Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal
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Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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best practices for obtaining adequate samples in the most frequent clinical scenarios: (a) native and prosthetic joint infections; (b) osteomyelitis and fracture-related infections; (c) spinal infections and; (d) diabetic foot infections. Although a
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. 4 However, the real incidence of IAFF is probably underestimated due to a lack of precise definition. When looking at the current literature, many studies have concentrated on prosthetic infections. Most of the applied concepts in the treatment of
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expected. 2 Differing causations hase been reported for TJA failure and revision. 3 , 4 According to recent data, peri-prosthetic joint infection (PJI) incidence constitutes between approximately 0.3% and 1.7% of all total hip arthroplasties (THA
Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Faculty of Medicine, University of Berne, Berne, Switzerland
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five years (author's transl) . Zeitschrift für Orthopädie und Ihre Grenzgebiete 1978 116 285 – 293 . 18. Barrack RL . Modularity of prosthetic implants . Journal of the American Academy of Orthopaedic Surgeons 1994 2 16 – 25 . ( https
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Orthopedics-Traumatology and Prosthetic Surgery and Hip and Knee Revision, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Purpose
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Leg length discrepancy (LLD) is a common complication following total hip arthroplasty (THA). The direct anterior approach (DAA) for THA is gaining popularity due to its advantages, but there is limited research on the incidence and size of LLD. This systematic review aims to explore the differences in LLD between DAA and other approaches, as well as the techniques to control LLD in DAA.
Methods
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A comprehensive literature search was conducted to identify relevant studies comparing THA by DAA with other surgical approaches and investigating methods to control LLD in DAA, following PRISMA guidelines and a priori registration on PROSPERO (CRD42023412644). The quality of the included studies was assessed. Data on preoperative and postoperative LLD and other relevant outcomes were extracted and analyzed descriptively.
Results
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In total, 29 studies were included in this systematic review. The majority (86%) were classified as level IV evidence. Comparisons between DAA and posterior approach (PA) or anterolateral approach (ALA) showed DAA had lower rates of LLD >10 mm compared to PA and ALA. Different pre- and intra-operative techniques were evaluated, but no consensus on the best method for preventing LLD in DAA was reached.
Conclusion
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DAA shows comparable or superior results in the prevention of LLD compared to other surgical approaches. Supine patient placement, direct leg measurement, and the use of IF contribute to these outcomes. Intraoperative fluoroscopy with a grid and preoperative planning offers a good option, especially for training purposes, but its role in preventing LLD by experienced DAA surgeons needs further investigation.
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expandable prosthetic titanium rib (VEPTR) ( Fig. 4 ) 15 , 16 or with magnetically-controlled growing rods (MCGR) ( Figs 5a and 5b ) 17 - 20 which allow the spine to grow until skeletal maturity when final spinal fusion may be performed. 21 , 22
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° anteversion, as they found it reduced the risk of prosthetic hip dislocation. While those initial surgical techniques made for popular and clinically successful total joint replacements, many complications have remained, most notably the functional
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is often considered a complementary prophylactic strategy. Cement spacers carrying high doses of antibiotics are often employed during two-stage treatment of infected prosthetic joints. However, in view of concerns regarding growing antibiotic
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reconstructive orthopaedic procedures ranging from synovectomy to prosthetic replacement. There is currently no disease-modifying therapy available to fill the gap between preventive measures and reconstructive procedures. Considering the pathogenic mechanisms
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aware, in case of a palliative or non-prosthetic option, of an alarming rate of structural failure (around 50%) in the short term. The current review does not support the initial use of complex and expensive techniques in management of posterosuperior
