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Background: Femoral neck fracture (FNF) is a prevalent injury among the elderly, associated with significant morbidity and mortality. Total joint arthroplasty (TJA) has markedly enhanced the quality of life for many patients; however, the benefits of the direct anterior approach (DAA), which has gained popularity in recent years, remain a subject of debate. Sarcopenia frequently occurs in patients with FNF and is linked to adverse surgical outcomes. This study aims to compare the effects of the DAA and the posterolateral approach (PLA) on the efficacy of TJA surgery in patients with FNF who also present with sarcopenia. Methods: This study retrospectively analyzed the clinical data of patients with FNF who underwent total hip arthroplasty (THA) using either DAA or PLA from December 2019 to December 2022. A total of 141 individuals were included, comprising 52 in the DAA group and 89 in the PLA group. The cross-sectional area (cm²) of the musculature at the pedicle level of the 12th thoracic vertebra (T12) was measured using chest computed tomography (CT). The skeletal muscle index (SMI) was calculated by dividing the cross-sectional area of the muscle at the T12 pedicle level by the square of the individual's height. Sarcopenia was diagnosed when both grip strength and SMI values fell below the diagnostic cutoff. The study compared various factors, including age, gender, SMI, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, operation time, incision length, blood loss, blood transfusion, hemoglobin drop, albumin drop, postoperative time to ambulation, length of hospitalization, visual analogue scale (VAS) score, Harris score at one and six months post-surgery, complications, revision rate, one-year survival rate following surgery, and patient satisfaction. Results: There were no statistically significant differences between the two groups regarding gender, age, SMI, BMI, ASA, operation time, blood transfusion, VAS score six months post-surgery, revision rate, satisfaction, and survival rate (P > 0.05). The incision length, blood loss, hemoglobin drop, albumin drop, hospitalization duration, VAS score, and complication rate one month after the operation in the DAA group were all significantly lower than those in the PLA group (P < 0.001). Additionally, the Harris scores at one month and six days post-operation were superior in the DAA group compared to the PLA group (P < 0.001). Furthermore, the incidence of complications in the DAA group was lower than that in the PLA group (P = 0.041). Univariate and multivariate Cox regression analyses indicated that age was an independent risk factor for patients' mortality risk (95% CI: 1.064–1.479, P = 0.007). Conclusion: DAA results in reduced surgical trauma, alleviates postoperative pain, decreases the incidence of complications, enhances the recovery of patients' mobility functions, shortens hospital stays, and is particularly suitable for FNF patients with sarcopenia. [ABSTRACT FROM AUTHOR]

Background: The neurosurgical treatment of thoracic disc herniation (TDH) has undergone dramatic changes over the years in terms of surgical approaches and intraoperative technological tools. There is still no unanimous consent on the criteria for approach selection, and the choice varies among Institutions. The aim of this study is to compare anterior and posterolateral approaches for TDH in terms of functional and surgical outcomes. Methods: A systematic literature review and meta-analysis according to PRISMA guidelines from EMBASE, PubMed, Cochrane Library, Web of Science, and Google Scholar online databases up to May 2024 incorporated studies that reported outcomes of thoracic disc herniation surgeries. Analyzed factors included major peri- and postoperative complications, intraoperative blood loss, hospital stay, neurological improvement, and complete hernia resection. Random-effect models were used to calculate pooled odds ratios and mean differences. Results: The posterolateral approach was associated with significantly lower rates of major medical (OR 0.14, 95% CI: 0.07 to 0.27) and surgical complications (OR 0.61, 95% CI: 0.38 to 0.99) compared to the anterior approach. Additionally, posterolateral approaches reduced intraoperative blood loss and shorter hospital stays. Posterolateral techniques were linked to higher odds of neurological improvement (OR 0.65, 95% CI: 0.43 to 0.99) and higher rates of complete hernia resection (OR 0.38, 95% CI: 0.21 to 0.71). Conclusions: Posterolateral approaches offer advantages in terms of safety, recovery, neurological improvement, and complete hernia resection. More extensive prospective studies are needed to confirm these findings and refine surgical strategies. Emerging technologies, such as the exoscope and 45° endoscopy, may further enhance surgical outcomes. [ABSTRACT FROM AUTHOR]

