Iliopsoas impingement is a well described cause of groin pain after direct anterior total hip arthroplasty (THA). We proposed to evaluate the incidence, natural history and response to treatment of iliopsoas impingement after direct anterior total hip arthroplasty. A retrospective chart review of 725 consecutive patients who underwent anterior approach total hip arthroplasty between 2009 and 2014 was conducted. All surgeries were performed by one of two surgeons. Patients were included if they underwent primary anterior approach THA and had a minimum of 2 years of follow up. Patients who had a posterior approach, revision surgery or had less than 2 years of follow up were excluded. Iliopsoas impingement was identified if patients reported groin pain at greater than 6 weeks of postoperative follow up and in association with pain with resisted seated hip flexion. The natural history and response to treatment was recorded for patients identified as having iliopsoas impingement.Introduction
Methods
The anterior approach for total hip arthroplasty (THA) has been associated with a faster earlier functional recovery and has gained increasing utilization for primary THA exposure. However, some studies have suggested a higher risk of femoral complications, as well as difficulty with femoral exposure. Techniques of soft tissue releases have been described to offer better femoral exposure, and to help mitigate complications like femoral fracture or breach of the canal with broaching. However, appropriate titrated soft release remains important to decrease potential risk of dislocation. Here we present a suggested technique and hierarchy of soft tissue releases to adequately expose the femur. In addition, we discuss adjunctive table and patient position maneuvers for femoral exposure, as well as more extensile and revision techniques if necessary. For any figures or tables, please contact authors directly.
The direct anterior (DA) approach for total hip arthroplasty has demonstrated successful short term outcomes. However, debate remains about which patients are candidates fo this approach. To our knowledge, there are no studies which specifically investigate short-term outcomes in obese versus non-obese patients undergoing THA through a DA approach. The purpose of this study was to evaluate complication rates and short term outcomes of obese, pre-obese, and normal BMI patients undergoing THA through DA approach. A retrospective review of 151 consecutive patients who underwent unilateral THA through a DA approach for osteoarthritis or avascular necrosis was performed after IRB approval. Forty patients had a normal BMI, 54 were pre-obese, and 57 were obese by WHO classification (37 class I obese, 12 class II obese, and 8 class III obese). Electronic and paper charts were reviewed to determine differences in surgical time, length of stay, disposition, wound and major complications, and short term outcome measures.Introduction
Methods
INTRODUCTION. The Woodpecker pneumatic broaching system facilitates femoral preparation to achieve optimal primary fixation of the stem in direct anterior hip replacement using a standard operating table. The high-frequency axial impulses of the device reduce excess bone tension, intraoperative femoral fractures and overall operating time. The Woodpecker device provides uniformity and enhanced control while broaching, optimizing cortical contact between the femur and implant and thereby maximizing prosthetic axial stability and longevity. This study aims to describe a single surgeon's experience using the Woodpecker pneumatic broaching system in 649 cases of direct anterior approach (DAA) total hip arthroplasties to determine the device's safety and efficacy. METHODOLOGY. All consecutive patients undergoing elective
Background. The anterior approach for total hip arthroplasty has recently been hypothesized to result in less muscle damage. While clinical outcome studies are essential, they are subject to patient and surgeon bias. We prospectively analyzed biochemical markers of muscle damage and inflammation in patients receiving anterior and posterior minimally-invasive total hip arthroplasty to provide objective evidence of the surgical insult. Methods. 29 patients receiving an anterior and 28 patients receiving a posterior total hip arthroplasty were analyzed. Peri-operative and radiographic data were collected to ensure similar cohorts. Creatine kinase, C-reactive protein, Interleukin-6, Interleukin-1beta, and Tumor necrosis factor-alpha were collected pre-operatively, post-operatively, and on post-operative days 1 and 2. Comparisons between the groups were made using the Student's t-test and Fisher's Exact test. Independent predictors of elevation in markers of inflammation and muscle damage were determined using multivariate logistic regression analysis. Results. Markers of inflammation were slightly decreased in direct anterior group (mean differences in C-reactive protein 27.5 [95% confidence interval −24.7–79.6] mg/dL, Interleukin-6 13.5 [95% confidence interval −11.5–38.4] pg/ml, Interleukin-1beta 42.6 [95% confidence interval −10.4–95.6], and Tumor necrosis factor-alpha 148.6 [95% confidence interval −69.3–366.6] pg/ml). The rise in creatine kinase was 5.5 times higher in the post anesthesia care unit (mean difference 150.3 [95% confidence interval 70.4–230.2] units/L, p < 0.05) and nearly twice as high cumulatively in the miniposterior approach group (305.0 [95% confidence interval −46.7–656.8] units/L, p < 0.05). Conclusion.
