Rivera Fabrizio, Comba Luca C, Bardelli Alessandro
Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy.
Department of Orthopedic Trauma, Università degli Studi di Torino, Torino 10124, Italy.
World J Orthop. 2022 Apr 18;13(4):388-399. doi: 10.5312/wjo.v13.i4.388.
The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers.
To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate.
All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients' follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.
A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.
DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.
全髋关节置换术的直接前路（DAA - THA）因手术创伤小、软组织剥离少、康复时间短、能更快恢复日常活动、脱位发生率低等优点而越来越受欢迎。另一方面，文献报道术中并发症发生率较高，已发表的论文中有许多不同的发生率和并发症类型。
分析我们的并发症情况，并与文献结果进行比较；报告我们为降低并发症发生率所采取的措施。
本回顾性研究纳入了2010年1月至2019年12月期间在单一高手术量中心接受手术且至少随访一年的所有DAA - THA患者。所有手术均使用非骨水泥短解剖型或直柄假体及压配髋臼杯。术后6周、3个月进行随访，之后每年进行临床和影像学评估。主要结局指标为无菌性松动导致的假体柄翻修和全因假体柄翻修。次要结局指标为术中及术后并发症的识别。
2010年1月至2019年12月共有394例患者接受了DDA - THA，共412髋；12例患者失访，1例因与手术无关的原因死亡，被排除在研究之外。手术时的平均年龄为61岁（范围28至78岁）。平均随访时间为64.8个月（范围12至120个月）。7例假体柄进行了翻修。1例皮质穿孔，1例大转子及外侧皮质壁术中骨折，1例骨干骨折，3例临床有症状的早期下沉，1例晚期无菌性松动。我们还观察到根据温哥华分类法的3例B1型假体周围骨折。其他无需假体柄翻修的轻微并发症包括5例采用预防性环扎治疗的股骨距无移位骨折，1例早期感染，1例晚期后脱位，18例无症状的假体柄下沉，6例股外侧皮神经感觉异常。
DAA与良好的结局及较低的脱位发生率相关。通过谨慎选择患者、进行全面的术前规划、有足够的学习曲线以及使用术中成像，可以降低并发症发生率。