The present study shows how posterior malleolus fractures (PMFs) and distal fibular fractures were fixed using the posterolateral approach with the patient in lateral decubitus position, not previously described in the literature. This technique has been used in 60 consecutive patients (42 women and 18 men; mean age 54.7; range 21-92 years), 33 of which presented as fracture dislocations from March, 2021 to December, 2023. After PMFs fixation in lateral decubitus position, release of the sacral support allowed patients to be placed supine (without de-sterilizing the operative field), in order to proceed with medial malleolus or posteromedial fragment fixation. Fractures were classified according to the Lauge Hansen classification as SER4 (n = 50), PER4 (n = 7), SAD (n = 1), and PAB (n = 2). Fractures were classified according to Rammelt & Bartonicek, as type B (n = 40), C (n = 13), and D (n = 7). During the same period of time 14 fractures involving the PM, classified as type A, were treated with indirect fixation, whilst 6 geriatric and/or poor mobility patients with fracture dislocations were treated with retrograde hindfoot nail fixation. Follow-up period ranged from 4-36 months (mean = 14.4; SD = 8.8). Complications occurred in 5 patients (8.3%; 3 had delayed (medial) wound healing, one developed CRPS and one required implants removal and arthroscopy because of metal irritation and stiffness). No deep infections, thromboembolic events, fracture malreductions or malunions were recorded and all patients returned to the preinjury mobilization status. In conclusion, PM fracture fixation was feasible and safely performed with patients in lateral decubitus position. [ABSTRACT FROM AUTHOR]

Abstract Background Femoral neck fracture (FNF) is a prevalent injury among the elderly, associated with significant morbidity and mortality. Total joint arthroplasty (TJA) has markedly enhanced the quality of life for many patients; however, the benefits of the direct anterior approach (DAA), which has gained popularity in recent years, remain a subject of debate. Sarcopenia frequently occurs in patients with FNF and is linked to adverse surgical outcomes. This study aims to compare the effects of the DAA and the posterolateral approach (PLA) on the efficacy of TJA surgery in patients with FNF who also present with sarcopenia. Methods This study retrospectively analyzed the clinical data of patients with FNF who underwent total hip arthroplasty (THA) using either DAA or PLA from December 2019 to December 2022. A total of 141 individuals were included, comprising 52 in the DAA group and 89 in the PLA group. The cross-sectional area (cm²) of the musculature at the pedicle level of the 12th thoracic vertebra (T12) was measured using chest computed tomography (CT). The skeletal muscle index (SMI) was calculated by dividing the cross-sectional area of the muscle at the T12 pedicle level by the square of the individual’s height. Sarcopenia was diagnosed when both grip strength and SMI values fell below the diagnostic cutoff. The study compared various factors, including age, gender, SMI, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, operation time, incision length, blood loss, blood transfusion, hemoglobin drop, albumin drop, postoperative time to ambulation, length of hospitalization, visual analogue scale (VAS) score, Harris score at one and six months post-surgery, complications, revision rate, one-year survival rate following surgery, and patient satisfaction. Results There were no statistically significant differences between the two groups regarding gender, age, SMI, BMI, ASA, operation time, blood transfusion, VAS score six months post-surgery, revision rate, satisfaction, and survival rate (P > 0.05). The incision length, blood loss, hemoglobin drop, albumin drop, hospitalization duration, VAS score, and complication rate one month after the operation in the DAA group were all significantly lower than those in the PLA group (P

Abstract Background The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity due to perceived advantages in achieving better early outcomes. However, the theoretical benefits such as precise implant positioning and accurate leg length restoration are still inconsistent. In this study, we compared implant position and leg length discrepancy (LLD) of the DAA and posterolateral approach (PLA) conducted by a single surgeon who had mastered both approaches. Methods This study retrospectively reviewed the medical records and radiographic images of 244 patients who underwent THA between 2012 and 2021 by a single experienced surgeon using either the DAA (n = 120) or PLA (n = 124). Postoperative pelvic anteroposterior radiographs at 6 months follow-up were used to assess acetabular component inclination and anteversion, as well as LLD. Mann-Whitney U tests and Chi-squared test were performed to compare outcomes between the two approaches. Results No significant differences were observed in patient demographics between the two groups. The DAA group demonstrated significantly lower postoperative LLD (0.00 mm) compared to the PLA group (5.00 mm, p

