December 1, 2016
Solon Rosenblatt, MD Prof. Munjed Al Muderis Christopher Eddes, MS IV William Lu, PhD
Taunton MJ, Mason JB, Odum SM, Springer BD. Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. 2014 May 25
Reasons given why I DON’T do the Anterior Approach to the Hip: • Technically challenging • Impaired visualization due to working between muscle planes. • Special surgical table required for manipulation of the leg during surgery • Intraoperative x-rays needed for implant positioning • Fracture risk increases in patients with osteoporosis
Reasons given why I DON’T do the Anterior Approach to the Hip: • Not suitable for patients with significant hip deformities, flexion contractures or are significantly overweight • Surgery takes too long to perform • My patients are doing just as well a year after surgery Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, and Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons. 2014;22:595-603.
Hana Table Cost: $150,000 USD
“The Times They Are A Changing” Peter, Paul and Mary Berend KR, Lombardi, AV, et al. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. Journal of Bone and Joint Surgery. 2009;91 Taunton MJ, Mason JB, Odum SM, Springer BD. Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. 2014 May 25 Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, and Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons. 2014;22:595-603.
• • • • • •
Less damage to major muscles Less post-operative pain Faster recovery Decreased risk of hip dislocation Better range of movement Ability to perform bilateral surgeries simultaneously
Berend KR, Lombardi, AV, et al. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. Journal of Bone and Joint Surgery. 2009;91
•2010 - Present •Primary Anterior Total Hip Arthroplasties: 610 Australian Orthopaedic Association National Joint Replacement Registry, 2016 Annual Report Outcomes Following the Single-Incision Anterior Approach to Total Hip Arthroplasty: A Multicenter Observational Study, Orthop. Clin. N.A. Vol 40, Issue 3, July 2009, Pages 329-342
Revision Rates by Year 12% 11%
10.64%
10% 8.47%
9% 8% 7%
6.06%
6% 5%
4.35%
4% 3% 1.43%
2%
1.36%
1% 0%
2009
2010
2011
2012
2013
2014
2015
0.75%
2016
2017
Revision Diagnosis
N
% Revision
Loosening/Lysis
7
35.0
Prosthesis Dislocation
6
30.0
Fracture
4
20.0
Incorrect Sizing / Subsidence Leg Length Discrepancy Pain
1
5.0
1
5.0
1
5.0
N Revision
20
Type of Revision
N
% Revision
Femoral Component
7
35.0
Acetabular Component Head Only
6
30.0
3
15.0
Total Hip Revision
2
10.0
Head / Insert
1
5.0
Minor Components
1
5.0
Total
20
ASA Score
Percent
BMI (Weight)
Percent
1
10.9
40.0
5.0
Walking frame / two crutches: One crutch or walking stick: Stairs: Rise from toilet without assistance: Driving (non brake/gas leg): Driving (brake/gas leg): Return to sedentary work:
1-2 days 2-4 days 2-4 days 2-3 days 2-3 weeks 3-4 weeks 4-6 weeks
• Standard OR Table • Spinal anesthesia has been induced. • Urinary catheter has been placed. • Patient placed in the center of the table • Pannus is pulled towards the opposite side • Arm on operative side is taped towards the opposite side of the table.
• Standard OR Table • Spinal anesthesia has been induced. • Urinary catheter has been placed. • Patient placed in the center of the table • Pannus is pulled towards the opposite side • Arm on operative side is taped towards the opposite side of the table.
• Standard OR Table • Spinal anesthesia has been induced. • Urinary catheter has been placed. • Patient placed in the center of the table • Pannus is pulled towards the opposite side • Arm on operative side is taped towards the opposite side of the table.
Inserting the Acetabular Cup
1.No abduction Pillow 2.Weight bearing as tolerated in the morning 3.Begin DVT/PE prophylaxis in the morning of POD #1 4.Remove drain by the evening of POD #1 5.Remove urinary catheter by the morning of POD #2 6.Discharge to home when cleared by physiotherapy
Post Operative X-rays
Advantages to the Anterior Approach to the Total Hip Arthroplasty Procedure • • • • • •
Less damage to major muscles Less post-operative pain Faster recovery Decreased risk of hip dislocation Better range of movement Ability to perform bilateral surgeries simultaneously
Berend KR, Lombardi, AV, et al. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. Journal of Bone and Joint Surgery. 2009;91
Advantages to the Anterior Approach to the Total Hip Arthroplasty Procedure Berend KR, Lombardi, AV, et al. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. Journal of Bone and Joint Surgery. 2009;91 Taunton MJ, Mason JB, Odum SM, Springer BD. Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. 2014 May 25 Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, and Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons. 2014;22:595-603.
First fellowship in the world to offer training: • Total Hip Arthroplasty • Total Knee Arthroplasty • Osseointegration Surgery
• Over 150 total hip arthroplasties / year • Over 225 total knee arthroplasties / year • Over 100 Osseointegation surgeries / year
For further information, please contact: Australian Institute of MuscularSkeletal Research E-mail:
[email protected] Phone: +61 2 8622 3328
