Conversion of a Fused or Ankylosed Hip to Total Hip Arthroplasty: Is the Direct Anterior Approach in the Lateral Decubitus Position an Ideal Solution?

Jiale Dong; Lingtong Kong; Siming Zhang; Xifu Shang; Jiaxing Wang; Xianzuo Zhang; Chen Zhu

doi:10.3389/fsurg.2022.819530

Conversion of a Fused or Ankylosed Hip to Total Hip Arthroplasty: Is the Direct Anterior Approach in the Lateral Decubitus Position an Ideal Solution?

Front Surg. 2022 Feb 8:9:819530. doi: 10.3389/fsurg.2022.819530. eCollection 2022.

Authors

Jiale Dong¹, Lingtong Kong¹, Siming Zhang², Xifu Shang², Jiaxing Wang³, Xianzuo Zhang², Chen Zhu¹

Affiliations

¹ Department of Orthopedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
² Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
³ Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Background: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). However, few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment.

Methods: Here, 127 hips (65 DAA, 62 PLA) were retrospectively evaluated. Early postoperative functional outcomes of DAA and PLA groups were assessed using Harris score and Oxford Hip Score (OHS) and standard anteroposterior hip radiographs. Surgical characteristics, perioperative results, and complications within 6 months postoperatively were recorded.

Results: Though baseline values were similar, Harris and OHS scores were better in the DAA group than in the PLA group at 1 and 3 months postoperatively. The average cup anteversion angle was significantly greater in the DAA group than in the PLA group (12.7° vs. 11.1°). More hips undergoing DAA were successfully orientated in both inclination and anteversion angles (46 vs. 32). Early postoperative hip function predictors were preoperative fused hip position, surgical approach, and range of motion. DAA was associated with reduced postoperative blood loss and shorter hospital stays. Furthermore, 14 vs. 8 complications occurred in the DAA vs. PLA group. Lateral femoral cutaneous nerve injuries were observed in eight hips (12.3%) of the DAA group.

Conclusion: For fused or ankylosed hips, THA using DAA in the lateral decubitus position may result in excellent prosthesis positioning and faster postoperative recovery throughout early follow-up vs. PLA.

Keywords: ankylosed hip; direct anterior approach; hip fusion; posterolateral approach; total hip arthroplasty.