Early Complications in Direct Transgluteal Anterolateral Total Hip Arthroplasty: A Comparative Study
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Published:
Oct 17, 2023
Keywords:
Total hip arthroplasty, anterolateral approach, hip replacement, complications, direct anterolateral approach
Main Article Content
Abstract
Introduction: In recent years, the advent of new procedures, surgical instruments, and surgeon skills has contributed to a reduction in the number of early complications that can arise after hip arthroplasty. Among the most frequent are femoral loosening, deep vein thrombosis, and dislocation.
Objective: To evaluate the rate of intraoperative complications and complications within the first 12 months after a hip arthroplasty performed utilizing the direct anterolateral approach; and to compare the results to a series published in 2007.
Materials and Methods: Retrospective cohort study, which included patients who underwent surgery for primary hip osteoarthritis at two institutions, divided into: group I (468 patients who were operated between June 1999 and June 2003) and group II (344 patients who were operated between January 2018 and January 2020).
Results: The global rate of complications in group II was 4.7%. Deep vein thrombosis was the most frequent event, and there were no episodes of dislocation. The use of 22 mm diameter heads was associated with a higher risk of dislocation compared to surgeries in which larger heads were used (OR= 6.7 - 95% CI 1.2 - 78.2).
Conclusions: Total hip replacement through a direct transgluteal anterolateral approach had a low global rate of complications within the first postoperative year. Complications were reduced by almost half in surgeries performed between 2018 and 2020, compared to the previous series, mainly in regards to dislocation.
Objective: To evaluate the rate of intraoperative complications and complications within the first 12 months after a hip arthroplasty performed utilizing the direct anterolateral approach; and to compare the results to a series published in 2007.
Materials and Methods: Retrospective cohort study, which included patients who underwent surgery for primary hip osteoarthritis at two institutions, divided into: group I (468 patients who were operated between June 1999 and June 2003) and group II (344 patients who were operated between January 2018 and January 2020).
Results: The global rate of complications in group II was 4.7%. Deep vein thrombosis was the most frequent event, and there were no episodes of dislocation. The use of 22 mm diameter heads was associated with a higher risk of dislocation compared to surgeries in which larger heads were used (OR= 6.7 - 95% CI 1.2 - 78.2).
Conclusions: Total hip replacement through a direct transgluteal anterolateral approach had a low global rate of complications within the first postoperative year. Complications were reduced by almost half in surgeries performed between 2018 and 2020, compared to the previous series, mainly in regards to dislocation.
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How to Cite
Tillet, F., Bochatey, E., Alonso, M. I., Martínez, W., & Lopreite, F. A. (2023). Early Complications in Direct Transgluteal Anterolateral Total Hip Arthroplasty: A Comparative Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 502-510. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1739
Section
Clinical Research
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References
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5. Schiffner E, Latz D, Thelen S, Grassmann JP, Karbowski A, Windolf J, et al. Aseptic loosening after THA and TKA
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https://doi.org/10.1016/j.jor.2019.03.018
6. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2015;6736(14):1-9. https://doi.org/10.1016/S0140-6736(14)61798-0
7. Sculco PK, Cottino U, Abdel MP, Sierra RJ. Avoiding hip instability and limb length discrepancy after total hip
arthroplasty. Orthop Clin North Am 2016;47(2):327-34. https://doi.org/10.1016/j.ocl.2015.09.006
8. Lopreite FA, Astudillo F, Del Sel H. Complicaciones tempranas en la artroplastia total de cadera por vía
anterolateral transglútea directa. Rev Asoc Argent Ortop Traumatol 2007;72(1):75-81. Disponible en:
https://www.aaot.org.ar/revista/2007/n1_vol72/art13.pdf
9. Blankstein M, Lentine B, Nelms NJ. The use of cement in hip arthroplasty: a contemporary perspective. J Am Acad Orthop Surg 2020;28(14):e586-e594. https://doi.org/10.5435/JAAOS-D-19-00604
10. Sukeik M, Alshryda S, Powell J, Haddad FS. The effect of tranexamic acid on wound complications in primary total hip arthroplasty: A meta-analysis. Surgeon 2020;18(1):53-61. https://doi.org/10.1016/j.surge.2019.05.003
11. Cooper HJ, Della Valle CJ. Large diameter femoral heads: is bigger always better? Bone Joint J 2014;96-B(11
Supple A):23-6. https://doi.org/10.1302/0301-620X.96B11.34342
12. Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 2001;83(11):1622-9. https://doi.org/10.2106/00004623-200111000-00002
13. Lopreite AF, Dainotto T, Gaggiotti S, Del Sel H. Estudio retrospectivo comparativo entre aspirina y dabigatrán en la incidencia de eventos tromboembólicos en pacientes con artroplastia de cadera y rodilla. Rev Asoc Argent Ortop Traumatol 2021;86(4):446-54. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1303
14. Martin R, Clayson PE, Troussel S, Fraser BP, Docquier PL. Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. J Arthroplasty 2011;26(8):1362-72. https://doi.org/10.1016/j.arth.2010.11.016
15. Amstutz HC, Markoff KL. Design features in total hip replacement. En: Harris WH (ed.). The Hip. Proceedings of the Second Open Scientific Meeting of the Hip Society. St Louis: CV Mosby Co; 1974:111-22.
