Total hip arthroplasty by direct anterior approach (Hueter)
Keywords:
total hip arthroplasty, direct anterior approach, Hueter.Abstract
Introduction: Hip arthroplasty is considered a successful treatment in Orthopedics. The direct anterior approach, through Hueter interval, avoids the dissection of muscular attachments to the bone and decreases the alteration of the soft tissues around the hip.
Objectives: To report the results of primary total hip arthroplasties, performed by direct anterior approach.
Methods: A descriptive-prospective case series study was carried out with patients who underwent primary uncemented total hip arthroplasty through a direct anterior approach.
Results: The female sex and the age groups of 45 and 60 years predominated. The body mass index was low and there was little anesthetic risk. Surgical time exceeded two hours, with little operative bleeding. The correct placement of the acetabular and femoral components allowed ambulation to begin in less than three days. Complications were rare and resolved with appropriate treatment.
Conclusions: The use of the direct anterior approach for primary total hip arthroplasties offers very satisfactory results.
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References
Aggarwal VK, Lorio R, Zuckerman JD, Long WJ. Surgical approaches for primary total hip arthroplasty from Charnley to now: The quest for the best approach. JBJS Rev. 2020;8(1):e58. DOI: https://doi.org/10.2106/jbjs.rvw.19.00058
Petis S, Howard J, Lanting B, Jones I, Birmingham T, Vasarhelyi E. Comparing the anterior, posterior and lateral approach: gait analysis in total hip arthroplasty. Can J Surg. 2018;61(1):2. DOI: https://doi.org/10.1503/cjs.003217
Maletti P, Garcia E, Mantilaro E, Maletti F. Abordaje anterior directo en el reemplazo total de cadera en camilla convencional con técnica mini-invasiva. Descripción de la técnica quirúrgica. Rev Acaro. 2017 [acceso 23/02/23];3(2):55-60. Disponible en: https://acarorevista.org.ar/joomla-pages-iii/categories-list/45-la-revista/ultima-edicion/143-abordaje-anterior-directo-en-el-reemplazo-total-de-cadera-en-camilla-convencional-con-tecnica-mini-invasiva-descripcion-de-la-tecnica-quirurgica
Fernández LJ, Diego D, González R. Abordaje anterior directo modificado en cirugía de cadera con técnica de mínima invasión y uso de mesa especial: descripción de la técnica. An Méd Asoc Méd Hosp ABC. 2021;66(2):104-9. DOI: https://doi.org/10.35366/100478
Tabares H, Tabares H. Abordaje anterior de la cadera: historia y beneficios. Rev Cub Ort Traumatol. 2021 [acceso 24/01/2023];35(2):e198. Disponible https://revortopedia.sld.cu/index.php/revortopedia/article/view/198
Bergin PF, Doppelt JD, Kephart CJ, Benke MT, Graeter JH, Holmes AS, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am. 2011;93(15):1392-8. DOI: https://doi.org/10.2106/jbjs.j.00557
Bremer AK, Kalberer F, Pfirrmann CW, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: Comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br. 2011;93(7):886-9. DOI: https://doi.org/10.1302/0301-620x.93b7.25058
Yang XT, Huang HF, Sun L, Yang Z, Deng CY, Tian XB. Direct anterior approach versus posterolateral approach in total hip arthroplasty: A systematic review and meta-analysis of randomized controlled studies. Orthop Surg. 2020;12(4):1065-73. DOI: https://doi.org/10.1111/os.12669
Tabares H, Quesada JM, Tabares H, Morales R. Comparación de resultados entre el abordaje anterior y posterior en la artroplastia total de cadera. Rev Cub Ort Traumatol. 2021 [acceso 24/01/2023];35(2):e258 Disponible en: https://revortopedia.sld.cu/index.php/revortopedia/article/view/258
Diego D, Cabal AA. Descripción anatómica del abordaje anterior de cadera: seguridad y efecto para artroplastía total. Acta Ortop Mex. 2020;34(2):123-8. DOI: https://doi.org/10.35366/95327
Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: A randomized controlled trial. J Arthroplasty. 2017;32(11):3421-8. DOI: https://doi.org/10.1016/j.arth.2017.05.056
Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015;30(9Suppl):94-7. DOI: https://doi.org/10.1016/j.arth.2014.12.038
Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: Perioperative findings. J OrthopTraumatol. 2011;12(3):123-9. DOI: https://doi.org/10.1007/s10195-011-0144-0
Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table: Short-term results from a community hospital. J Arthroplasty. 2009;24(7):999-1005. DOI: https://doi.org/10.1016/j.arth.2009.04.001
Sheth D, Cafri G, Inacio MC, Paxton EW, Namba RS. Anterior and anterolateral approaches for tha are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res. 2015;473(11):3401-8. DOI: https://doi.org/10.1007/s11999-015-4230-0
Fransen B, Hoozemans M, Vos S. Direct anterior approach versus posterolateral approach in total hip arthroplasty: One surgeon, two approaches. Acta Orthop Belg. 2016 [acceso 24/01/2023];82(2):240-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27831458/
