The optimal approach for total hip arthroplasty (THA) remains controversial. We present the results of the Direct Superior Approach (DSA), an improved variation of the posterior approach with high levels of stability, patient-reported functional outcomes, and satisfaction. This is a single-surgeon prospective series. All patients undergoing THA between 2010 and 2015 via the DSA were included. Complication data was collected by interrogation of the Scottish Arthroplasty Project national joint registry. Pre and one-year post-operative Oxford Hip Score (OHS), Euroqol-5D (EQ-5D), and patient satisfaction questionnaires were collected. 659 patients received a THA via the DSA during the study period. Average age was 61.8 years (range 16.4–93.3). Analysis of registry data revealed no cases of dislocation, 5 cases of venous thromboembolism (0.75%), and 5 cases of deep infection (0.75%). 586 patients (88.9%) underwent their surgery in the National Health Service, and post-operative outcomes were available for 337 of these patients (57.5% follow-up) at one year. Average improvement in OHS and EQ-5D was 20 (range −14 – 48) and 0.39 (−0.697–1.2) respectively. 311 patients (92.3%) were satisfied. This description of the DSA is accessible to all surgeons, confers excellent stability with no dislocations, and is associated with excellent post-operative functional outcomes and patient satisfaction

The direct superior approach (DSA) is a modification of the posterior approach (PA) that preserves the iliotibial band and short external rotators except for the piriformis or conjoined tendon during total hip arthroplasty (THA). The objective of this study was to compare postoperative pain, early functional rehabilitation, functional outcomes, implant positioning, implant migration, and complications in patients undergoing the DSA versus PA for THA. This study included 80 patients with symptomatic hip arthritis undergoing primary THA. Patients were prospectively randomised to receive either the DSA or PA for THA, surgery was undertaken using identical implant designs in both groups, and all patients received a standardized postoperative rehabilitation programme. Predefined study outcomes were recorded by blinded observers at regular intervals for two-years after THA. Radiosteriometric analysis (RSA) was used to assess implant migration. There were no statistical differences between the DSA and PA in postoperative pain scores (p=0.312), opiate analgesia consumption (p=0.067), and time to hospital discharge (p=0.416). At two years follow-up, both groups had comparable Oxford hip scores (p=0.476); Harris hip scores (p=0.293); Hip disability and osteoarthritis outcome scores (p=0.543); University of California at Los Angeles scores (p=0.609); Western Ontario and McMaster Universities Arthritis Index (p=0.833); and European Quality of Life questionnaire with 5 dimensions scores (p=0.418). Radiographic analysis revealed no difference between the two treatment groups for overall accuracy of acetabular cup positioning (p=0.687) and femoral stem alignment (p=0.564). RSA revealed no difference in femoral component migration (p=0.145) between the groups at two years follow-up. There were no differences between patients undergoing the DSA versus PA for THA with respect to postoperative pain scores, functional rehabilitation, patient-reported outcome measurements, accuracy of implant positioning, and implant migration at two years follow-up. Both treatment groups had excellent outcomes that remained comparable at all follow-up intervals

Introduction & aims. Apparently well-orientated total hip replacements (THR) can still fail due to functional component malalignment. Previously defined “safe zones” are not appropriate for all patients as they do not consider an individual's spinopelvic mobility. The Optimized Positioning System, OPS. TM. (Corin, UK), comprises preoperative planning based on a patient-specific dynamic analysis, and patient-specific instrumentation for delivery of the target component alignment. The aim of this study was to determine the early revision rate from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for THRs implanted using OPS. TM. . Method. Between January 4. th. 2016 and December 20. st. 2017, a consecutive series of 841 OPS. TM. cementless total hip replacements were implanted using a Trinity acetabular cup (Corin, UK) with either a TriFit TS stem (98%) or a non-collared MetaFix stem (2%). 502 (59%) procedures were performed through a posterior approach, and 355 (41%) using the direct superior approach. Mean age was 64 (range; 27 to 92) and 51% were female. At a mean follow-up of 15 months (range; 3 to 27), the complete list of 857 patients was sent to the AOANJRR for analysis. Results. There were 5 revisions: . a periprosthetic femoral fracture at 1-month post-op in a 70F. a ceramic head fracture at 12-months post-op in a 59M. a femoral stem loosening at 7-months post-op in a 58M. a femoral stem loosening at 16-months post-op in a 64M. an anterior dislocation in a 53M, that was revised 9 days after the primary procedure. CT analysis, prior to revision surgery, revealed acetabular cup orientation of 46°/31° (inclination/anteversion) and femoral stem anteversion of 38°. Conclusions. These preliminary findings suggest the OPS. TM. dynamic planning and delivery system provides good early results, with a low rate of revision for dislocation. Limitations of the study will be discussed

The SPAIRE technique (Spare Piriformis And Internus, Repair Externus) involves a muscle sparing mini-posterior approach to the hip. Evidence will be prevented that the principle function of the “short external rotator” muscle group is primarily as an abductor and extensor of the flexed hip and has a profound influenced on weight bearing rising and propulsive motions; also that details of the insertions of the piriformis tendon and conjoint insertion of obturator internus and the gemelli (the Quadriceps Coxa) have previously been poorly appreciated. We have developed a surgical technique (SPAIRE) during which the only tendon released, and subsequently repaired, is obturator externus. The author has carried out the SPAIRE technique for all routine hip arthroplasties for the last 18 months. This cohort has been compared with a matched control group for a comprehensive array of outcome measures. Results show no disadvantage of using the technique. On-table stability is so impressive that when the SPAIRE technique has been used no postoperative restrictions whatsoever are placed on the patient who is immediately encouraged to exercise the hip through a full excursion of movement. Fewer tendons are damaged using the SPAIRE technique than any other approach to the hip including Direct Anterior and Direct Superior approaches. Randomised prospective studies are on-going using objective measurements of Gait and muscle power as well as functional and patient reported outcomes to prove benefit of the SPAIRE technique. For hemiarthroplasty cases a separate RCT is being undertaken comparing the SPAIRE technique with a direct lateral approach. It is believed that this technique may become the default technique for hemi- and total- hip arthroplasty through a posterior approach and for all hip fracture arthroplasty cases

Little has been written about the results of isolated acromioclavicular joint (ACJ) resection using the superior approach. We report the results of our large series. Between June 1994 and October 2003, a single surgeon performed 155 isolated ACJ resections, using the direct superior approach. Exclusion criteria were previous ipsilateral shoulder surgery, simultaneous arthroscopic procedures and OA. We asked 90 of the patients (94 shoulders) to complete the Simple Shoulder Test questionnaire by telephone. The median age of the 72 males and 18 females was 38 years (16 to 62). The dominant shoulder was involved in 54 patients. There was a history of trauma in 44 patients, with 11 rugby injuries. The median follow-up period was 29 months (6 to 118). One portal infection resolved with debridement and antibiotics. Five revision procedures were done, four open revision Mumfords and one subacromial decompression. The mean postoperative Simple Shoulder score was 11.5 (6 to 12). Patients rated outcome as excellent in 63 shoulders, good in 22, moderate in five and poor in four. The technique provides consistently good or excellent results (90%) and allows rapid return to normal function. There was complete resolution of pain in 73 of the 94 shoulders. All rugby players returned to the same level of play