Direct anterior approach in total hip arthroplasty: influence of stem length on clinical and radiological outcomes at medium-term follow-up.
Direct anterior approach
Functional outcomes
Hip arthroplasty
Short metaphyseal-fitting stem
Standard-length stem
Journal
Musculoskeletal surgery
ISSN: 2035-5114
Titre abrégé: Musculoskelet Surg
Pays: Italy
ID NLM: 101498346
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
20
06
2021
accepted:
28
07
2022
medline:
18
8
2023
pubmed:
20
8
2022
entrez:
19
8
2022
Statut:
ppublish
Résumé
To evaluate the influence of short versus long stems implanted through a Direct Anterior Approach (DAA) on clinical and radiological outcomes in THA at medium-term follow-up (average follow-up of 44.8 months). 167 consecutive total hip arthroplasties treating patients affected by primary hip osteoarthritis were retrospectively evaluated. A standard-length stem (H-MAXs) was used in 70 patients, while a short metaphyseal-fitting femoral stem (MINIMA) was used in 97 patients. The Harris Hip Score (HHS) and Forgotten Joint Score-12 (FJS) were used as outcomes measurements. Post-operatively, Engh's score and Brooker classification were analyzed at 6 months, 1 year and every 2 years until the final FU. The correct size of the implant was evaluated determining the canal fill index (CFI), and all undersized stems were classified according to Magra classification. The average HHS was 83 ± 13.4 in the standard stems group and 87 ± 14.1 for short stems group (p = 0.148). The average FJS was 87.9 ± 15.2 for patients in the standard stems group and 84.5 ± 17.7 with no significant differences (p = 0.327). None of the stems showed radiographic signs of instability (standard stems mean Engh's score: 19.25 versus short stems mean Engh's score: 19.50-p = 0.41). According to Brooker classification, no significant difference in severity was found using different stems (p = 0.715). A high rate of undersized stems was found (standard stems 24%-short stems 25%) but without statistical difference between groups (p = 0.078), while a different trend in malposition following the recent classification proposed by Magra et al. was observed evaluating all undersized stems (p = 0.0387). Both groups achieved good and comparable patient-reported outcome measurements (PROMs) and radiographic stability with fixation observed by bone ingrowth. A high rate of undersized stems was found with a correlation between femoral stem length and specific pattern of malposition. Malalignment in Varus was frequent in shorter stems in contact proximally with medial calcar and distally with lateral cortex, while a uniform undersizing was observed for longer ones with a continuous margin around the stem. However, the stems never presented progressive radiolucent lines over the whole surface of the stem.
Identifiants
pubmed: 35984610
doi: 10.1007/s12306-022-00758-7
pii: 10.1007/s12306-022-00758-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
305-311Informations de copyright
© 2022. The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.
Références
Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Jt Surg Am 100:1455–1460. https://doi.org/10.2106/JBJS.17.01617
doi: 10.2106/JBJS.17.01617
Kurtz SM, Lau E, Ong K et al (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. In: Clinical orthopaedics and related research. Springer, New York, pp 2606–2612
Grieco PW, Pascal S, Newman JM et al (2018) New alternate bearing surfaces in total hip arthroplasty: a review of the current literature. J Clin Orthop Trauma 9:7–16
doi: 10.1016/j.jcot.2017.10.013
pubmed: 29628677
Meermans G, Konan S, Das R et al (2017) The direct anterior approach in total hip arthroplasty a systematic review of the literature. Bone Jt J 99B:732–740
doi: 10.1302/0301-620X.99B6.38053
Christensen CP, Jacobs CA (2015) Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty 30:94–97. https://doi.org/10.1016/j.arth.2014.12.038
doi: 10.1016/j.arth.2014.12.038