16. Ritter MA. Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res 1976;(121):92-4.
PMID: 991523
17. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am 1990;72(4):518-28. PMID: 2324138
18. Hammerberg EM, Wan Z, Dastane M, Dorr LD. Wear and range of motion of different femoral head sizes. J
Arthroplasty 2010;25(6):839-43. https://doi.org/10.1016/j.arth.2009.07.007
19. Comtesse S, de Gast A, Rehbein P, French G, Helmy N, Becker R, et al. Wear and migration are not influenced
by head size in a vitamin E-infused highly cross-linked polyethylene acetabular cup. Orthop Traumatol Surg Res
2021;107(1):102644. https://doi.org/10.1016/j.otsr.2020.03.030
20. Brown JM, Mistry JB, Cherian JJ, Elmallah RK, Chughtai M, Harwin SF, et al. Femoral component revision of total hip arthroplasty. Orthopedics 2016;39(6):e1129-e1139. https://doi.org/10.3928/01477447-20160819-06
21. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the
United States. J Bone Joint Surg Am 2009;91(1):128-33. https://doi.org/10.2106/JBJS.H.00155
22. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years
old. A five-year follow-up study. J Bone Joint Surg Am 1981;63(9):1426-34. PMID: 7320033
23. Ranawat CS, Atkinson RE, Salvati EA, Wilson Jr PD. Conventional total hip arthroplasty for degenerative joint
disease in patients between the ages of forty and sixty years. J Bone Joint Surg Am 1984;66(5):745-52.
PMID: 6725322
24. Bizot P, Banallec L. Alumina-on-alumina total hip prostheses in patients 40 years of age or younger. Clin Orthop Relat Res 2000;(379):68-76. https://doi.org/10.1097/00003086-200010000-00010
25. Simesen de Bielke H, Pérez Alamino L, Garabano G, Pesciallo CA, del Sel H, Lopreite FA. Comportamiento de los tallos no cementados recubiertos con hidroxiapatita colocados con alineación coronal inadecuada en la artroplastia primaria de cadera. Resultados del seguimiento a largo plazo. Rev Asoc Argent Ortop Traumatol 2021;86(4):455-62. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1321
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Synder M, Drobniewski M, Sibiński M. Long-term results of cementless hip arthroplasty with ceramic-on-ceramic articulation. Int Orthop 2012;36(11):2225-9. https://doi.org/10.1007/s00264-012-1639-x
3. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007;370(9597):1508-19. https://doi.org/10.1016/S0140-6736(07)60457-7
4. Alp NB, Akdağ G, Erdoğan F. Long-term results of total hip arthroplasty in developmental dysplasia of hip patients. Jt Dis Relat Surg 2020;31(2):298-305. https://doi.org/10.5606/ehc.2020.74412
5. Schiffner E, Latz D, Thelen S, Grassmann JP, Karbowski A, Windolf J, et al. Aseptic loosening after THA and TKA
- Do gender, tobacco use and BMI have an impact on implant survival time? J Orthop 2019;16(3):269-72.