Purpose: This single-center study aimed to determine whether surgical neurolysis influences muscle power recovery in sciatic nerve palsy following total hip arthroplasty (THA). Methods: Among 1912 THAs performed between 2007 and 2019, a total of 1575 THAs using a posterolateral approach (primary THA, 1483 cases; revision THA, 92 cases) were retrospectively reviewed. Subjects who showed sciatic nerve palsy with motor disturbance were extracted. Demographic data, muscle power, and sensory disturbance at the onset of palsy and at final follow-up were examined. Subjects were divided into two groups (conservative treatment group and surgical treatment group) and clinical outcomes were compared between the two groups. Positive recovery was defined as muscle power greater than Manual Muscle Test grade 3. Results: Thirteen cases (0.8%), including eight in the conservative treatment group and five in the surgical treatment group, showed post-operative sciatic nerve palsy. Four cases (80.0%) in the surgical treatment group achieved full muscle power recovery. All three subjects who received surgical treatment on the day of onset of palsy achieved full muscle power and sensory recovery. More patients recovered muscle power in the surgical treatment group than in the conservative treatment group. Conclusion: Muscle power recovery was found in 80.0% of cases in the surgical treatment group and 12.5% of the conservative treatment group. All cases that received surgical intervention on the onset day of palsy achieved full muscle power and sensory recovery, whereas no cases achieved full muscle power recovery in the conservative treatment group. Immediate surgical intervention should be considered for sciatic nerve palsy following THA using a posterolateral approach.

Abstract Background The surgical approach impacts the outcomes and recovery after total hip arthroplasty (THA), and approaches may affect the stem positioning. Contrary to the general concept of minimally invasive surgery, the direct anterior approach (DAA) results in more intraoperative blood loss. Therefore, the objective of this study was to compare stem positioning and hidden blood loss (HBL) among three surgical approaches: the minimally invasive DAA, Orthopadische Chirurgie Munchen (OCM), and the traditional posterolateral approach (PLA). Methods A total of 201 patients undergoing their first non-cemented THA using the DAA, OCM, and PLA were included in the study. General demographic data, stem alignment, and blood loss were evaluated. Specific comparison measurements included femoral neck anteversion, femoral stem anteversion, alignment of the stem in coronal and sagittal planes, proximal and distal medullary ratios, and femoral offset. Blood loss was measured by calculating Intraoperative Blood Loss ( IBL), visible blood loss (VBL), and hidden blood loss (HBL). Results There were no significant differences in age, gender, body mass index, preoperative diagnosis, or femoral Dorr classification among the three groups. The mean surgical time was longer for the DAA and OCM compared to the PLA (P

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity due to perceived advantages in achieving better early outcomes. However, the theoretical benefits such as precise implant positioning and accurate leg length restoration are still inconsistent. In this study, we compared implant position and leg length discrepancy (LLD) of the DAA and posterolateral approach (PLA) conducted by a single surgeon who had mastered both approaches. Methods: This study retrospectively reviewed the medical records and radiographic images of 244 patients who underwent THA between 2012 and 2021 by a single experienced surgeon using either the DAA (n = 120) or PLA (n = 124). Postoperative pelvic anteroposterior radiographs at 6 months follow-up were used to assess acetabular component inclination and anteversion, as well as LLD. Mann-Whitney U tests and Chi-squared test were performed to compare outcomes between the two approaches. Results: No significant differences were observed in patient demographics between the two groups. The DAA group demonstrated significantly lower postoperative LLD (0.00 mm) compared to the PLA group (5.00 mm, p < 0.0001). No significant difference was observed in the Lewinnek zone for cup anteversion and inclination angles between the two groups. Conclusions: For experienced surgeons in other approaches, our findings suggest transferring to the DAA may not substantially improve cup positioning, but it might slightly enhance limb length measurement. For surgeons already proficient in other approaches and deciding to maintain those approaches, their primary concern for optimal THA outcome should be striving for leg length equivalence. [ABSTRACT FROM AUTHOR]

There are two main surgical fixation methods for the posterior malleolar fractures (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs. We searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications. Six studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], P ＜0.00001, I2 =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], P = 0.04, I2 =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. We suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications (arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs. Ⅱb [ABSTRACT FROM AUTHOR]

Background: To compare the efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in total hip arthroplasty (THA) in terms of operation time, incision length, intraoperative blood loss, postoperative pain, and incision infection rate. Methods: We systematically searched databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese sci-tech journals, Chinese Biomedical Literature Database (CBM), PubMed, and Cochrane Library up to December 2023. We included randomized controlled trials (RCTs) that compared DAA with PLA in THA, with a minimum sample size of 80 and a follow-up of at least 6 months. Studies were screened by two independent researchers, following PRISMA guidelines. Data were extracted using a pre-established feature table, capturing study design, sample size, patient demographics, and outcomes of interest. Meta-analysis was performed using RevMan 5.4.1 software. Heterogeneity was assessed using the Q-value statistical test and I² test. The fixed-effects model was used when heterogeneity was low; otherwise, the random-effects model was applied. Results: A total of 19 RCTs met the inclusion criteria. The Meta-analysis revealed that DAA was associated with a longer operation time [MD = 5.89, 95%CI(2.26 to 9.51), P = 0.001] but resulted in a smaller incision length [MD = -2.99, 95%CI(-3.76 to -2.22), P < 0.00001], less intraoperative blood loss [MD=-108.36, 95%CI(-131.10 to -85.62), P < 0.00001], lower incidence of postoperative incision infection [OR = 0.39, 95%CI(0.19 to 0.83), P = 0.01], and reduced hip Visual Analog Scale (VAS) scores on the 1st and 3rd days postoperatively [MD=-0.85, 95%CI(-0.96 to -0.74), P < 0.00001; MD=-0.60, 95%CI(-1.13 to -0.07), P = 0.03]. No significant difference was observed in VAS scores on the 7th postoperative day. Conclusion: The DAA for THA offers advantages over PLA, including reduced incision size, blood loss, and postoperative pain, albeit with a longer operation time. These findings should guide clinical decision-making, considering the benefits and potential increased complexity of the DAA. [ABSTRACT FROM AUTHOR]

