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      Learning curve in tissue sparing total hip replacement: comparison between different approaches

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          Abstract

          Background

          The tissue sparing surgery (TSS) concept means not only smaller incisions but also less tissue disruption, allowing decreased blood loss and improved function. However, TSS techniques can result in more complications related to the learning curve. The aim of this study was to compare the learning curve of an experienced surgeon with different TSS approaches for total hip replacement (THR) from a clinical and surgical point of view, focussing especially on complications related to the use of different geometric stems.

          Materials and methods

          Sixty patients scheduled to be operated for a primary THR were enrolled in the study and were randomly assigned to surgery by one of three different TSS approaches: lateral with mini incision (group A), minimally invasive anterior (group B) and minimally invasive antero-lateral (group C). Results from the three TSS groups were compared with a control group of 149 patients (group D).

          Results

          Our results reveal significantly reduced blood loss in the TSS groups compared with the control group, with no differences between the TSS groups. We found better early functional scores in the two minimally invasive groups (anterior and anterolateral), and a lower rate of complications with the antero-lateral TSS approach.

          Conclusion

          The antero-lateral TSS approach seems to be safer and less demanding than standard THR surgery, and is suitable for use with different stems.

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          Most cited references12

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          The direct lateral approach to the hip.

          K Hardinge (1981)
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            Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe.

            The purpose of this study was to assess current practices in blood management in elective orthopedic surgery in Europe. For this 225-center prospective survey, data were collected on 3996 patients. Actual perioperative blood loss was compared to preoperative estimates. Differences in Hb levels and other outcome variables for patients receiving allogeneic versus autologous transfusions were evaluated. The probability of allogeneic transfusion based on selected predictor variables was estimated. A total of 2640 (67%) hip and 1305 (33%) knee arthroplasty patients were evaluated. Estimated blood loss (median, 750 mL) was significantly lower than computed blood loss (median, 1944 mL). A total of 2762 (69%) patients received transfusions, including 1393 (35%) autologous-only and 1024 (25%) allogeneic-only. The probability of allogeneic transfusion decreased with increasing baseline Hb, but differentially so for men and women. Transfusion triggers were Hb levels of 8.93 +/- 1.83 g per dL for allogeneic transfusions, and 21 percent of these occurred when the Hb level was greater than 10 g per dL. Autologous blood transfusion was associated with a significantly lower rate (1%) of wound infections than allogeneic blood transfusion (4.2%). Accurate assessment of preoperative Hb levels, better estimation of perioperative blood loss, efficient use of autologous blood, adherence to transfusion guidelines, and pharmacologic alternatives contribute to effective and comprehensive blood and anemia management.
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              A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial.

              Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions. The orthopaedic literature is deficient in well-designed scientific studies to support the clinical superiority of this approach. The objective of this study was to compare the results of a single mini-incision approach with those of a standard-incision total hip arthroplasty in the early postoperative period. Two hundred and nineteen patients (219 hips) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were randomized to undergo surgery through a short incision of
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                Author and article information

                Contributors
                edoardo.monaco@tin.it
                Journal
                J Orthop Traumatol
                Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology
                Springer Milan (Milan )
                1590-9921
                1590-9999
                31 January 2009
                March 2009
                : 10
                : 1
                : 47-54
                Affiliations
                II School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
                Article
                43
                10.1007/s10195-008-0043-1
                2657353
                19384637
                054a2888-cdde-481d-bf3a-6252e3db98c2
                © Springer-Verlag 2009
                History
                : 15 October 2008
                : 15 December 2008
                Categories
                Tissue-Sparing Surgery Section
                Custom metadata
                © Springer-Verlag 2009

                Orthopedics
                antero-lateral approach,hip replacement,learning curve,tissue sparing surgery
                Orthopedics
                antero-lateral approach, hip replacement, learning curve, tissue sparing surgery

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