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Published on: September 7, 2022
Facing complications of direct anterior approach in total hip arthroplasty during the learning curve
Carlo Dall'Oca1, Alberto Ceccato2, Matteo Cresceri3
1Azienda Ospedaliera Universitaria Integrata Verona, Ortopedia e Traumatologia B, Verona, Italy. carlo.dalloca@univr.it.
Insights
Direct anterior approach total hip arthroplasty (THA) shows comparable complication rates to literature, demonstrating safety and efficiency. However, surgeons require significant training for optimal outcomes with this technique.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Surgical Outcomes Analysis
Background:
- Total hip arthroplasty (THA) is a common procedure for hip joint issues.
- The direct anterior approach (DAA) is an alternative surgical technique for THA.
- Evaluating DAA's safety and effectiveness is crucial for patient care.
Purpose of the Study:
- To assess complications associated with the direct anterior approach (DAA) in total hip arthroplasty (THA).
- To evaluate early postoperative clinical outcomes following DAA in THA.
- To compare DAA complication rates with existing literature.
Main Methods:
- Retrospective analysis of 91 patients undergoing primary elective unilateral THA via DAA.
- Data collection included patient demographics, estimated blood loss, length of stay, and operative time.
- Complications such as infection, dislocation, fracture, nerve damage, and reoperations were meticulously recorded.
Main Results:
- A total of 15.4% complications and 13.18% postoperative anemizations were observed.
- No deep infections were reported; common issues included nerve damage (3.29%), trochanter fracture (3.29%), and wound problems (3.29%).
- Dislocations occurred in 2.19% of cases, with low rates of periprosthetic fracture and revision surgery.
Conclusions:
- The complication rate for DAA in THA is comparable to established surgical methods.
- DAA is a safe and effective procedure for total hip replacement.
- Successful implementation of DAA requires a substantial learning curve for surgeons.
Background:
This study aims to evaluate complications and early postoperative clinical outcomes of direct anterior approach (DAA) in total hip arthroplasty (THA).
Methods:
Ninety-one consecutive patients who underwent primary elective unilateral THA between January 2013 and December 2019 were identified. Collected data included age of patient, BMI, ASA score, EBL (estimated blood loss), LOS (length of stay), operating time, and intra/postoperative complications. The recorded complications included prolonged wound drainage without infection, superficial and deep infection, dislocation, periprosthetic fracture, aseptic loosening or failure of osteointegration and nervous damage. Any reoperation, with or without prosthetic component revision, was recorded.
Results:
Fourteen complications (15,4%) and 12 (13,18%) postoperative anemizations were observed in this series. No deep infection was reported. Most common complications were nerve damage (3/91;3,29%), greater trochanter fracture (3/91; 3,29%), and wound trouble (3/91; 3,29%). Two (2,19%) dislocations were reported. One (1,09%) intraoperative periprosthetic fracture was treated with cerclage wiring. One (1,09%) revision was needed for an acetabular mobilization. One patient (1,09%) had severe periprosthetic ectopic ossifications (Brooker 4), needing reintervention because of severe limitations of the range of motion (ROM).
Conclusions:
Complications rate in this study with THA by DAA is comparable to those reported in literature. DAA is a safe, efficient procedure but it needs a steep learning curve. (www.actabiomedica.it).
