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 purpose of the study was to assess the clinical outcomes of an algorithm for soft tissue femoral release in anterior approach (AA) total hip arthroplasty (THA). Specifically, the following were assessed in this series of patients utilizing a standardized soft tissue release sequence: 1) clinical outcomes with the Harris Hip Score (HHS); 2) re-operation rates; 3) component survivorship; and 4) complications. We retrospectively analyzed a prospectively maintained database of patients who underwent AA THA from 2014 to 2017. A total of 1000 patients were included, with minimum follow up of 2 years (range 2–5 years). The mean age was 65 years (range, 22–89), 48% were males, and the mean Body Mass Index was 34 (range, 20–52). Descriptive statistics were performed for most endpoints except for component survivorship, which was assessed with Kaplan-Meier analysis.Introduction
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There is a paucity of studies analyzing the rates of revision total knee arthroplasty in diabetic patients stratified by glycated hemoglobin levels. The purpose of this study was to: 1) determine the incidence of revision TKA; 2) correlate the percent of glycated hemoglobin with incidence of revision; and 3) determine the cause of revision in diabetic patients stratified by glycated hemoglobin level. We utilized a national private payer dataset within the PearlDiver database from 2007 to 2015 quarter 1 to determine who had diabetes and underwent TKA. There were 424,107 patients who were included in the analysis. We determined the incidence of revision TKA in the overall cohort, in addition to stratifying the incidence by glycated hemoglobin levels. To determine the effect of glycated hemoglobin levels on revision TKA rate, we performed a correlation analysis between the level of glycated hemoglobin and the incidence of revision TKA. We performed descriptive statistics of the underlying cause of revision TKA in both the overall and stratified cohortsIntroduction
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