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Category: Volume 06 Issue 03 March 2018
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Title: Various Approaches in Total Hip Replacement: Evaluation of Functional Outcome

Authors: Dr Ravindra Gupta, (M.S.), Dr Deepak Mantri  (M.S.), Dr Sunil Rajan (M.S.)

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.217

Abstract

Objectives & Aims: 1) To evaluate best approach for performing primary total hip replacement in view of functional improvement, intra-op minimal trauma, intra-op surgeon’s preference, post-op rehabilitation.

Various approaches available are Anterior approach, Antero-lateral approach, Lateral approach, Posterior approach, Trans trochanteric approach & Mini incision anterior approach. In our study only anterolateral (4 cases), lateral (12 cases) & posterior (7 cases) have been performed.

Evaluation of approach was based on Intra-op assessment by surgeon & Post-op assessment that included Subjective assessment by scoring system & Objective assessment by muscle charting.

Material & Methods: This Prospective study done at department of orthopaedics in M. Y. Hospital & M.G.M. Medical college INDORE from june 2010 to august 2012. All cases irrespective of cause admitted in routine opd for THR were included in study. All surgeries were elective & planned.

 Cases were studied by History, Intra-operative assessment of surgical approach used, implant details, Pre-op & post-op assessment of functional status with help of standard scoring systems. 

Conclusion: I-deal approach for total hip replacement should provide wide exposure, should be extensile, Minimal traumatic, Safe for neurovascular with Accurate Leg length & implant placement, Early & good Post-op rehabilitation, allows good post-op nursing care, Improvement in functional status etcin our study we found anterolateral approach to b superior than lateral & posterior approach

Keywords: Approach, Functional Outcome, Oxford Score, Total Score

References

  1. Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 1937;70:1.
  2. Jacobs LG, Buxton RA. The anatomy of the superior gluteal nerve: its relevance to the direct lateral approach for hip arthroplasty. J B J Surg Am 1989;71:1239–43.
  3. Burke DW, Gates EI, Harris WH. Centrifugation as a method of improving tensile and fatigue properties of acrylic bone cement. J Bone Joint Surg Am 1984;66: 1265–73.
  4. Alkire MJ, Dabezies EJ, Hastings PR. High vacuum as a method of reducing porosity of polymethylmethacrylate. Orthopedics 1987;10:1533–9.
  5. Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am 1990;72:501–8.
  6. Andersson GB, Freeman MA, Swanson SA. Loosening of the cemented acetabular cup in total hip replacement. J Bone Joint Surg Br 1972;54:590–9.
  7. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;121:20–32.
  8. Stauffer RN. Contemporary cement technique—results: total joint arthroplasty. Presented at the 1991 Hip and Knee Arthroplasty: Current Techniques Meeting; 1990 April 5; Scottsdale, AZ.
  9. Wroblewski BM, Lynch M, Atkinson JR, et al. External wear of the polyethylene socket in cemented total hip arthroplasty. J Bone Joint Surg Br 1987;69:61–3.
  10. Hartofilakidis G, Stamos K, Ioannidis TT. Fifteen years’ experience with Charnley low-friction arthroplasty. Clin Orthop 1989;246:48–56.
  11. Harris WH, Penenberg BL. Further follow-up on socket fixation using a metal-backed acetabular component for total hip replacement: a minimum ten-year follow-up study. J Bone Joint Surg Am 1987;69:1140–3.
  12. Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation: five to ten-year results. J Bone Joint Surg Am 1996;78:975–81.
  13. Havelin LI, Vollset SE, Engesaeter LB. Revision for aseptic loosening of uncemented cups in 4,352 primary total hip prostheses: a report from the Norwegian Arthroplasty Orthopaedic Surgery Volume 7, Part 1 11 Acta Orthop Scand 1995;66:494–500.
  14. Berry DJ, Barnes CL, Scott RD, et al. Catastrophic failure of the polyethylene liner of uncemented acetabular components. J Bone Joint Surg Br 1994;76:575–8.
  15. Presented at the Harris hip course. Boston, 1992.
  16. Fitzgerald RH Jr, Brindley GW, Kavanagh BF. The uncemented total hip arthroplasty: intraoperative femoral fractures. Clin Orthop 1988;235:61–6.
  17. Oishi CS, Walker RH, Colwell CW Jr. The femoral component in total hip arthroplasty: six to eight-year followup of one hundred consecutive patients after use of a third-generation cementing technique. J Bone Joint Surg Am 1994;76:1130–6.
  18. Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg Am 1997;79:177–84.
  19. Xenos JS, Hopkinson WJ, Callaghan JJ, et al. Osteolysis around an uncemented cobalt chrome total hip arthroplasty. Clin Orthop 1995;317:29–36.
  20. Capello WN, D’Antonio JA, Feinberg JR, Manley MT. Hydroxyapatite-coated total hip femoral components in patients less than fifty years old: clinical and radiographic results after five to eight years of follow-up. J Bone Joint Surg Am 1997;79:1023–9.
  21. Berger RA, Kull LR, Rosenberg AG, Galante JO. Hybrid total hip arthroplasty: 7- to 10-year results. Clin Orthop 1996;333:134–46.
  22. Lewallen DG, Cabanela ME. Hybrid primary total hip arthroplasty: a 5- to 9-year followup study. Clin Orthop 1996;333:126–33.
  23. Smith SE, Harris WH. Total hip arthroplasty performed with insertion of the femoral component with cement and the acetabular component without cement: ten to thirteenyear results. J Bone Joint Surg Am 1997;79:1827–33.

Corresponding Author

Dr Ravindra Gupta (M.S.)

Assist Prof. Index Medical College Indore (MP), India

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