https://doi.org/10.1016/j.jor.2019.03.018
6. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2015;6736(14):1-9. https://doi.org/10.1016/S0140-6736(14)61798-0
7. Sculco PK, Cottino U, Abdel MP, Sierra RJ. Avoiding hip instability and limb length discrepancy after total hip
arthroplasty. Orthop Clin North Am 2016;47(2):327-34. https://doi.org/10.1016/j.ocl.2015.09.006
8. Lopreite FA, Astudillo F, Del Sel H. Complicaciones tempranas en la artroplastia total de cadera por vía
anterolateral transglútea directa. Rev Asoc Argent Ortop Traumatol 2007;72(1):75-81. Disponible en:
https://www.aaot.org.ar/revista/2007/n1_vol72/art13.pdf
9. Blankstein M, Lentine B, Nelms NJ. The use of cement in hip arthroplasty: a contemporary perspective. J Am Acad Orthop Surg 2020;28(14):e586-e594. https://doi.org/10.5435/JAAOS-D-19-00604
10. Sukeik M, Alshryda S, Powell J, Haddad FS. The effect of tranexamic acid on wound complications in primary total hip arthroplasty: A meta-analysis. Surgeon 2020;18(1):53-61. https://doi.org/10.1016/j.surge.2019.05.003
11. Cooper HJ, Della Valle CJ. Large diameter femoral heads: is bigger always better? Bone Joint J 2014;96-B(11
Supple A):23-6. https://doi.org/10.1302/0301-620X.96B11.34342
12. Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 2001;83(11):1622-9. https://doi.org/10.2106/00004623-200111000-00002
13. Lopreite AF, Dainotto T, Gaggiotti S, Del Sel H. Estudio retrospectivo comparativo entre aspirina y dabigatrán en la incidencia de eventos tromboembólicos en pacientes con artroplastia de cadera y rodilla. Rev Asoc Argent Ortop Traumatol 2021;86(4):446-54. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1303
14. Martin R, Clayson PE, Troussel S, Fraser BP, Docquier PL. Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. J Arthroplasty 2011;26(8):1362-72. https://doi.org/10.1016/j.arth.2010.11.016
15. Amstutz HC, Markoff KL. Design features in total hip replacement. En: Harris WH (ed.). The Hip. Proceedings of the Second Open Scientific Meeting of the Hip Society. St Louis: CV Mosby Co; 1974:111-22.
16. Ritter MA. Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res 1976;(121):92-4.
PMID: 991523
17. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am 1990;72(4):518-28. PMID: 2324138
18. Hammerberg EM, Wan Z, Dastane M, Dorr LD. Wear and range of motion of different femoral head sizes. J
Arthroplasty 2010;25(6):839-43. https://doi.org/10.1016/j.arth.2009.07.007
19. Comtesse S, de Gast A, Rehbein P, French G, Helmy N, Becker R, et al. Wear and migration are not influenced
by head size in a vitamin E-infused highly cross-linked polyethylene acetabular cup. Orthop Traumatol Surg Res
2021;107(1):102644. https://doi.org/10.1016/j.otsr.2020.03.030
20. Brown JM, Mistry JB, Cherian JJ, Elmallah RK, Chughtai M, Harwin SF, et al. Femoral component revision of total hip arthroplasty. Orthopedics 2016;39(6):e1129-e1139. https://doi.org/10.3928/01477447-20160819-06
21. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the
United States. J Bone Joint Surg Am 2009;91(1):128-33. https://doi.org/10.2106/JBJS.H.00155
22. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years
old. A five-year follow-up study. J Bone Joint Surg Am 1981;63(9):1426-34. PMID: 7320033
23. Ranawat CS, Atkinson RE, Salvati EA, Wilson Jr PD. Conventional total hip arthroplasty for degenerative joint
disease in patients between the ages of forty and sixty years. J Bone Joint Surg Am 1984;66(5):745-52.
PMID: 6725322
24. Bizot P, Banallec L. Alumina-on-alumina total hip prostheses in patients 40 years of age or younger. Clin Orthop Relat Res 2000;(379):68-76. https://doi.org/10.1097/00003086-200010000-00010
25. Simesen de Bielke H, Pérez Alamino L, Garabano G, Pesciallo CA, del Sel H, Lopreite FA. Comportamiento de los tallos no cementados recubiertos con hidroxiapatita colocados con alineación coronal inadecuada en la artroplastia primaria de cadera. Resultados del seguimiento a largo plazo. Rev Asoc Argent Ortop Traumatol 2021;86(4):455-62. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1321