The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty - is dislocation still a major issue? a case control study

BMC Musculoskeletal Disorders

Gregor Hauschild³  Ralf Dieckmann¹  Helmut Ahrens³  Georg Gosheger³  Marius Sander²  Steffen Hoell¹ 

[1] Center of arthroplasty and revision arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany;University Hospital Muenster, 48149 Muenster, Germany;Department of general orthopedics and tumor orthopedics, University Hospital Muenster, 48149 Muenster, Germany

关键词: Dislocation rate;    Total hip arthroplasty;    Minimal invasive surgery;    Large heads;    Direct anterior approach;   

Others  :  1128673
DOI  :  10.1186/1471-2474-15-80

 received in 2013-10-09, accepted in 2014-03-04,  发布年份 2014

【 摘 要 】

Background

There have been increasing numbers of publications in recent years on minimally invasive surgery (MIS) for total hip arthroplasty (THA), reporting results with the use of different head sizes, tribologic and functional outcomes. This study presents the results and early complication rates after THA using the direct anterior approach (DAA) in combination with head sizes ≥ 36 mm.

Methods

A total of 113 patients with THA were included in the study. The Harris Hip Score (HHS) was determined, a radiographic evaluation was carried out, and complications were recorded. The minimum follow-up period was 2 years (means 35 ± 7 months).

Results

The HHS improved from 43.6 (± 12) to 88.2 (± 14; P < 0.01). One early infection occurred, one periprosthetic fracture, and three cases of aseptic stem loosening. No incorrect positioning of the implants was observed, and there were no dislocations.

Conclusion

THA with the minimally invasive DAA in combination with large heads is associated with good to very good functional results in the majority of cases. The complication rates are not increased. The rate of dislocation mainly as an complication of the first two years can be markedly reduced in particular.

