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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.

          Related collections

          Most cited references 14

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          Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.

          Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
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            Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.

             Tajie Harris (1969)
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              The direct lateral approach to the hip.

               K Hardinge (1981)
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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
                © Springer-Verlag 2009
                Categories
                Tissue-Sparing Surgery Section
                Custom metadata
                © Springer-Verlag 2009

                Orthopedics

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

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