Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2022; 13(4): 388-399
Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.388
Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review
Fabrizio Rivera, Luca C Comba, Alessandro Bardelli
Fabrizio Rivera, Alessandro Bardelli, Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
Luca C Comba, Department of Orthopedic Trauma, Università degli Studi di Torino, Torino 10124, Italy
Author contributions: All authors gave substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, drafting the article and making critical revisions related to important intellectual content of the manuscript and final approval of the version of the article to be published.
Institutional review board statement: The study and follow-up, respecting the criteria of the Declaration of Helsinki, were approved by the ASN/Sav Institutional Review Board.
Informed consent statement: In this retrospective analysis we used anonymous clinical data that were obtained after each patient agreed to treatment by written consent form; all patients accepted the proposed treatment and follow-up after adequate information and gave written consent. For full disclosure, paper copy is available at SS Annunziata Hospital, Savigliano, Italy.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at rivgio@libero.it. The presented data are anonymized and risk of identification is very low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrizio Rivera, MD, Director, Department of Orthopedic Trauma, SS Annunziata Hospital, Via Ospedali n.14, Savigliano 12038, Italy. rivgio@libero.it
Received: June 26, 2021
Peer-review started: June 26, 2021
First decision: October 18, 2021
Revised: October 31, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: April 18, 2022
Processing time: 289 Days and 22.3 Hours
Abstract
BACKGROUND

The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers.

AIM

To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate.

METHODS

All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.

RESULTS

A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.

CONCLUSION

DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.

Keywords: Hip arthroplasty; Direct anterior approach; Short hip stem; Minimally invasive surgery; Complications

Core Tip: Direct anterior approach for total hip arthroplasty is increasing in popularity due to some advantages such as less surgical trauma, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. Moreover, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers. The aim of this paper is to analyze our complications comparing the results obtained in a total of 412 hips at a mean follow-up of 64.8 mo with those reported in the literature and to describe measures that we have taken to reduce complications rate.