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A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical extension table

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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.

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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

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Christoph Knoth, Ralph Zettl, Valentino Bruhin & Florian Hess

  2. Institute of Anesthesia and Intensive Care Medicine, Spital Thurgau Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Andrew Markle & Alexander Dullenkopf

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  1. Christoph Knoth
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  2. Ralph Zettl
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Correspondence to Florian Hess.

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Appendix

Appendix

Table 1 Comparison of demographic characteristics according to surgical group with or without extension table
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Table 2 Intra- and postoperative outcomes according to surgical group with or without extension table
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Knoth, C., Zettl, R., Markle, A. et al. A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical extension table. International Orthopaedics (SICOT) 44, 1701–1709 (2020). https://doi.org/10.1007/s00264-020-04596-9

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