Which Patient-specific Parameters Correlate with Operation Time for Total Hip Arthroplasty? - A Retrospective Analysis of the Direct Anterior Approach

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2023 Jun 3

PMID 37269401

Authors

Sebastian von Hertzberg-Boelch

Laura Mueller

Ioannis Stratos

Joerg Arnholdt

Boris Holzapfel

Maximilian Rudert

Affiliations

Soon will be listed here.

Abstract

Purpose: The current study aims to identify patient-specific factors that correlate with operation time for total hip arthroplasty (THA) performed via the direct anterior approach (DAA).

Methods: In this retrospective study, patient-specific factors were tabulated from the charts and measured from preoperative templating radiographs. These factors were correlated with operation time by bivariate analysis. Significant factors were used for stepwise multiple regression analysis.

Results: Nine hundred-sixty procedures were included. BMI (R = 0.283), the distance from the superior iliac spine to the greater trochanter (DAA Plane) (R = - 0.154), patients age (R = 0.152) and the abdominal fat flap (R = 0.134) showed the strongest correlations (p < 0.005) with operation time. The multiple regression model including BMI, Kellgren and Lawrence Score, Age, DAA Plane and the Canal to Calcar ratio had the best predictive accuracy (corrected R = 0.122).

Conclusions: Patient-specific factors that make the entry into the femur difficult correlate significantly with operation time of THA via the DAA.

Citing Articles

Comparison of surgical efficacy between direct anterior approach and posterolateral approach in the treatment of sarcopenia with femoral neck fractures.

Yin Z, Hu Q, Zhang B, Yi J, Zhang H, Yin J BMC Geriatr. 2024; 24(1):1021.

PMID: 39702122 PMC: 11660708. DOI: 10.1186/s12877-024-05621-x.

Direct Anterior Approach Total Hip Arthroplasty for Femoral Neck Fractures in the Lateral Position.

Wang X, Dai J, Wu Z, Yang Y, Zhang J, Meng X Clin Interv Aging. 2024; 19:883-889.

PMID: 38784158 PMC: 11112128. DOI: 10.2147/CIA.S458179.

Impact of obesity on outcomes after surgical stabilization of multiple rib fractures: Evidence from the US nationwide inpatient sample.

Liu Y, Chen T, Tseng C, Wang J, Wang W PLoS One. 2024; 19(2):e0299256.

PMID: 38421963 PMC: 10903825. DOI: 10.1371/journal.pone.0299256.

Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches.

Banasiak S, Hartel M, Frosch K, Berger-Groch J J Orthop Surg Res. 2024; 19(1):54.

PMID: 38212819 PMC: 10782765. DOI: 10.1186/s13018-023-04525-7.

References

Learmonth I, Young C, Rorabeck C . The operation of the century: total hip replacement. Lancet. 2007; 370(9597):1508-19. DOI: 10.1016/S0140-6736(07)60457-7. View

Fischer S, Heusgen C, Brkic M, Neun O, Klug A, Hoffmann R . Value of closed suction drainage in arthroscopic and minimally invasive surgery of the ankle joint: a prospective randomised study. Arch Orthop Trauma Surg. 2021; 143(2):657-663. DOI: 10.1007/s00402-021-04107-4. View

Moorthy V, Chen J, Liow M, Pang H, Tay D, Chia S . The effect of topical tranexamic acid on functional outcomes and quality of life in patients undergoing unicompartmental knee arthroplasty. Arch Orthop Trauma Surg. 2022; 143(7):4395-4400. DOI: 10.1007/s00402-022-04711-y. View

Rudy M, Bentley J, Ahuja N, Rohatgi N . Determinants of Cost Variation in Total Hip and Knee Arthroplasty: Implications for Alternative Payment Models. J Am Acad Orthop Surg. 2019; 28(6):e245-e254. DOI: 10.5435/JAAOS-D-18-00718. View

Samuel L, Sultan A, Rabin J, Surace P, Yao B, Moskal J . Medical Malpractice Litigation Following Primary Total Joint Arthroplasty: A Comprehensive, Nationwide Analysis of the Past Decade. J Arthroplasty. 2019; 34(7S):S102-S107. DOI: 10.1016/j.arth.2019.02.066. View