Background: The surgical approach impacts the outcomes and recovery after total hip arthroplasty (THA), and approaches may affect the stem positioning. Contrary to the general concept of minimally invasive surgery, the direct anterior approach (DAA) results in more intraoperative blood loss. Therefore, the objective of this study was to compare stem positioning and hidden blood loss (HBL) among three surgical approaches: the minimally invasive DAA, Orthopadische Chirurgie Munchen (OCM), and the traditional posterolateral approach (PLA). Methods: A total of 201 patients undergoing their first non-cemented THA using the DAA, OCM, and PLA were included in the study. General demographic data, stem alignment, and blood loss were evaluated. Specific comparison measurements included femoral neck anteversion, femoral stem anteversion, alignment of the stem in coronal and sagittal planes, proximal and distal medullary ratios, and femoral offset. Blood loss was measured by calculating Intraoperative Blood Loss (IBL), visible blood loss (VBL), and hidden blood loss (HBL). Results: There were no significant differences in age, gender, body mass index, preoperative diagnosis, or femoral Dorr classification among the three groups. The mean surgical time was longer for the DAA and OCM compared to the PLA (P < 0.01). IBL was highest in the DAA group and lowest in the PLA (P < 0.05). Postoperative stem anteversion were significantly different among the groups, with the DAA showing the greatest anteversion difference (P < 0.05). There was no difference in the stem coronal alignment. However, there were more valgus and varus implants in the sagittal plane for the DAA and OCM. The femoral offset reduction was less optimal in the DAA and OCM groups (P < 0.05). The proximal and distal medullary ratios were lower in the DAA and OCM (P < 0.05). HBL was significantly lower in the DAA and OCM compared to the PLA (P < 0.05). Conclusion: Minimally invasive approaches such as DAA and OCM offer advantages in muscle and soft tissue preservation, leading to reduced HBL compared to the conventional PLA. However, these approaches present challenges in femoral stem positioning and longer surgical times. [ABSTRACT FROM AUTHOR]

Purpose: In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. Methods: This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. Results: This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. Conclusions: This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length. [ABSTRACT FROM AUTHOR]

There is no consensus on whether direct anterior approach (DAA) or postero-lateral approach (PLA) total hip arthroplasty (THA) confers a lower risk of postoperative complications. Robotic assistance in THA results in a more consistently accurate component position compared to manual THA. The objective of this study was to compare rates of dislocation, reoperation, revision, and patient-reported outcome measures between patients undergoing DAA and PLA robotic-assisted primary THA. We identified 2,040 consecutive robotic-assisted primary THAs performed for primary osteoarthritis, using DAA (n = 497) or PLA (n = 1,542) between 2017 and 2020. The mean follow-up was 18 months. Kaplan-Meier analysis estimated survivorship free of dislocation, reoperation, and revision. Achievement of patient acceptable symptom state and minimum clinically important difference were used to compare changes in the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) and Visual Analog Scale. Dislocation was rare in this series (14 in 2,040, 0.7%), including 1 of 497 (0.2%) in the DAA cohort and 13 of 1,542 (0.8%) in the PLA cohort (P =.210). There was no difference in 2-year reoperation-free survivorship (97.8 versus 98.6%, P =.59) or revision-free survivorship (98.8 versus 99.0%, P =.87) at any time point. After controlling for age, sex, and body mass index, there was no difference in dislocation, reoperation, or revision. At 6-week follow-up, after controlling for age, sex, and body mass index, patients in the DAA cohort had higher odds of achieving HOOS JR minimum clinically important difference (odds ratio = 2.01, P =.012) and HOOS JR patient acceptable symptom state (odds ratio = 1.72, P =.028). There were no differences in patient-reported outcome measures by 3 months. For robotic-assisted primary THA, DAA may confer enhanced early (<6 weeks) functional recovery compared to the PLA, but there was no significant difference in postoperative dislocation, reoperation, or revision rates. [ABSTRACT FROM AUTHOR]

