Disclosure. Direct Anterior THA via Extension Table. History 11/3/2015
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1 Direct Anterior THA via Extension Table J. Masonis, M.D. OrthoCarolina Hip & Knee Center Chief Adult Hip & Knee reconstruction Carolinas Medical Center Disclosure Consultant & Design Smith & Nephew Zimmer Corin OrthoCarolina Research Institute DePuy Corin Zimmer Smith & Nephew History 1
2 THA - What is the problem? THA is extremely successful Problems affecting longevity Infection Dislocation Osteolysis Liner wear/fracture Cup Position Strategies to reduce dislocation Larger femoral heads Taper corrosion (titanium/cobal chrome) HXLPE fracture Modular necks Taper corosion Neck / housing fracture Dual mobility articulations Limited data High surface area for volumetric poly wear Strategies to reduce wear HXLPE excellent results at 13 yr f/u Metal Metal Largely abandoned Ignorance regarding cause/effect Ceramic Ceramic Ceramic noise Liner impingement 2
3 Should we just fix the problem? Extension Table Radiolucent Extension Table: Any Advantages? Positioning / Draping Hip Extension (femoral exposure) C-Arm imaging XR in the OR, accept nothing short of perfection. XR in the PACU, accept anything short of disaster. 3
4 Positioning & Draping Conjoined tendon / femoral elevation Posterior Medial Anterio r 4
5 Video hip extension Supine position = C Arm 5
6 6
7 Video of DA THA case Effect of surgical approach and intra-operative imaging on component alignment in THA Masonis J,Ruffolo MR, Bates M, Odum S, Mason B, Fehring TK, Nogler M OrthoCarolina Hip & Knee Center Methods Retrospective chart review (600 cases) 8 Adult Reconstruction surgeons High volume subspecialty trained THA Groups based off approach and imaging method: Group 1: Direct Anterior with Fluoroscopy Group 2: Posterior with Intra-op Xray Group 3: Posterior without imaging Primary Total Hip Arthroplasty Inclusion Criteria: Adequate imaging A centered and non-rotated AP pelvis Exclusion Criteria: Patients without adequate imaging 7
8 Methods Measurement of anteversion and abduction TraumaCad 3.0 All measurements obtained by a single observer Observer blinded to the surgeon, group number, and values of anteversion and abduction. Ideal Ranges: Anteversion: Abduction: Abduction o Within Ideal Range? No Yes Anterior with Flouro 4% 96% Posterior with XR 14% 86% Posterior no XR 27% 73% 8
9 Anteversion o Within Ideal Range? No Yes Anterior with Flouro 16% 84% Posterior with XR 48% 52% Posterior no XR 46% 54% Abduction o Anteversion o Within Ideal Range? No Yes Anterior with Flouro 15% 81% Posterior with XR 55% 45% Posterior no XR 59% 41% Results Percentage of Cups in the Ideal Range Anteversion (10-30 ) Abduction (30-50 ) Both Direct Anterior 82% 96% 81% (133) p < p < Posterior Xray (195) 51% 88% 45% Posterior No Xray (131) 54% 73% 41% p < p = NS p = p = NS 9
10 References: 1. D Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW Jr. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am. 2000;82: Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty. 1998;13: Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60(2): Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau HM. John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469: Matta JM, Bhandari M, Dodgin D, Kreuzer S, Bradley G, Sprague S, Sidorkiewicz N, Mignot T, Grimes J, Masonis J, Yun A, Matthys G, Jewett B, Bellino M. Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study. Orthop Clin North Am. 2009;40(3):
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