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Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 11, pp 1595–1600 | Cite as

Surgical approach and prosthesis fixation in hip arthroplasty world wide

  • Ofir Chechik
  • Morsi Khashan
  • Ran Lador
  • Moshe Salai
  • Eyal Amar
Hip Arthroplasty

Abstract

Background

Hip arthroplasty is one of the most common and successful surgical procedures worldwide. Component design and materials as well as surgical techniques constantly evolve. There is no consensus among surgeons regarding the ideal surgical approach and method of fixation.

Materials and methods

292 orthopedic surgeons of 10 subspecialties from 57 countries were surveyed on their choice of surgical approach and prosthesis fixation in hip arthroplasty. Their preferences were analyzed according to country of origin, field of expertise and seniority, and compared to current publications.

Results

The response rate was 95–98 %. Surgeons were split between the posterior approach (45 %) and the direct lateral approach (42 %) followed by the anterior approach (10 %) or other (3 %). North American surgeons favored the posterior approach more often than Europeans (69 % compared to 36 %, P < 0.0001) and surgeons from other countries (69 % compared to 45 %, P = 0.01). Sixty-eight percent of all surgeons routinely used noncemented hip prosthesis while 16 % use cemented and 16 % hybrid fixation. Noncemented fixation was preferred among surgeons from Europe and North America compared to other countries (73 % compared to 55 %, P < 0.05). There were no significant differences based on subspecialty, seniority or the number of years of experience.

Conclusions

The most common surgical approaches in use in hip arthroplasty are posterior and lateral. Anterior approach is used by a minority of orthopedic surgeons for that purpose. Cementing hip prosthesis is falling out of favor among orthopedic surgeons worldwide. The trend toward un-cemented hip arthroplasty is not well supported in the current literature.

Keywords

Hip Arthroplasty Cement Surgical approach 

Notes

Acknowledgments

Esther Eshkol is thanked for editorial assistance.

