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Total hip replacement (THR) has become one of the most commonly performed orthopedic surgical procedures, and levels of patient satisfaction are generally high. (1) Nevertheless, some controversy still exists regarding [...], Background: The most effective surgical approach to total hip replacement (THR) remains controversial. Most studies that have compared approaches have reported only short-term outcome data. It is therefore unclear in the literature if a particular surgical approach offers long-term advantages. The aim of this study was to determine the effect of the 3 main surgical approaches to THR on patient-reported outcomes 5 years after surgery. Methods: All patients who underwent a THR for osteoarthritis or osteonecrosis between 2008 and 2012 by an anterior, posterior or lateral approach at The Ottawa Hospital in Ontario, Canada, were included in the study. All preoperative and postoperative scores for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) questionnaires were recorded. Analy sis of covariance was used to study the relationship between the amount of change in scores on the HOOS and WOMAC subscales (dependent variables) and the surgical approach. The confounding factors of age, sex, American Society of Anesthesiologists (ASA) class, Charnley classification and body mass index were included in the analysis. Results: There were 138 patients (37.6%) in the posterior approach group, 104 (28.3%) in the lateral approach group and 125 (34.1%) in the anterior approach group. There were no significant differences among the 3 groups in terms of Charnley classification, body mass index, sex, ASA class, surgical side and preoperative functional scores. We did not observe any sig nificant differences in the amount of change in the scores for HOOS and WOMAC subscales among the 3 groups. There were also no differences in the final postoperative scores. Conclusion: Our findings suggest that the choice of surgical approach in primary THR surgery without revision has no influence on functional outcomes and quality of life after 5 years. Further studies are needed to assess how patient age and sex may influence the functional outcome of individual surgical approaches. Contexte : L'approche chirurgicale la plus efficace pour l'arthroplastie totale de la hanche (ATH) n'a pas ete determinee. La plupart des etudes qui ont compare les differentes approches n'ont fait etat que de donnees a court terme. Donc, la litterature nous renseigne peu sur leurs bienfaits a long terme. Le but de cette etude est de verifer l'effet des 3 principales approches chirurgicales pour l'ATH sur les parametres rapportes par les patients 5 ans apres la chirurgie. Methodes : Tous les patients soumis a une ATH pour arthrose ou osteonecrose entre 2008 et 2012 par approche anterieure, posterieure ou laterale a l'Hopital d'Ottawa, en Ontario, au Canada, ont ete inclus dans l'etude; et tous les scores preoperatoires et postoperatoires des questionnaires HOOS (Hip Disability and Osteoarthritis Outcome Score) et WOMAC (Western Ontario and MacMaster Universities Osteoarthritis Index) ont ete enregistres. L'analyse de covariance a servi a etudier le lien entre l'ampleur des changements aux scores des sous-echelles HOOS et WOMAC (variables dependantes) et l'approche chirurgicale. L'analyse a aussi tenu compte de facteurs de confusion tels que l'age, le sexe, la classe ASA (American Society of Anesthesiologists), classification de Charnley et indice de masse corporelle. Resultats : Le groupe soumis a l'approche posterieure comptait 138 patients (37,6 %), a l'approche laterale 104 (28,3 %) et a l'approche anterieure 125 (34,1 %). Il n'y avait pas de differences significatives entre les 3 groupes aux plans de la classification de Charnley, de l'indice de masse corporelle, du sexe, de la classe ASA, du cote ou la chirurgie a ete effectuee et des parametres fonctionnels preoperatoires. Nous n'avons observe aucune difference significative quant a l'ampleur du changement aux scores des sous-echelles HOOS et WOMAC entre les 3 groupes; il en est alle de meme pour les scores postoperatoires finaux. Conclusion : Selon nos observations, le choix de l'approche chirurgicale pour l'ATH primaire sans revision n'exerce aucune influence sur les parametres fonctionnels et la qualite de vie apres 5 ans. Il faudra proceder a d'autres etudes pour evaluer l'influence potentielle de l'age et du sexe sur les parametres fonctionnels des differentes approches.

Background: Preoperative planning is a fundamental step for successful total hip arthroplasty (THA). Studies have highlighted the accuracy of preoperative digital templating for estimating acetabular cup and stem size. Stem design such as single-wedge metadiaphyseal (Type 1 stem) versus mid-short stem (microplasty) and surgical approach (anterior, direct lateral or posterior) have not been well investigated as predictors of THA templating accuracy. Methods: 204 patients (220 hips) who had undergone elective THA between November 2016 and December 2019 and presented a saved preoperative template were retrospectively reviewed. Templates from 5 different surgeons were involved in the analysis. 3 different approaches were used: direct lateral (DL), posterior (PA), direct anterior (DAA). 2 different stem designs were used: single-wedge metadiaphyseal and single-wedge mid-short (Biomet Taperloc Microplasty), while the acetabular component remained the same. Bivariate and multivariate regression analyses were performed to determine predictors of accuracy. Results: Femoral component size templating accuracy was significantly improved when using the single-wedge mid-short stem (Taperloc Microplasty) design when performing bivariate analysis. Although accuracy of cup sizing was not affected by approach, precision was significantly better in the PA group (p < 0.05). Accuracy of templating was found to be independent of BMI and gender but dependent on presence of calibration marker and stem design (p < 0.05). Conclusions: When striving for improved templating accuracy, acetabular and femoral component accuracy were best achieved using a calibration marker and a metaphyseal short femoral stem design. [ABSTRACT FROM AUTHOR]