Aim: To facilitate the posterolateral approach to the posterior malleolus patients are often positioned prone initially, then turned supine to complete fixation at the medial malleolus. We sought to define observed differences in the radiographic appearance of implants relative to the joint line, in prone and supine positions. Methods: A 3.5 mm tubular plate and a 3.5 mm posterior distal tibial periarticular plate were applied sequentially to 3 individual cadaveric legs, via a posterolateral approach. The tubular plate was positioned to simulate buttress fixation and the posterolateral plate placed more distally. Each limb was secured on a custom jig and radiographs were taken on a mobile c-arm fluoroscopy machine with a calibration ball. A series of prone AP, supine PA and mortise radiographs were taken. Prone radiographs were also taken in different degrees of caudal tilt to simulate knee flexion which occurs in practice, during intraoperative positioning. Plate tip-joint line distances were measured and Mann–Whitney U tests performed. Results: There was no statistically significant difference in plate tip-joint line distance when comparing equivalent prone and supine views (PA/AP or mortise). However, significant differences in apparent implant position were noted with alterations in caudal tilt. When taking a prone image, when the knee is flexed to 20 degrees, the plate tip will appear 6.5–8.5 mm more proximal than in the equivalent supine image where the knee is extended and the fluoroscopy beam is orthogonal to the anatomic axis of the tibia. Conclusion: Observed differences in radiographic appearance of metalwork in the prone and supine position are most likely due to knee flexion and the resulting variation in the angle of the fluoroscopy beam, rather than projectional differences between supine and prone views. Surgeons should be alert to this when analysing intraoperative images. [ABSTRACT FROM AUTHOR]

AbstractObjective The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those who received posterolateral approach (PLA) for total hip arthroplasty (THA) in the treatment of femoral neck fractures.Methods An electronic search was conducted in databases including PubMed, Embase, Web of Science, the Cochrane Library, and CNKI from their inception to January 2022. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of DAA compared to PLA for the management of total hip arthroplasty (THA) in elderly patients using the dichotomous or continuous method with a random or fixed-effect model.Results 15 studies involving 1284 patients were included; 640 patients receiving DAA and 644 patients receiving PLA. DAA had a longer surgery duration than PLA [WMD = 9.41, 95% CI (4.64, 14.19), I2=95.5%]; The amount of postoperative drainage [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], length of incision [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], blood loss [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], hospitalization time [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], and postoperative bedtime [WMD = −5.56,95% CI (−7.11, −4.01), I2=99.0%], were similar between the two groups (p 0.05).Conclusions DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients than PLA. However, DAA was found to be associated with a high incidence of lateral femoral cutaneous nerve injury and a low incidence of postoperative dislocation.Key messagesThe present study aims to evaluate the clinical outcomes in elderly patients receiving DAA versus PLA for THA in the treatment of femoral neck fractures by mate-analysis.DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients. No significant difference was observed between the colchicine and comparators in terms of the need for HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively, acetabular anteversion angle, acetabular abduction angle, and complications (wound infection, deep vein thrombosis, and intraoperative fracture).

Background. Almost half of the patients with ankle fractures have fracture of the posterior malleolus. Conclusions of the existing studies are contradictory and do not provide a decisive answer to the question of the need for fixation of the posterior tibial fragment. Aim of the study — to compare the radiologic and functional outcomes of osteosynthesis of the posterior tibial fragment in unstable ankle fractures using closed reduction and minimally invasive technique and direct open reduction using posterolateral and posteromedial surgical approaches. Methods. Prospective multicenter study enrolled 132 patients with complex ankle and posterior malleolus fractures. They were divided into three groups depending on the technique of fixation of posterior tibia. Functional and radiologic results of treatment were assessed at 12, 24, and 48 weeks after osteosynthesis. The AOFAS and Neer scales were used. Results. Bone union occurred in all patients at an average of 8.3±0.8 weeks after surgery. Analysis of postoperative CT scans showed that the use of posterior approaches provided statistically significantly more precise reduction of the fragments of posterior tibia. Functional results of patients of the second (posterolateral approach) and third (posteromedial approach) groups at 24 and 48 weeks of follow-up were statistically significantly superior to those of the first group. The median AOFAS score at 48 weeks of follow-up was 86 for group 2 patients and 90 — for group 3. The median scores on the Neer scale were 88 and 94 points respectively. Conclusion. Posterior approaches in the surgical treatment of patients with complex ankle and posterior malleolus fractures allow for more precise fragment open reduction compared to closed one. These patients also show better mid-term functional outcomes.

