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      Standard Transgluteal versus Minimal Invasive Anterior Approach in hip Arthroplasty: A Prospective, Consecutive Cohort Study

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          A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach.

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          Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients.

          Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction after total hip and knee replacement surgery. Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit. Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. We identified several patient characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation.
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            Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

            Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed. There were 54 hybrid and 442 uncemented hips in the 437 patients (57 bilateral). The average patient age was 64 years. Radiographic analysis showed an average abduction angle of 42 degrees , with 96% in the range of 35 degrees to 50 degrees abduction. The average cup anteversion was 19 degrees with 93% within the target range of 10 degrees to 25 degrees . Postoperative leg length discrepancy averaged 3 +/- 2 mm (range, 0-26 mm). Three patients sustained dislocations for an overall dislocation rate of 0.61%, and no patients required revision surgery for recurrent dislocation. There were 17 operative complications, including one deep infection, three wound infections, one transient femoral nerve palsy, three greater trochanter fracture, two femoral shaft fractures four calcar fractures, and three ankle fractures. Operative time averaged 75 minutes (range 40-150 minutes), and the average blood loss was 350 mL (range, 100-1300 mL). The mean hospital stay was 3 days (range, 1-17 days). The anterior approach on the orthopaedic table is a minimally invasive technique applicable to all primary hip patients. This technique allows accurate and reproducible component positioning and leg-length restoration and does not increase the rate of hip dislocation. Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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              The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital.

              Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations. We determined the percent of optimally positioned acetabular cups and whether patient and surgical factors affected acetabular component position. We obtained postoperative AP pelvis and cross-table lateral radiographs on 2061 consecutive patients who received a THA or hip resurfacing from 2004 to 2008. One thousand nine hundred and fifty-two hips had AP pelvic radiographs with correct position of the hip center, and 1823 had both version and abduction angles measured. The AP radiograph was measured using Hip Analysis Suite™ to calculate the cup inclination and version angles, using the lateral film to determine version direction. Acceptable ranges were defined for abduction (30°-45°) and version (5°-25°). From the 1823 hips, 1144 (63%) acetabular cups were within the abduction range, 1441 (79%) were within the version range, and 917 (50%) were within the range for both. Surgical approach, surgeon volume, and obesity (body mass index > 30) independently predicted malpositioned cups. Comparison of low versus high volume surgeons, minimally invasive surgical versus posterolateral approach, and obesity versus all other body mass index groups showed a twofold (1.5-2.8), sixfold (3.5-10.7), and 1.3-fold (1.1-1.7) increased risk for malpositioned cups, respectively. Factors correlated to malpositioned cups included surgical approach, surgeon volume, and body mass index with increased risk of malpositioning for minimally invasive surgical approach, low volume surgeons, and obese patients. Further analyses on patient and surgical factors' influence on cup position at a lower volume medical center would provide a valuable comparison. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

                Author and article information

                Orthop Rev (Pavia)
                Orthop Rev (Pavia)
                Orthopedic Reviews
                PAGEPress Publications, Pavia, Italy
                06 November 2013
                December 2013
                : 5
                : 4
                Department of Orthopedic Surgery, Kantonsspital Baselland , Liestal, Switzerland
                Author notes
                Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland. Tel. +41.61.9252223 - Fax: +41.61.9252871. E-mail: thomas.ilchmann@

                Contributions: TI, MC, study design, manuscript writing, data analysis; SG, LZ, data collection, data analysis, statistics

                Conflict of interests: the authors declare no potential conflict of interests.

                ©Copyright T. Ilchmann et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 28, Pages: 5


                early rehabilitation, anterior approach, minimal invasive, hip replacement


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