Comparison of complications after transtrochanteric and posterolateral approaches for primary total hip arthroplasty☆
Section snippets
Materials and methods
The demographic and clinical data from patients who underwent primary THA performed by a single, experienced surgeon (Nas S. Eftekhar, MD) between December 1987 and December 1995 were studied. All surgeries were performed at a single university hospital (Columbia Presbyterian Medical Center, New York, NY). Prospective collection of all data was possible with the use of the Hip Assessment Record, which included the hip examination and grading of hips both preoperatively and postoperatively
Transtrochanteric approach group
The transtrochanteric group consisted of 100 THAs in 90 patients. The mean age and standard deviation for this group at the time of THA was 63 ± 11.9 years (range, 19–88 years). Fifty-four (60%) of these patients were women and 36 were men. The average patient in this group weighed 69.1 kg (range, 45.9–103.5 kg) and was 168.0 cm in height (range, 147.3–185.4 cm); corresponding to a mean body mass index of 24.9 (STD, 3.8). Fifty-four of the 100 THAs (54%) were performed on the left hip while the
Discussion
Total hip arthroplasty has long been an accepted orthopaedic procedure capable of providing high-quality results and significant patient satisfaction. Obtaining these results relies partly on the surgeon’s ability to achieve the necessary surgical exposure. The transtrochanteric approach pioneered by Charnley provides an extensive surgical exposure and allows for advancement of the trochanter and proper soft tissue tensioning, aids the accurate orientation of prosthetic implants, and
Acknowledgements
The authors wish to thank Louis U. Bigliani, M.D. for his leadership and guidance and Maureen Sheahan for her help with logistics and manuscript preparation.
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Cited by (17)
Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial
2021, Revue de Chirurgie Orthopedique et TraumatologiqueGreater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial
2021, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Patients with GTP have shown pain and activity levels similar to patients with osteoarthritis [4]. Several studies have compared the posterior and the transtrochanteric approach, reporting less GTP for the posterior approach [1,2,5]. The posterior approach (PA) was regarded as relatively more protective, compared to the lateral approach.
Lateral Trochanteric Pain Following Primary Total Hip Arthroplasty: Incidence and Success of Nonoperative Treatment
2021, Journal of ArthroplastyCitation Excerpt :Prior literature surrounding surgical approach as an independent risk factor for the development of LTP following THA is lacking. The transtrochanteric approach has been illustrated as a risk factor for postoperative LTP [6,7]; however, this approach is not commonly utilized for primary THA [20,21]. Few studies have attempted to quantify the incidence of LTP following THA by surgical approach.
The “capsular noose”: A new capsular repair technique to diminish dislocation risk after the posterior approach total hip arthroplasty
2019, International Journal of Surgery OpenCitation Excerpt :Although causes of postoperative dislocation of the hip can be multifactorial and include patient-dependent factors like gender, previous hip surgery, dysplasia,neurological status and patient compliance [1–5], common causes under the surgeon's direct influence include component malpositioning and failure to restore soft tissue tension through accurate restoration of leg length and femoral offset. Surgical approach has also been shown to affect dislocation rates especially the posterior approach which classically carries the highest risk of dislocation when compared to the direct lateral, true anterolateral, and direct anterior approaches [6–8]. Traditionally, the posterior approach has been popular because of minimized blood loss and operative time, ease of exposure, minimal postoperative abductor weakness, and lower risk of heterotopic ossification [1,9–11].
Total Hip Arthroplasty Requiring Subtrochanteric Osteotomy for Developmental Hip Dysplasia. 5- to 14-Year Results
2007, Journal of ArthroplastyCitation Excerpt :Our approach preserves the integrity of the abductor muscles and proximal femoral bony architecture. Previously described techniques, particularly the transtrochanteric approach, which decompresses tissue tension by removal of the proximal femur then advancement of the greater trochanter to the residual femur, significantly violate the osseous and soft tissues of the hip and increase healing requirements [10, 11]. This study has several shortcomings, including its retrospective methodology and small sample size.
Technique of tissue-preserving, minimally-invasive total hip arthroplasty using a superior capsulotomy
2004, Operative Techniques in Orthopaedics
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No benefits or funds were received in support of this study.