Background: Many patients undergo both THA and spinal arthrodesis, and those patients may not fare as well as those who undergo one procedure but not the other. The mechanisms of how spinal arthrodesis affects patient function after THA remain unclear.Questions/purposes: The aims of our study were to (1) determine how patient-reported outcome measures (PROMs), including the Oxford hip score as well as dislocations and complications compare after THA between patients with and without spinal arthrodesis; (2) characterize sagittal pelvic changes in these patients that occur when moving between different functional positions and test for differences between patients with and without spinal arthrodesis; and (3) assess whether differences in sagittal pelvic dynamics are associated with PROMs, complications, and dislocations after THA.Methods: In this case-control study, we identified 42 patients (60 hips) who had undergone both THA and spinal arthrodesis between 2002 and 2016 and who were available for followup at a minimum of 12 months (mean, 6 ± 5 years) after the later of the two procedures. These cases were case-control-matched for age, gender, and body mass index with 42 patients (60 hips) who underwent only THA and had no known spinal pathology. All patients completed PROMs, including the Oxford hip score, and underwent four radiographs of the pelvis and spinopelvic complex in three positions (supine, standing, and deep-seated). Cup orientation and various spinopelvic parameters, including pelvic tilt and pelvic-femoral angle, were measured. The difference in pelvic tilt between standing and seated allowed for patient classification based on spinopelvic mobility into normal (± 10°-30°), stiff (< ± 10°) or hypermobile (> ± 30°) groups.Results: Compared with the THA-only group, the THA-spinal arthrodesis group had inferior PROMs (Oxford hip score, 33 ± 10 versus 43 ± 6; p < 0.001) and more surgery-related complications (such as dislocation, loosening, periprosthetic fracture or infection, psoas irritation) (12 versus 3; p = 0.013), especially dislocation (5 versus 0; p = 0.023). We detected no difference in change of pelvic tilt between supine and standing positions between the groups. When standing, patients undergoing THA-spinal arthrodesis had greater pelvic tilt (25° ± 11° versus 17° ± 8°; p < 0.001) and the hip was more extended (193° ± 22° versus 185° ± 30°; p = 0.012). We found that patients undergoing THA-spinal arthrodesis were more likely to have spinopelvic hypermobility (12 of 42 versus three of 42; odds ratio, 5.2; p = 0.02) with anterior tilting of the pelvis. Of all biomechanical parameters, only spinopelvic hypermobility was associated with inferior PROMs (Oxford hip score, 35 ± 9 versus 40 ± 7 in normal mobility; p = 0.049) and was also present in dislocating hips that underwent revision despite acceptable cup orientation.Conclusions: In patients with spinal arthrodesis who have undergone THA, spinopelvic hypermobility is associated with inferior outcomes, including hip instability. Spinopelvic hypermobility should be routinely assessed because these patients may have a narrow zone of optimum cup orientation that would require new technology to define and assist the surgeon in obtaining it.Level of Evidence Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

The current depth and breadth of experience in hip resurfacing in Canadian academic centers is not well known. This study endeavors to increase awareness of the prevalence of programs and current experience in a select number of representative teaching centers by examining the learning curve of high-volume surgeons. A questionnaire, was sent to all academic centers in Canada to identify the volume of hip resurfacing, surgical approach, and type of prosthesis. In addition, five surgeons, not fellowship-trained in hip resurfacing, were selected for a detailed review of their first 50 cases, including survey of patient demographics, surgical approach, radiographic evaluation, complications, and revision. Eleven of 14 academic centers am currently performing hip resurfacing. All of these centers had performed more than 50 cases, with 10 of 11 of them having more trait one surgeon performing the procedure. The posterior approach was found to he the most commonly utilized in surgeries. The overall revision rate was 3.2% at a mean time of 2 years, with femoral neck fracture (1.6%) being the most common cause for failure. The failure rate was comparable to other centers of expertise and lower than previously published multicenter trials. All surgeons reviewed were in specialized arthroplasty practices, which may contribute to the relatively low complication rates reported. [ABSTRACT FROM AUTHOR]