pubmed: 26096071
Abe H, Sakai T, Takao M et al (2015) Difference in stem alignment between the direct anterior approach and the posterolateral approach in total hip arthroplasty. J Arthroplasty 30:1761–1766. https://doi.org/10.1016/j.arth.2015.04.026
doi: 10.1016/j.arth.2015.04.026
pubmed: 25956522
Vaughan PD, Singh PJ, Teare R et al (2007) Femoral stem tip orientation and surgical approach in total hip arthroplasty. HIP Int 17:212–217. https://doi.org/10.5301/HIP.2008.3618
doi: 10.5301/HIP.2008.3618
pubmed: 19197870
Newman EA, Holst DC, Bracey DN et al (2016) Incidence of heterotopic ossification in direct anterior vs posterior approach to total hip arthroplasty: a retrospective radiographic review. Int Orthop 40:1967–1973. https://doi.org/10.1007/s00264-015-3048-4
doi: 10.1007/s00264-015-3048-4
pubmed: 26611728
Post ZD, Orozco F, Diaz-Ledezma C et al (2014) Direct anterior approach for total hip arthroplasty: Indications, technique, and results. J Am Acad Orthop Surg 22:595–603
doi: 10.5435/JAAOS-22-09-595
pubmed: 25157041
Galakatos GR (2018) direct anterior total hip arthroplasty. Missouri State Medical Association
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Jt Surg Am 55:1629–1632
doi: 10.2106/00004623-197355080-00006
Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Jt Surg Br 69:45–55
doi: 10.1302/0301-620X.69B1.3818732
Hwang KT, Kim YH, Kim YS, Choi IY (2012) Total hip arthroplasty using cementless grit-blasted femoral component. A minimum 10-year follow-up study. J Arthroplasty 27:1554–1561. https://doi.org/10.1016/j.arth.2012.02.005
doi: 10.1016/j.arth.2012.02.005
pubmed: 22480522
Magra M, McConnell J, … FS-O (2018) Undefined a classification system for undersized femoral stems in uncemented hip arthroplasty. online.boneandjoint.org.uk
Maldonado DR, Kyin C, Walker-Santiago R et al (2019) Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes. HIP Int. https://doi.org/10.1177/1120700019881937
doi: 10.1177/1120700019881937
pubmed: 31630564
Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 28:1634–1638. https://doi.org/10.1016/j.arth.2013.01.034
doi: 10.1016/j.arth.2013.01.034
pubmed: 23523485
Frye BM, Berend KR, Lombardi AV et al (2015) Do sex and BMI predict or does stem design prevent muscle damage in anterior supine minimally invasive THA? Clin Orthop Relat Res 473:632–638. https://doi.org/10.1007/s11999-014-3991-1
doi: 10.1007/s11999-014-3991-1
pubmed: 25337974
Lect CD-IC, 1995 undefined Fractures of the femur after hip replacement. ci.nii.ac.jp
Miller LE, Gondusky JS, Kamath AF et al (2018) Influence of surgical approach on complication risk in primary total hip arthroplasty: systematic review and meta-analysis. Acta Orthop 89:289–294. https://doi.org/10.1080/17453674.2018.1438694
doi: 10.1080/17453674.2018.1438694
pubmed: 29451051
pmcid: 6055783
Eggli S, Rodriguez J, Belgica RG-AO (2000) Undefined Heterotopic ossification in total hip arthroplasty: the significance for clinical outcome. ncbi.nlm.nih.gov
Kutzner KP, Hechtner M, Pfeil D et al (2017) Incidence of heterotopic ossification in minimally invasive short-stem tha using the modified anterolateral approach. HIP Int 27:162–168. https://doi.org/10.5301/hipint.5000448
doi: 10.5301/hipint.5000448
pubmed: 28218370
Molli RG, Lombardi A V., Berend KR et al (2012) A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. In: Clinical orthopaedics and related research. Springer, New York, pp 450–461
Rivera F, Leonardi F, Evangelista A, Pierannunzii L (2016) Risk of stem undersizing with direct anterior approach for total hip arthroplasty. HIP Int 26:249–253. https://doi.org/10.5301/hipint.5000337
doi: 10.5301/hipint.5000337
pubmed: 27013489
Kutzner KP, Freitag T, Bieger R (2020) Defining ‘undersizing’ in short-stem total hip arthroplasty: the importance of sufficient contact with the lateral femoral cortex. HIP Int. https://doi.org/10.1177/1120700020940276
doi: 10.1177/1120700020940276
pubmed: 32644828
pmcid: 8978469