Abstract Background With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery. Methods A total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77). Results Group A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041). Conclusion The use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.

Abstract Background This retrospective study compares the invasiveness of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA) by assessing three widely used inflammation-related serum markers in the first ten post-operative days. Methods The database of our institution was mined for primary THAs conducted by the DAA or the PLA from February 2020 to June 2022. Demographics and creatine kinase (CK), C-reactive protein (CRP), and white blood cells were compared. Propensity Score Matching (PSM) analysis (1:1 ratio) was conducted based on multiple variables. Results PSM analysis yielded 44 pairs of DAA and PLA patients. CK was significantly higher (p

A patient with pain after right total hip arthroplasty (THA) in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine was recorded. The patient conducted the posterolateral approach hip revision by comprehensive diagnosis after admission. The AIHIP system was used for preoperative design. During the operation, it was found that the polyethylene liner was worn and broken, but the bone of the acetabular cup was well inserted and extremely firm. Therefore, the internal surface of the acetabular cup was polished, the polyethylene liner was implanted, and the revision was performed by using bone cement fixation, instead of all replacement of the femoral head, lining and acetabular side prosthesis. The operation was successful, the patient recovered well after the operation, and was cured and discharged. The loss of conventional polyethylene material lining is about 20 years, and the lining of this patient was worn through and broken in 8 years after surgery without further loosening of the prosthesis, which was relatively special. In this study, the causes of rupture and treatment revision methods were discussed, surgery, treatment methods and precautions were exchanged, and relevant literature was reviewed. [ABSTRACT FROM AUTHOR]

Background: The treatment of the third malleolus has evolved in recent years, and surgical treatment can be carried out with traditional percutaneous osteosynthesis using anteroposterior screws or ORIF with a posterolateral plate. Methods: Our study included 54 patients divided into two groups based on the intervention type (screw or plate). Instrumental assessments comprised pre- and post-operative X-rays and pre-operative CT scans to evaluate joint step-off. The mean follow-up duration was 1 year and 9 months. Results: Radiographic control revealed no loss of reduction or mobilization of the synthesis devices, and all patients achieved fracture healing. Articular step-off > 2 mm was observed in 21 patients (38.9%), including 4 in the plate group and 17 in the screw group, with a statistically significant likelihood of step-off presence in the latter. The mean AOFAS score was 90 points, negatively correlated with age, and lower in patients with joint step-off and a 15° reduction in ROM. Conclusions: The management of posterior malleolus fractures has changed with anatomical studies and an understanding of ankle stability through CT scans. ORIF with a posterior plate is advantageous for anatomical reduction of the tibial plafond but is disadvantageous in terms of surgical invasiveness and technical difficulty. [ABSTRACT FROM AUTHOR]

To design percutaneous endoscopic surgery via a posterolateral approach for the treatment of central cervical disc herniation. From October 2019 to October 2020, 12 consecutive patients with central cervical disc herniation underwent percutaneous endoscopic posterior lateral cervical surgery. The imaging examination (dynamic X-ray, computed tomography, and magnetic resonance imaging of the cervical spine) was conducted after the operation. Visual analog scale score and the modified Japanese Orthopaedic Association score was performed before and after the operation. Twelve patients (6 men and 6 women; mean age 52.08 ± 9.3 years) were included, and the average operation time was 105.00 ± 10.55 minutes. Postoperative computed tomography and magnetic resonance imaging results showed that the treatment segment of all patients was prominent, the cervical intervertebral disc was completely removed, the cervical spinal cord was fully decompressed, and there were no cases of infection, cerebrospinal fluid leakage or neurological complications. The average follow-up time after the operation was 22.83 ± 3.13 months. One year after the operation, there was no cervical instability in the X-ray examination of cervical flexion and extension position. Preoperative visual analog scale score and the modified Japanese Orthopaedic Association score were significantly improved at the last follow-up. Percutaneous endoscopic posterior lateral cervical discectomy provides a new surgical method for the endoscopic treatment of central cervical disc herniation. This treatment has a better surgical field and easier operation, which can remove the protruding cervical disc under the endoscope and make sure that the cervical spinal cord is fully decompressed. The clinical effect is satisfactory. A small amount of pedicle resection will not cause cervical instability. [ABSTRACT FROM AUTHOR]

