PMID- 34192914
OWN - NLM
STAT- MEDLINE
DCOM- 20210712
LR  - 20210712
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 103-B
IP  - 7 Supple B
DP  - 2021 Jul
TI  - Primary total hip arthroplasty via the direct anterior approach in the lateral 
      decubitus position : surgical technique, learning curve, complications, and early 
      results.
PG  - 53-58
LID - 10.1302/0301-620X.103B7.BJJ-2020-2460.R1 [doi]
AB  - AIMS: The direct anterior approach (DAA) for total hip arthroplasty (THA) has 
      potential advantages over other approaches and is most commonly performed with 
      the patient in the supine position. We describe a technique for DAA THA with the 
      patient in the lateral decubitus position and report the early clinical and 
      radiological outcomes, the characteristics of the learning curve, and 
      perioperative complications. METHODS: All primary DAA THAs performed in the 
      lateral position by a single surgeon over a four-year period from the surgeon's 
      first case using the technique were identified from a prospectively collected 
      database. Modified Harris Hip Scores (mHHS) were collected to assess clinical 
      outcome, and routine radiological analysis was performed. Retrospective review of 
      the medical records identified perioperative complications, the characteristics 
      of the learning curve, and revisions. RESULTS: A total of 257 patients were 
      included in the study. Their mean age was 60 years (SD 9.0). A total of 164 (64%) 
      were female. The mean mHHS improved significantly from 52.1 (SD 16.2) 
      preoperatively to 94.4 (SD 11) at a follow-up of one year (p < 0.001), with 212 
      of 225 patients (94%) achieving a minimal clinically important difference (MCID) 
      (> 8 points). Radiological evaluation showed a mean leg length discrepancy of 2.6 
      mm (SD 5.9) and a mean difference in femoral offset of 0.2 mm (SD 4.9). A total 
      of 234/243 acetabular components (96.3%) were positioned within Lewinnek's safe 
      zone. Analysis of operating time, blood loss, the position of the components, and 
      complications did not identify a learning curve. A total of 14 patients (5.4%) 
      had a major perioperative complication and three (1.2%) required revision THA. 
      There were no major neurovascular complications and no dislocations. CONCLUSION: 
      We have described and analyzed a surgical technique for undertaking DAA THA in 
      the familiar lateral decubitus position using a routine operating table, 
      positioning devices, and instrumentation, and shown that it can be performed 
      safely and effectively under these circumstances. Cite this article: Bone Joint 
      J 2021;103-B(7 Supple B):53-58.
FAU - Lawrie, Charles M
AU  - Lawrie CM
AD  - Washington University in Saint Louis School of Medicine, St. Louis, Missouri, 
      USA.
FAU - Bechtold, Daniel
AU  - Bechtold D
AD  - Washington University in Saint Louis School of Medicine, St. Louis, Missouri, 
      USA.
FAU - Schwabe, Maria
AU  - Schwabe M
AD  - Washington University in Saint Louis School of Medicine, St. Louis, Missouri, 
      USA.
FAU - Clohisy, John C
AU  - Clohisy JC
AD  - Washington University in Saint Louis School of Medicine, St. Louis, Missouri, 
      USA.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - IM
MH  - Arthroplasty, Replacement, Hip/*methods
MH  - Female
MH  - Humans
MH  - Learning Curve
MH  - Male
MH  - Middle Aged
MH  - *Patient Positioning
MH  - Postoperative Complications/*diagnostic imaging
MH  - Reoperation/statistics & numerical data
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Anterior approach
OT  - Complications
OT  - Learning curve
OT  - Outcomes
OT  - Technique
OT  - Total hip arthroplasty
EDAT- 2021/07/02 06:00
MHDA- 2021/07/13 06:00
CRDT- 2021/07/01 05:35
PHST- 2021/07/01 05:35 [entrez]
PHST- 2021/07/02 06:00 [pubmed]
PHST- 2021/07/13 06:00 [medline]
AID - 10.1302/0301-620X.103B7.BJJ-2020-2460.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2021 Jul;103-B(7 Supple B):53-58. doi: 
      10.1302/0301-620X.103B7.BJJ-2020-2460.R1.