Department of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
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MSK Lab, Imperial College London, London, UK
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Introduction Prosthetic joint infection (PJI) is one of the most feared complications of arthroplasty surgery due to its resistance to therapy with existing antibiotics. 1 It is a major cause of failure in arthroplasty, being the leading
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Introduction Being the third most common cause of revision surgery following primary total hip arthroplasty (THA), peri-prosthetic joint infection (PJI) constitutes one of the most undesired complications, with a prevalence of 0.3% to 2
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School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
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School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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debris (ARMD) ( 1 , 2 , 3 , 4 ). There is also an increasing number of case reports describing systemic reactions in relation to elevated blood cobalt concentrations known as prosthetic hip-associated cobalt toxicity (PHACT) ( 5 , 6 ). Increased
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Leeds Institute of Rheumatic Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds, UK
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Leeds Institute of Rheumatic Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds, UK
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Leeds Institute of Rheumatic Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds, UK
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Joint Registry (NJR) data indicating 10-year revision rates of approximately 2% for a number of commonly used prostheses ( 6 ). Nonetheless, prosthetic joint infection (PJI) remains a devastating complication. Of all single- and first-stage revisions (of
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Introduction Minor prosthetic migration as detected by radiostereometric analysis (RSA) 1 – with a detection limit of 0.1–0.2 mm – is sometimes seen as unrelated to loosening since such prosthetic components usually remain asymptomatic
Department of Surgery, Albany Health Campus, Albany, Australia
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Department of Surgery, Université de Montréal, Montréal, Québec, Canada
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personalized medicine, we aim to reproduce the patient’s native anatomy and the physiological articular environment, aiming to improve prosthetic kinematics and restoring normal function. Our new quest is to offer a forgotten hip joint to our patients
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
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Department of Trauma and Orthopaedic Surgery, Hospital Nostra Senyora de Meritxell, Andorra
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Universidad de Valladolid, Valladolid, Spain
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Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
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fracture in the presence of a pre-existing non-prosthetic implant ( 4 , 5 ). Even with implant improvement, several reports have shown a potential risk of femoral fractures after osteosynthesis due to changes in bone elastic modulus, ‘stress riser’ effect
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.
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
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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
