteric and posterolateral approaches for primary total hip arthroplasty

For this study, 100 total hip arthroplasties (THAs) in a transtrochanteric approach group and 100 THAs in a posterolateral approach group were performed at one university hospital by a single, experienced surgeon. These THAs were then followed up for a minimum of 2 years to determine the incidence of postoperative complications. In our study, patients undergoing primary THA by the posterolateral approach were 18.4 times more likely to be complication free than patients in whom the transtrochanteric approach was used. This benefit, combined with a shortened surgical time, decreased blood loss, and technical ease, shows the advantages of the posterolateral approach for THA.