Bedard N, Pugely A, Dowdle S, Duchman K, Glass N, Callaghan J . Opioid Use Following Total Hip Arthroplasty: Trends and Risk Factors for Prolonged Use. J Arthroplasty. 2017; 32(12):3675-3679. DOI: 10.1016/j.arth.2017.08.010. View

Kraus K, Dilley J, Ziemba-Davis M, Meneghini R . Procedure Duration, Time Under Anesthesia, and Readmissions in Direct Anterior and Posterior Approach Total Hip Arthroplasty. J Arthroplasty. 2022; 37(12):2387-2393. DOI: 10.1016/j.arth.2022.06.022. View

Lu Y, Yang J, Xu Y, Ma T, Li M, Ren C . An Approach to Intraoperatively Identify the Coronal Plane Deformities of the Distal Tibia When Treating Tibial Fractures with Intramedullary Nail Fixation: a Retrospective Study. Orthop Surg. 2021; 14(2):365-373. PMC: 8867441. DOI: 10.1111/os.13194. View

Dimitriou D, Helmy N, Hasler J, Flury A, Finsterwald M, Antoniadis A . The Role of Total Hip Arthroplasty Through the Direct Anterior Approach in Femoral Neck Fracture and Factors Affecting the Outcome. J Arthroplasty. 2018; 34(1):82-87. DOI: 10.1016/j.arth.2018.08.037. View

10.

Stratos I, Heller K, Rudert M . German surgeons' technical preferences for performing total hip arthroplasties: a survey from the National Endoprosthesis Society. Int Orthop. 2021; 46(4):733-739. PMC: 8930942. DOI: 10.1007/s00264-021-05188-x. View

11.

Goebel S, Steinert A, Schillinger J, Eulert J, Broscheit J, Rudert M . Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop. 2011; 36(3):491-8. PMC: 3291765. DOI: 10.1007/s00264-011-1280-0. View

12.

Kohn M, Sassoon A, Fernando N . Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016; 474(8):1886-93. PMC: 4925407. DOI: 10.1007/s11999-016-4732-4. View

13.

Holzapfel B, Burklein D, Greimel F, Noth U, Hoberg M, Gollwitzer H . [Total hip replacement in developmental dysplasia: anatomical features and technical pitfalls]. Orthopade. 2011; 40(6):543-53. DOI: 10.1007/s00132-011-1754-1. View

14.

Woolson S, Murphy M . Wear of the polyethylene of Harris-Galante acetabular components inserted without cement. J Bone Joint Surg Am. 1995; 77(9):1311-4. DOI: 10.2106/00004623-199509000-00003. View

15.

Haversath M, Busch A, Jager M, Tassemeier T, Brandenburger D, Serong S . The 'critical trochanter angle': a predictor for stem alignment in total hip arthroplasty. J Orthop Surg Res. 2019; 14(1):165. PMC: 6542108. DOI: 10.1186/s13018-019-1206-x. View

16.

Luger M, Hochgatterer R, Schopper C, Pisecky L, Allerstorfer J, Klasan A . Obesity in short stem total hip arthroplasty using a minimally invasive supine anterolateral approach-a risk factor for short-term complications?. Int Orthop. 2021; 45(11):2833-2841. PMC: 8560722. DOI: 10.1007/s00264-021-05079-1. View

17.

Hartford J, Graw B, Frosch D . Perioperative Complications Stratified by Body Mass Index for the Direct Anterior Approach to Total Hip Arthroplasty. J Arthroplasty. 2020; 35(9):2652-2657. DOI: 10.1016/j.arth.2020.04.018. View

18.

Rudert M, Thaler M, Holzapfel B . Primary hip arthroplasty via the direct anterior approach. Oper Orthop Traumatol. 2021; 33(4):287. DOI: 10.1007/s00064-021-00725-8. View

19.

Corten K, Holzapfel B . Direct anterior approach for total hip arthroplasty using the "bikini incision". Oper Orthop Traumatol. 2021; 33(4):318-330. DOI: 10.1007/s00064-021-00721-y. View

20.

Nistor D, Caterev S, Bolboaca S, Cosma D, Lucaciu D, Todor A . Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?. Int Orthop. 2017; 41(11):2245-2252. DOI: 10.1007/s00264-017-3480-8. View