Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Affiliated Hospital of Qingdao University, Qingdao, China.
Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2019 Feb;34(2):327-332. doi: 10.1016/j.arth.2018.10.023. Epub 2018 Oct 26.
Our experience with direct anterior approach total hip arthroplasty (THA) suggests that it can be performed successfully with a morphometrically optimized metaphyseal-diaphyseal engaging femoral stem (NOT a short stem), a regular operating room table (NOT a special custom table), and WITHOUT intraoperative fluoroscopy. We report our minimum 2-year results.
A retrospective review of a single-surgeon series of primary direct anterior approach THAs was performed. All procedures were performed on a regular table, without fluoroscopy, using a cementless tapered femoral stem. Clinical, functional, and radiographic outcomes were evaluated at a minimum of 2 years.
In total, 1017 primary THAs were performed. The preoperative Harris Hip Score was 40.7 ± 5.1 and improved to 95.3 ± 4.2 at minimum 2-year follow-up. There were 3 dislocations (0.3%) and 15 revisions (1.5%): 7 for infection (0.7%), 4 for periprosthetic fractures (0.4%), 2 for instability (0.2%), 1 for loosening (0.1%), and 1 for pain (0.1%). Five patients (0.5%) required blood transfusion. One patient developed deep vein thrombosis and pulmonary embolism. No intraoperative fractures, perforation, or THA-related mortality occurred. Neutral stem alignment was confirmed in 98.3%. Mean cup inclination was 38.8° ± 5.1° and anteversion was 16.2° ± 3.5°. The mean leg-length discrepancy was corrected from 1.2 ± 0.2 cm preoperatively to 0.2 ± 0.1 cm postoperatively.
Using a morphometrically optimized metaphyseal-diaphyseal engaging tapered femoral stem instead of a short stem reduces component malposition and minimizes risk of loosening. Combining the use of this implant design and the technique and elements described in our cohort demonstrated to have excellent results at 2 years. The patients will need continued follow-up to demonstrate further durability of this device and technique compared to others performing direct anterior THA.
我们在直接前路全髋关节置换术（THA）方面的经验表明，使用形态学优化的干骺端-骨干接合的髓腔锉股骨柄（而非短柄）、常规手术台（而非特殊定制台），并且无需术中透视，即可成功完成手术。我们报告了最低 2 年的结果。
对单外科医生系列原发性直接前路 THA 进行回顾性研究。所有手术均在常规手术台上进行，不透视，使用非骨水泥锥形股骨柄。至少 2 年时评估临床、功能和影像学结果。
共进行了 1017 例原发性 THA。术前 Harris 髋关节评分为 40.7±5.1，最低 2 年随访时改善至 95.3±4.2。有 3 例脱位（0.3%）和 15 例翻修（1.5%）：7 例感染（0.7%）、4 例假体周围骨折（0.4%）、2 例不稳定（0.2%）、1 例松动（0.1%）和 1 例疼痛（0.1%）。5 例（0.5%）患者需要输血。1 例发生深静脉血栓形成和肺栓塞。无术中骨折、穿孔或与 THA 相关的死亡。98.3%的患者股骨柄中立对线良好。髋臼杯平均倾斜度为 38.8°±5.1°，前倾角为 16.2°±3.5°。平均下肢长度差异从术前的 1.2±0.2cm 矫正至术后的 0.2±0.1cm。
使用形态学优化的干骺端-骨干接合的锥形髓腔锉股骨柄替代短柄可减少假体位置不当并最大程度降低松动风险。在我们的队列中，结合使用这种植入物设计和技术以及描述的技术元素，在 2 年时显示出优异的结果。需要对患者进行持续随访，以证明与进行直接前路 THA 的其他方法相比，该装置和技术具有更高的耐用性。