【 授权许可】

   
2014 Hoell et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD: Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 2011 Sep, 12(3):123-129.
• [2]Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A, Krismer M, Leardini A: A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech (Bristol, Avon). 2009, 24(10):812-818.
• [3]Wohlrab D, Hagel A, Hein W: Advantages of minimal invasive total hip replacement in the early phase of rehabilitation. Z Orthop Ihre Grenzgeb 2004, 142(6):685-690.
• [4]Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ: Muscle damage during MIS total hip arthroplasty: smith-Petersen versus posterior approach. Clin Orthop Relat Res 2006 Dec, 453:293-298.
• [5]Muller M, Tohtz S, Dewey M, Springer I, Perka C: Evidence of reduced muscle trauma through a minimally invasive anterolateral approach by means of MRI. Clin Orthop Relat Res 2010 Dec, 468(12):3192-3200.
• [6]Barrett WP, Turner SE, Leopold JP: Prospective randomized study of direct anterior vs postero-lateral approach for total Hip arthroplasty. J Arthroplasty 2013, 19:1634-1638.
• [7]Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH: Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty 2005 Jan, 20(1):11-19.
• [8]Amstutz HC, Lodwig RM, Schurman DJ, Hodgson AG: Range of motion studies for total hip replacements. A comparative study with a new experimental apparatus. Clin Orthop Relat Res 1975 Sep, 111:124-130.
• [9]Crowninshield RD, Maloney WJ, Wentz DH, Humphrey SM, Blanchard CR: Biomechanics of large femoral heads: what they do and don't do. Clin Orthop Relat Res 2004 Dec, 429:102-107.
• [10]Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, Meek RM, Reed MR: Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. J Bone Joint Surg (Br) 2011 Jul, 93(7):876-880.
• [11]Lachiewicz PF, Soileau ES: Low early and late dislocation rates with 36- and 40-mm heads in patients at high risk for dislocation. Clin Orthop Relat Res 2013 Feb, 471(2):439-443.
• [12]Rodriguez JA, Rathod PA: Large diameter heads: is bigger always better? J Bone Joint Surg (Br) 2012, 94(11 Suppl A):52-54.
• [13]Woo RY, Morrey BF: Dislocations after total hip arthroplasty. J Bone Joint Surg Am 1982 Dec, 64(9):1295-1306.
• [14]Amlie E, Hovik O, Reikeras O: Dislocation after total hip arthroplasty with 28 and 32-mm femoral head. J Orthop Traumatol 2010 Jun, 11(2):111-115.
• [15]Huo MH, Parvizi J, Bal BS, Mont MA: What's new in total hip arthroplasty. J Bone Joint Surg Am 2009 Oct, 91(10):2522-2534.
• [16]Howie DW, Holubowycz OT, Middleton R: Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2012 Jun 20, 94(12):1095-1102.
• [17]Berry DJ, von Knoch M, Schleck CD, Harmsen WS: Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 2005 Nov, 87(11):2456-2463.
• [18]Dudda M, Gueleryuez A, Gautier E, Busato A, Roeder C: Risk factors for early dislocation after total hip arthroplasty: a matched case–control study. J Orthop Surg (Hong Kong). 2010 Aug, 18(2):179-183.
• [19]Newington DP, Bannister GC, Fordyce M: Primary total hip replacement in patients over 80 years of age. J Bone Joint Surg (Br) 1990 May, 72(3):450-452.
• [20]Kurtz SM, Gawel HA, Patel JD: History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res 2011 Aug, 469(8):2262-2277.
• [21]Sayeed SA, Mont MA, Costa CR, Johnson AJ, Naziri Q, Bonutti PM, Delanois RE: Early outcomes of sequentially cross-linked thin polyethylene liners with large diameter femoral heads in total hip arthroplasty. Bull NYU Hosp Jt Dis. 2011, 69(Suppl 1):S90-S94.
• [22]DeLee JG, Charnley J: Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976, 121:20-32.
• [23]Gruen TA, McNeice GM, Amstutz HC: "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 1979 Jun, 141:17-27.
• [24]Perka C, Heller M, Wilke K, Taylor WR, Haas NP, Zippel H, Duda GN: Surgical approach influences periprosthetic femoral bone density. Clin Orthop Relat Res 2005 Mar, 432:153-159.
• [25]Moskal JT, Capps SG: Is limited incision better than standard total hip arthroplasty? A meta-analysis. Clin Orthop Relat Res 2013 Apr, 471(4):1283-1294.
• [26]Mayr E, Krismer M, Ertl M, Kessler O, Thaler M, Nogler M: Uncompromised quality of the cement mantle in Exeter femoral components implanted through a minimally-invasive direct anterior approach. A prospective, randomised cadaver study. J Bone Joint Surg (Br) 2006 Sep, 88(9):1252-1256.
• [27]White CA, Carsen S, Rasuli K, Feibel RJ, Kim PR, Beaule PE: High incidence of migration with poor initial fixation of the accolade (R) stem. Clin Orthop Relat R 2012 Feb, 470(2):410-417.
• [28]Hartog YM, Vehmeijer SB: High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 2013 Feb, 84(1):116-117.
• [29]Ji HM, Kim KC, Lee YK, Ha YC, Koo KH: Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplasty 2012 Mar, 27(3):378-385.
• [30]Bouchet R, Mercier N, Saragaglia D: Posterior approach and dislocation rate: a 213 total hip replacements case–control study comparing the dual mobility cup with a conventional 28-mm metal head/polyethylene prosthesis. Orthop Traumatol Surg Res 2011 Feb, 97(1):2-7.
• [31]Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S, Pederson AB, Karrholm J, Garellick G, Pulkkinen P, Eskelinen A, Makela K, Engesaeter LB: Increasing risk of prosthetic joint infection after total hip arthroplasty. Acta Orthop 2012 Oct, 83(5):449-458.
• [32]Sikes CV, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM: Instability after total hip arthroplasty: treatment with large femoral heads vs constrained liners. J Arthroplasty 2008 Oct, 23(7 Suppl):59-63.
• [33]McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD: Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009 Apr, 91(4):773-782.
• [34]Muratoglu OK, Bragdon CR, O'Connor DO, Jasty M, Harris WH: A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul award. J Arthroplasty 2001 Feb, 16(2):149-160.
• [35]Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM: Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Relat Res 2009 Dec, 467(12):3290-3296.
• [36]Bartelt RB, Yuan BJ, Trousdale RT, Sierra RJ: The prevalence of groin pain after metal-on-metal total hip arthroplasty and total hip resurfacing. Clin Orthop Relat Res 2010 Sep, 468(9):2346-2356.