The mini-incision posterior approach may appeal to surgeons comfortable with the standard posterior approach to the hip. We present the first systematic review and meta-analysis of these two approaches. Twelve randomised controlled trials and four non-randomised trials comprising of 1498 total hip arthroplasties were included. The mini-incision posterior approach was associated with an early improvement in Harris hip score of 1.8 points (P < 0.001), reduced operating time (5 minutes, P < 0.001), length of hospital stay (14 hours, P < 0.001), intraoperative and total blood loss (63 ml, P < 0.001 and 119 ml, P < 0.001 respectively). There were no statistically significant differences on the incidence of dislocation, nerve injury, infection or venous thromboembolic events. The minimally invasive posterior approach appears to provide a safe and acceptable alternative to the standard incision posterior approach.
The subvastus approach has potential early advantages over the medial parapatellar approach because it avoids disruption of the quadriceps tendon. We present a systematic review and meta-analysis of the functional outcomes and complications associated with these two approaches. Following an extensive search of prospective trials published in any language before 1st August 2014, studies were screened in duplicate according to pre-defined inclusion and exclusion criteria. Sixteen randomised controlled trials were included in the meta-analysis comprising of 1,711 total knee replacements. Knee society score and range of movement were significantly superior in the subvastus group at early and one-year follow up. The subvastus approach was also associated with a statistically significant reduction in the requirement for intraoperative lateral release, perioperative blood loss, visual analogue score for pain on day 1 post operatively, and the number of days to achieve active straight leg raising. Both tourniquet time and total operative time were increased for the subvastus approach. There was no statistically significant difference in complications such as stiffness requiring MUA, superficial and deep infection and deep vein thrombosis. The subvastus approach confers a functional advantage over the medial parapatellar approach to the knee which lasts for a minimum of one year postoperatively.
Cement-in-cement femoral component revision is a useful and commonly practised technique. Onerous and hazardous re-shaping of the original cement mantle is required if the new stem does not seat easily. Furthermore, without removing the entirety of the original cement mantle, the freedom to alter anteversion or leg length is difficult to predict preoperatively. We present data from in vitro experiments testing the compatibility of the top cemented stems according to UK registry figures (NJR 2013). This data augments preoperative planning by indicating which revision stems require minimal or no cement reshaping when being inserted into another stem's mantle. We also present the maximum shortening and anteversion that can be achieved without reshaping the original cement mantle.
Triple-tapered cemented stems were developed in the hope that they would reduce aseptic loosening and prevent calcar bone loss. Between March 2005 and April 2008, a consecutive series of 415 primary C-stem AMT hip arthroplasties in 386 patients were performed under the care of three surgeons at our institution. When all the patients had reached the 5-year anniversary of surgery, functional questionnaires were sent out by mail. In the event of non-response, reminders were sent by post before the patients were contacted by telephone. Postoperative radiographs were also reviewed. Follow-up ranges from 60 to 99 months, with a mean of 76 months. 32 hips (8%) were lost to follow-up. The median OHS was 40, median SF-12 mental component score (MCS) was 50, and median SF-12 physical component score (PCS) was 39. Radiographic review showed that aseptic femoral component loosening has yet to be observed. At 99 months follow up, stem survivorship is 96.9% (95% confidence interval (CI) 82.5 to 99.5). Adverse events such as calcar fracture, greater trochanter fracture and dislocation were rare at <1%. The C-stem AMT demonstrates excellent implant survivorship at 5–8 year follow-up, as well as good midterm functional outcome.