The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those who received posterolateral approach (PLA) for total hip arthroplasty (THA) in the treatment of femoral neck fractures. An electronic search was conducted in databases including PubMed, Embase, Web of Science, the Cochrane Library, and CNKI from their inception to January 2022. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of DAA compared to PLA for the management of total hip arthroplasty (THA) in elderly patients using the dichotomous or continuous method with a random or fixed-effect model. 15 studies involving 1284 patients were included; 640 patients receiving DAA and 644 patients receiving PLA. DAA had a longer surgery duration than PLA [WMD = 9.41, 95% CI (4.64, 14.19), I2=95.5%]; The amount of postoperative drainage [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], length of incision [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], blood loss [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], hospitalization time [WMD= −3.88, 95% CI (−5.59, −2.17), I2=98.3%], and postoperative bedtime [WMD = −5.56,95% CI (−7.11, −4.01), I2=99.0%], were similar between the two groups (p < 0.05). The HHS at 1 month, 12 months postoperatively [WMD = 7.58, 95%CI (5.70,9.46), I2=89.5%; WMD= 2.56, 95%CI 0.11,5.00, I2=93.2%] and the incidence of LFCN in patients were higher in the DAA group (OR = 2.91, 95% CI 1.26 to 6.71, I2=0.0%), while fewer patients in the DAA group suffered from postoperative dislocation than in the PLA group (OR = 0.26, 95% CI 0.11 to 0.60, I2=0.0%). No significant difference was observed in HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively at each time point, acetabular anteversion angle, acetabular abduction angle, wound infection, deep vein thrombosis, and intraoperative fracture (p > 0.05). DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients than PLA. However, DAA was found to be associated with a high incidence of lateral femoral cutaneous nerve injury and a low incidence of postoperative dislocation. The present study aims to evaluate the clinical outcomes in elderly patients receiving DAA versus PLA for THA in the treatment of femoral neck fractures by mate-analysis. DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients. No significant difference was observed between the colchicine and comparators in terms of the need for HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively, acetabular anteversion angle, acetabular abduction angle, and complications (wound infection, deep vein thrombosis, and intraoperative fracture). [ABSTRACT FROM AUTHOR]

Introduction: Total hip arthroplasty (THA) is a successful surgery, but despite the advancements in anesthesiology and orthopedics, sometimes blood transfusions are required to manage the anemia due to the blood loss, involving a substantial number of patients. The aim of this retrospective comparative study is to define how the choice of the surgical approach, either direct anterior (DA) or posterolateral (PL), may influence the postoperative blood loss and the need for transfusion in THA. Materials and methods: Data collection was carried out retrospectively of THAs performed between 2016 and 2021 on primary hip osteoarthritis treated by DA or with PL approach. Clinical and perioperative anesthetic data were collected. Preoperative hemoglobin levels were compared with the lowest detected level by calculating ΔHb (hemoglobin decrease). Then, data from the two groups were cross-checked: duration of surgery, whether premedication with tranexamic acid, duration of the hospitalization, rate of need for hemotransfusions, and amount of blood transfused. The two samples were subdivided into subgroups according to age, BMI, tranexamic acid prophylaxis, and chronic treatment with drugs that alter coagulative properties. Results: Time of surgery was longer for patients treated with DA access (mean DA: 78.8 min; mean PL: 74.8 min; p: 0.05; 95% CI), but the length of hospitalization was shorter for patients treated with DA group with a mean time of 6.23 days versus 7.12 days for the PL group (p < 0.01). DA THA resulted advantageous mainly in patients between 66 and 75 years, showing a reduced postoperative transfusion requirement in the postoperative period (DA: 13.43%—mean: 1.33 units; PL: 26.82%—mean: 1.18 units; p: 0.044, 95% CI). Patients that assume blood-altering drugs showed a higher transfusion rate (p < 0.01), but comparison of the two subgroups showed that the choice of the surgical approach did not significantly affect the transfusion rate in these patients (p: 0.512). Prophylaxis with tranexamic acid reduced the transfusion rate (p < 0.01). Conclusion: Patients treated by minimally invasive direct anterior approach undergo a significantly shorter hospitalization. From the analysis of patient's subgroups those aged between 66- and 75-years benefit from the DA approach mainly for the minor blood loss with less frequent transfusion requirement. [ABSTRACT FROM AUTHOR]