References

  1. 1.
    Morshed S, Bozic KJ, Ries MD, Malchau H, Colford JM Jr (2007) Comparison of cemented and uncemented fixation in total hip replacement: a meta-analysis. Acta Orthop 78(3):315–326PubMedCrossRefGoogle Scholar
  2. 2.
    Huo MH, Osier CJ (2008) Is cement still a fixation option for total hip arthroplasty? J Arthroplast 23(7 Suppl):51–54CrossRefGoogle Scholar
  3. 3.
    Puolakka TJ, Pajamäki KJ, Pulkkinen PO, Nevalainen JK (1999) Poor survival of cementless Biomet total hip: a report on 1,047 hips from the finnish arthroplasty register. Acta Orthop Scand 70(5):425–429PubMedCrossRefGoogle Scholar
  4. 4.
    Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplast 25(5):671-9.e1CrossRefGoogle Scholar
  5. 5.
    Barton C, Kim PR (2009) Complications of the direct anterior approach for total hiparthroplasty. Orthop Clin North Am 40(3):371–375PubMedCrossRefGoogle Scholar
  6. 6.
    Kuhn JE, Dunn WR, Spindler KP (2005) Evidence-based medicine for orthopedic surgeons. J Knee Surg 18(1):57–63PubMedGoogle Scholar
  7. 7.
    Suk M, Hanson B, Helfet DL (2010) Evidence-based orthopedic surgery: is it possible? Orthop Clin North Am 241(2):139–143CrossRefGoogle Scholar
  8. 8.
    Jolles BM, Bogoch ER (2004) Surgical approach for total hip arthroplasty: direct lateral or posterior? J Rheumatol 31(9):1790–1796PubMedGoogle Scholar
  9. 9.
    Lindgren V, Garellick G, Kärrholm J, Wretenberg P (2012) The type of surgical approach influences the risk of revision in total hip arthroplasty. Acta Orthop 83(6):559–565PubMedCrossRefGoogle Scholar
  10. 10.
    Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ (2006) Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res 447:34–38PubMedCrossRefGoogle Scholar
  11. 11.
    Jolles BM, Bogoch ER (2006) Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev 9(3):CD003828Google Scholar
  12. 12.
    Teratani T, Naito M, Shiramizu K (2010) Intraoperative muscle damage in total hip arthroplasty. J Arthroplast 25(6):977–981 Epub 2009 Jul 4CrossRefGoogle Scholar
  13. 13.
    Kakar S, Tornetta P 3rd, Schemitsch EH, International Hip Fracture Research Collaborative et al (2007) Technical considerations in the operative management of femoral neck fractures in elderly patients: a multinational survey. J Trauma 63(3):641–646PubMedCrossRefGoogle Scholar
  14. 14.
    Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12(3):123–129PubMedCrossRefGoogle Scholar
  15. 15.
    Müller M, Schwachmeyer V, Tohtz S, Tohtz S, Duda GN, Perka C, Heller MO (2012) The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach. Arch Orthop Trauma Surg 132(5):725–731PubMedCrossRefGoogle Scholar
  16. 16.
    Auffarth A, Resch H, Lederer S, Karpik S, Hitzl W, Bogner R, Mayer M, Matis N (2011) Does the choice of approach for hip hemiarthroplasty in geriatric patients significantly influence early postoperative outcomes? A randomized-controlled trial comparing the modified Smith-Petersen and Hardinge approaches. J Trauma 70(5):1257–1262PubMedCrossRefGoogle Scholar
  17. 17.
    Havelin LI, Espehaug B, Vollset SE, Engesaeter LB (1995) The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian arthroplasty register. J Bone Joint Surg Am 77(10):1543–1550PubMedGoogle Scholar
  18. 18.
    Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE (2000) The Norwegian arthroplasty register: 11 years and 73,000 arthroplasties. Acta Orthop Scand 71(4):337–353PubMedCrossRefGoogle Scholar
  19. 19.
    Havelin LI, Robertsson O, Fenstad AM, Overgaard S, Garellick G, Furnes O (2011) A Scandinavian experience of register collaboration: the nordic arthroplasty register association (NARA). J Bone Joint Surg Am 21(93 Suppl 3):13–19CrossRefGoogle Scholar
  20. 20.
    Emerson RH Jr, Head WC, Emerson CB, Rosenfeldt W, Higgins LL (2002) A comparison of cemented and cementless titanium femoral components used for primary total hip arthroplasty: a radiographic and survivorship study. J Arthroplast 17(5):584–591CrossRefGoogle Scholar
  21. 21.
    Müller LA, Wenger N, Schramm M, Hohmann D, Forst R, Carl HD (2011) 17-year follow-up of the rough-blasted threaded Weill cup in uncemented total hip arthroplasty. Arch Orthop Trauma Surg 131(4):557–561PubMedCrossRefGoogle Scholar
  22. 22.
    Laupacis A, Bourne R, Rorabeck C, Feeny D, Tugwell P, Wong C (2002) Comparison of total hip arthroplasty performed with and without cement: a randomized trial. J Bone Joint Surg Am. 84(A10):1823–1828PubMedGoogle Scholar
  23. 23.
    Ström H, Kolstad K, Mallmin H, Sahlstedt B, Milbrink J (2006) Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: an RSA, clinical and radiographic study. Acta Orthop 77(1):71–78PubMedCrossRefGoogle Scholar
  24. 24.
    Burston BJ, Barnett AJ, Amirfeyz R, Yates PJ, Bannister GC (2012) Clinical and radiological results of the collarless polished tapered stem at 15 years follow-up. J Bone Joint Surg Br 94(7):889–894PubMedGoogle Scholar
  25. 25.
    Clement ND, Biant LC, Breusch SJ (2012) Total hip arthroplasty: to cement or not to cement the acetabular socket? A critical review of the literature. Arch Orthop Trauma Surg 132(3):411–427PubMedCrossRefGoogle Scholar
  26. 26.
    Kim YH, Kim JS, Park JW, Joo JH (2011) Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years. J Bone Joint Surg Br 93(4):449–455PubMedCrossRefGoogle Scholar
  27. 27.
    Corten K, Bourne RB, Charron KD, Au K, Rorabeck CH (2011) Comparison of total hip arthroplasty performed with and without cement: a randomized trial. A concise follow-up, at twenty years, of previous reports. J Bone Joint Surg Am 20 93(14):1335–1338CrossRefGoogle Scholar
  28. 28.
    Kim YH, Oh SW, Kim JS (2002) Prevalence of fat embolism following bilateral simultaneous and unilateral total hip arthroplasty performed with or without cement : a prospective, randomized clinical study. J Bone Joint Surg Am 84(A8):1372–1379PubMedGoogle Scholar
  29. 29.
    Christie J, Burnett R, Potts HR, Pell AC (1994) Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg Br 76(3):409–412PubMedGoogle Scholar
  30. 30.
    Koessler MJ, Fabiani R, Hamer H, Pitto RP (2001) The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty: a randomized clinical trial. Anesth Analg 92(1):49–55PubMedCrossRefGoogle Scholar
  31. 31.
    Pitto RP, Koessler M, Kuehle JW (1999) Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. J Bone Joint Surg Am 81(6):831–843PubMedGoogle Scholar
  32. 32.
    Nayak KN, Mulliken B, Rorabeck CH, Bourne RB, Woolfrey MR (1997) Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial. Can J Surg 40(5):368–374PubMedGoogle Scholar
  33. 33.
    Engesaeter LB, Espehaug B, Lie SA, Furnes O, Havelin LI (2006) Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0–16 years in the Norwegian arthroplasty register. Acta Orthop 77(3):351–358PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ofir Chechik
    • 1
  • Morsi Khashan
    • 1
  • Ran Lador
    • 1
  • Moshe Salai
    • 1
  • Eyal Amar
    • 1
  1. 1.Department of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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