Favorable Radiographic and Early Postoperative Results with the - - PowerPoint PPT Presentation
Favorable Radiographic and Early Postoperative Results with the Inguinal Crease Direct Anterior Total Hip Arthroplasty Bradford Waddell 1,2 MD, Jesse Raszweski 3 BS, Imraan Khan 2 BS, Benjamin Ricciardi 2 MD, Robert Fischer 1 BS, Brian Godshaw 1
1Ochsner Clinic Foundation; New Orleans, Louisiana 2Hospital for Special Surgery; New York, New York 3Alabama College of Osteopathic Medicine; Dothan, Alabama
– Inter-nervous and inter-muscular planes – Minimal muscle detachment – Few post operative restrictions
– Injury to lateral femoral cutaneous nerve (LCFN) – Longitudinal incision
– 29 standard direct anterior incision – 41 oblique inguinal crease incision
– Hana table – Standard approach
– Flat table, both legs prepped to assess limb length – Incision: 8cm in inguinal crease with 1/3 medial to ASIS – Femoral preparation: leg is adducted under contralateral leg
– Acetabular cup version and inclination – Heterotopic ossification (HO) formation – Leg lengths – Complications
* Most recent follow-up visit
Table 1. Demographic Data by Surgical Approach Inguinal Crease Anterior Standard Direct Anterior P-value Age 59.41 (22-83) 64.6 (46-83) 0.08 Height (cm) 164.9(155-173) 164.5 (144-205) 0.73 Weight (kg) 58.7 (45-72) 62.77 (48-92) 0.004* BMI 21.31 (18-27) 23.05 (19-27) 0.001* Sex (Percent Female) 97.5 82.7 0.03* Mean (range), *Denotes statistical significance
Table 2. Radiographic Results and Harris Hip Scores by Surgical Approach
Inguinal Crease Anterior Standard Direct Anterior P-value Length Surgery (mins) 92.0 (68-158) 92.6 (61-142) 0.97 Blood loss (cc) 166.9 (100-200) 153.45 (100-250) 0.2 Cup Size 50.4 (48-56) 51.1 (46-58) 0.29 Head Size 33.2 (32-36) 32.5 (28-40) 0.5 Stem Size 4.92 (3-10) 5.58 (4-10) 0.11 Length of Stay (days) 2.15 (1-5) 2.24(1-4) 0.67 Preop LLD (mm) 5.9 (0-30) 4.8 (0-18) 0.39 Post-op LLD (mm) 1.15 (0-4) 2.58 (0-8) 0.008* Cup Inclination (degrees) 37.39 (30-49) 40.1 (33-49) 0.02* Cup Version (degrees) 20.76 (7-28) 16.93 (9-29) 0.01* Preop HHS 60.36 (40-81) 63.35 (49-83) 0.36 Postop HHS 92.61 (61-100) 89.9 (73-100) 0.35 Preop vs Postop HHS p= 2.2x10-17 p= 1.8x10-8
*Denotes statistical significance, LLD=Limb length discrepancy, HHS=Harris Hip Score
– Inguinal crease: 0 – Direct anterior : 2 (Brooker 1)
– Inguinal crease: 4 – Direct anterior: 1 – P = 0.17
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