Transitioning the total hip arthroplasty technique from posterior approach in lateral position to direct anterior approa
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ORIGINAL PAPER
Transitioning the total hip arthroplasty technique from posterior approach in lateral position to direct anterior approach in supine position—risk factors for acetabular malpositioning and the learning curve Constant Foissey 1 & Cécile Batailler 1 & Cam Fary 2 & Francesco Luceri 3 & Elvire Servien 1,4 & Sébastien Lustig 1,5 Received: 15 February 2020 / Accepted: 18 April 2020 # SICOT aisbl 2020
Abstract Purpose Cup positioning is important for optimum hip stability, avoiding component impingement and decreasing both bearing surface wear and revision rate. Transitioning from posterior approach in a lateral position to direct anterior approach (DAA) in a supine presents unique challenges for surgeons. The aim of this study was to examine the learning curve when using standard instrumentation that was not specific to DAA. Methods A consecutive retrospective series of 537 total hip arthroplasty by DAA from May 2013 to December 2017. Cup positioning was analysed on radiographs and classified whether inside or outside two safe zones (inclination 30–50° and anteversion 10–30°). The demographic data (age, BMI, gender, neck shaft angle (NSA)), surgeon’s dominant side and experience were assessed as risk factors. Results Eighty per cent of cups (n = 426) were in the combined safe zones. Eighty-eight per cent (n = 470) were in appropriate anteversion and 87% (n = 463) abduction. Two factors that were significant were identified: Cups of left hips operated by righthanded surgeons were more anteverted (OR = 4.06) and more vertical (OR = 2.23); females had a higher anteversion of the cup (OR = 2.42). Obesity, age and NSA were not risk factors for cup malposition. There was a spike of cups too horizontal at the beginning of the experience (OR = 3.86), and no learning curve was observed in the other orientations. Conclusion With our DAA technique using standard instrumentation, there were no risk factors linked to the patient identified for cup malposition. DAA-specific instrumentation is not required to achieve optimum positioning of the cup. Surgeon has to be aware of an excess of abduction at the beginning of his experience and an excess of anteversion and adduction when performing THA on the opposite side of his dominant hand. Keywords Total hip arthroplasty . Direct anterior approach . Cup positioning . Instrumentation
Level of evidence: IV retrospective, consecutive case series Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00264-020-04583-0) contains supplementary material, which is available to authorized users. * Constant Foissey [email protected]
3
Università degli Studi di Milano, Milan, Italy
4
LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
1
Orthopaedics surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
5
Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622 Ly
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