Cha Y, Yoo JI, Kim JT, Park CH, Choy W, Ha YC, et al. Disadvantage during perioperative period of total hip arthroplasty using the direct anterior approach: A network meta-analysis. J Korean Med Sci. 2020;35(18):e111. DOI: https://doi.org/10.3346/jkms.2020.35.e111
Yang Z, Feng S, Guo KJ, Zha GC. Patient-reported results of simultaneous direct anterior approach and posterolateral approach total hip arthroplasties performed in the same patients. J Orthop Traumatol. 2021;22(1):46. DOI: https://doi.org/10.1186/s10195-021-00611-w
Hsu CH, Lin PC, Kuo FC, Wang JW.A regime of two intravenous injections of tranexamic acid reduces blood loss in minimally invasive total hip arthroplasty: A prospective randomized double-blind study. Bone Joint J. 2015;97-B(7):905-10. DOI: https://doi.org/10.1302/0301-620x.97b7.35029
Gilbody J, Dhotar HS, Perruccio AV, Davey JR. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty. J Arthroplasty. 2014;29(4):681-4. DOI: https://doi.org/10.1016/j.arth.2013.09.005
Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty. 2013;28(9):1473-6. DOI: https://doi.org/10.1016/j.arth.2013.06.011
Chen W, Sun JN, Zhang Y, Zhang Y, Chen XY, Feng S. Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: A systematic review and meta-analysis. J Orthop Surg Res. 2020;15(1):231. DOI: https://doi.org/10.1186/s13018-020-01747-x
Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634-8. DOI: https://doi.org/10.1016/j.arth.2013.01.034
Sun X, Zhao X, Zhou L, Su Z. Direct anterior approach versus posterolateral approach in total hip arthroplasty: A meta-analysis of results on early post-operative period. J Orthop Surg Res. 2021;16(1):69. DOI: https://doi.org/10.1186/s13018-021-02218-7
Wu H, Cheng WD, Jing J. Total hip arthroplasty by direct anterior approach in the lateral position for the treatment of ankylosed hips. Eur J Orthop Surg Traumatol. 2020;30(6):993-1001. DOI: https://doi.org/10.1007/s00590-020-02655-w
Bartlett JD, Lawrence JE, Khanduja V. What is the risk posed to the lateral femoral cutaneous nerve during the use of the anterior portal of supine hip arthroscopy and the minimally invasive anterior approach for total hip arthroplasty? Arthroscopy. 2018;34(6):1833-40. DOI: https://doi.org/10.1016/j.arthro.2018.01.012
Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop. 2012;83(4):342-6. DOI: https://doi.org/10.3109/17453674.2012.711701
Aggarwal VK, Elbuluk A, Dundon J, Herrero C, Hernandez C, Vigdorchik JM, et al. Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J. 2019;101-B(6):646-51. DOI: https://doi.org/10.1302/0301-620x.101b6.bjj-2018-1474.r1
Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table: Short-term results from a community hospital. J Arthroplasty. 2009;24(7):999-1005. DOI: https://doi.org/10.1016/j.arth.2009.04.001
Moskal JT, Capps SG, Scanelli JA. Anterior muscle sparing approach for total hip arthroplasty. World J Orthop. 2013;4(1):12-8. DOI: https://doi.org/10.5312/wjo.v4.i1.12
Alexandrov T, Ahlmann ER, Menendez LR, Bach C. Early clinical and radiographic results of minimally invasive anterior approach hip arthroplasty. Adv Orthop. 2014;2014:954208. DOI: https://doi.org/10.1155/2014/954208
Moerenhout K, Derome P, Laflamme GY, Leduc S, Gaspard HS, Benoit B. Direct anterior versus posterior approach for total hip arthroplasty: A multicentre, prospective, randomized clinical trial. Can J Surg. 2020;63(5):E412-7. DOI: https://doi.org/10.1503/cjs.012019
Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015;30(9Suppl):94-7. DOI: https://doi.org/10.1016/j.arth.2014.12.038
Macheras GA, Christofilopoulos P, Lepetsos P, Leonidou AO, Anastasopoulos PP, Galanakos SP. Nerve injuries in total hip arthroplasty with a mini-invasive anterior approach. Hip Int. 2016;26(4):338-43. DOI: https://doi.org/10.5301/hipint.5000352
Dietze S, Perka C, Baecker H. Blood vessel and nerve damage in total hip arthroplasty. Orthopade. 2014;43(1):64-9. DOI: https://doi.org/10.1007/s00132-013-2126-9
Bhargava T, Goytia RN, Jones LC, Hungerford MW. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics. 2010;33(7):472. DOI: https://doi.org/10.3928/01477447-20100526-05
Ozaki Y, Homma Y, Baba T, Sano K, Desroches A, Kaneko K. Spontaneous healing of lateral femoral cutaneous nerve injury and improved quality of life after total hip arthroplasty via a direct anterior approach. J Orthop Surg (Hong Kong). 2017;25(1):612345038. DOI: https://doi.org/10.1177/2309499016684750
Vajapey SP, Morris J, Lynch D, Spitzer A, Li M, Glassman AH. Nerve injuries with the direct anterior approach to total hip arthroplasty. JBJS Rev. 2020;8(2):e0109. DOI: https://doi.org/10.2106/jbjs.rvw.19.00109
Xu J, Zhuang WD, Li XW, Yu GY, Lin Y, Luo FQ, et al. Comparison of the effects of total hip arthroplasty via direct anterior approach and posterolateral piriformis-sparing approach. Beijing Da XueXueBao Yi Xue Ban. 2017 [acceso 23/01/23];49(2):214-20. Disponible en: https://europepmc.org/article/med/28416827
