A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical exte
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ORIGINAL PAPER
A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical extension table Christoph Knoth 1 & Ralph Zettl 1 & Andrew Markle 2 & Alexander Dullenkopf 2 & Valentino Bruhin 1 & Florian Hess 1 Received: 27 January 2020 / Accepted: 27 April 2020 # SICOT aisbl 2020
Abstract Purpose Using a surgical extension table during total hip arthroplasty (THA) is widely considered state-of-the-art. However, intra-operative leg positioning requires additional time and leg length determination can be challenging. Our study’s aim was to compare patient outcomes, particularly leg length precision, following surgery with or without an extension table. Methods This retrospective study included data from medical records of 324 patients who underwent THA using the direct anterior approach by one surgeon at a Swiss cantonal hospital (2015–2017). Patients were grouped by table type—standard (TS) or extension table (TE). Variables analyzed were demographics, operative/anaesthetic conditions, and medical outcomes. The leg length was measured pre- and post-operatively with mediCAD Classic®. Results An extension table was used in 161 (49.7%) patients. The median operative duration (minutes) was shorter in TS (55 (interquartile range (IQR) 48–67) than TE (60 (IQR 54–69)) (p = 0.002) and blood loss (ml) was lower (TS = 400 (IQR 300–500), TE = 500 (IQR 300–600), p = 0.0175). The median post-operative leg length discrepancy (mm) was less in TS (TS = 1 (IQR 0–3), TE = 2 (IQR 0–4), p = 0.0122). All four dislocations occurred in TE, and 7.4% of patients had complications (TS = 7%, TE = 7.5%, p = 0.99). Conclusion We found that operating on a standard table during THA resulted in slightly more favourable outcomes. Given the added expenses, human resources, and time associated with an extension table, opting for a standard table remains a sensible choice. Keywords Total hip arthroplasty . Surgical extension table . Arthroplasty . Direct anterior approach
* Florian Hess [email protected] Christoph Knoth [email protected] Ralph Zettl [email protected] Andrew Markle [email protected] Alexander Dullenkopf [email protected]
Abbreviations ASA American Society of Anesthesiologists BMI Body mass index DAA Direct anterior approach EKOS Ethikkommission Ostschweiz GT Greater trochanter IQR Interquartile range LLD Leg length discrepancy PACU Post-anaesthesia care unit SD Standard deviation TE Surgical extension table (study group) TS Standard surgical table (study group) THA Total hip arthroplasty VAS Visual analogue scale
Valentino Bruhin [email protected] 1
Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
2
Institute of Anesthesia and Intensive Care Medicine, Spital Thurgau Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
Introduction Carl Hueter first introduced the anterior approach for hip surgery in 1883 [1], which was later disseminated in 1917 to
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