Elhadi Sariali1,2, Yves Catonne3, Hugues Pascal-Moussellard3. 1. Hôpital Pitié Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. hedisari@yahoo.fr. 2. Laboratoire d'imagerie Biomédicale, 15 rue des cordeliers, 75005, Paris, France. hedisari@yahoo.fr. 3. Hôpital Pitié Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.
Abstract
PURPOSE: The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD). METHODS: One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up. RESULTS: No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved. CONCLUSIONS: This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure. LEVEL OF EVIDENCE: Level IV.
PURPOSE: The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD). METHODS: One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up. RESULTS: No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved. CONCLUSIONS: This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure. LEVEL OF EVIDENCE: Level IV.
Entities:
Keywords:
Accuracy; Direct anterior approach; Dislocation; Planning; Three-dimensional