Increased complication rates have been reported during the learning curve for direct anterior approach (DAA) total hip arthroplasty (THA). However, emerging literature suggests that complications associated with the learning curve may be substantially reduced with fellowship training. Our institutional database was queried to identify 2 groups: (1) 600 THAs comprised of the first 300 consecutive cases performed by 2 DAA fellowship-trained surgeons; and (2) 600 posterolateral approach (PA) THAs, including the most recent 300 primary cases performed by 2 experienced PA surgeons. All-cause complications, revision rates, reoperations, operative times, and transfusion rates were evaluated. Comparing DAA and PA cases, there were no significant differences in rates of all-cause complications (DAA = 18, 3.0% versus PA = 23, 3.8%; P =.43), periprosthetic fractures (DAA = 5, 0.8% versus PA = 10, 1.7%; P =.19), wound complications (DAA = 7, 1.2% versus PA = 2, 0.3%; P =.09), dislocations (DAA = 2, 0.3% versus PA = 8, 1.3%, P =.06), or revisions (DAA = 2, 0.3% versus PL = 5, 0.8%; P =.45) at 120 days postoperatively. There were 4 patients who required reoperation for wound complications, all within the DAA group (DAA = 4, 0.67% versus PA = 0; P =.045). Operative times were shorter in the DAA group (DAA <1.5 hours = 93% versus PA <1.5 hours = 86%; P <.01). No blood transfusions were given in either group. In this retrospective study, DAA THAs performed by fellowship-trained surgeons early in practice were not associated with higher complication rates compared to THAs performed by experienced PA surgeons. These results suggest that fellowship training may allow DAA surgeons to complete their learning curve period with complication rates similar to experienced PA surgeons. [ABSTRACT FROM AUTHOR]

Background: There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce further heterogeneity and bias to the evidence presented. This meta-analysis aims to present level I evidence by comparing functional outcomes, peri-operative parameters and complications of direct anterior approach (DAA) versus posterior approach (PA) or lateral approach (LA) in THA. Patients and methods: A comprehensive multi-database search (PubMed, OVID Medline, EMBASE) was conducted from date of database inception to 1st December 2020. Data from randomised controlled trials comparing outcomes of DAA versus PA or LA in THA were extracted and analysed. Results: Twenty-four studies comprising 2010 patients were included in this meta-analysis. DAA has a longer operative time (MD = 17.38 min, 95%CI: 12.28, 22.47 min, P < 0.001) but a shorter length of stay compared to PA (MD = − 0.33 days, 95%CI: − 0.55, − 0.11 days, P = 0.003). There was no difference in operative time or length of stay when comparing DAA versus LA. DAA also had significantly better HHS than PA at 6 weeks (MD = 8.00, 95%CI: 5.85, 10.15, P < 0.001) and LA at 12 weeks (MD = 2.23, 95%CI: 0.31, 4.15, P = 0.02). There was no significant difference in risk of neurapraxia for DAA versus LA or in risk of dislocations, periprosthetic fractures or VTE between DAA and PA or DAA and LA. Conclusion: The DAA has better early functional outcomes with shorter mean length of stay but was associated with a longer operative time than PA. There was no difference in risk of dislocations, neurapraxias, periprosthetic fractures or VTE between approaches. Based on our results, choice of THA approach should ultimately be guided by surgeon experience, surgeon preference and patient factors. Level of evidence I: Meta-analysis of randomised controlled trials. [ABSTRACT FROM AUTHOR]

Background: With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery. Methods: A total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77). Results: Group A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041). Conclusion: The use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to investigate the clinical outcomes of salvage total hip arthroplasty (THA) after medial buttress plate surgery for femoral neck fractures via the modified Hardinge approach (MHA) and posterolateral approach (PLA) through a retrospective analysis. PATIENTS AND METHODS: From October 2016 to October 2020, a total of 41 patients with failed femoral neck fractures treated with cannulated screws and medial buttress plates underwent unilateral salvage THA, and a retrospective study was conducted. According to the surgical approach, patients were divided into PLA group and MHA group. Clinical and radiological data were evaluated. The primary outcome indicators were the Pain Visual Analog Scale (VAS) and Hip Harris Score (HHS). Secondary outcome indicators include hemoglobin (HGB), hematocrit (HCT), creatine kinase (CK), creatine kinase-MB (CK-MB), etc. The occurrence of postoperative complications was also recorded. RESULTS: There were no differences in demographic or clinical characteristics before surgery. There were no differences in postoperative HGB, HCT, CK-MB and radiological parameters. The surgical approach had no effect on the hospitalization period. The PLA group had earlier ambulation time, and the serum level of CK was also low. Analysis of the HHS and VAS showed that on postoperative day 3, the PLA group had superior scores. The incidence of complications did not significantly differ between groups. CONCLUSIONS: The posterolateral approach for salvage THA provides better functional recovery with less muscle damage in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: This retrospective study compares the invasiveness of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA) by assessing three widely used inflammation-related serum markers in the first ten post-operative days. Methods: The database of our institution was mined for primary THAs conducted by the DAA or the PLA from February 2020 to June 2022. Demographics and creatine kinase (CK), C-reactive protein (CRP), and white blood cells were compared. Propensity Score Matching (PSM) analysis (1:1 ratio) was conducted based on multiple variables. Results: PSM analysis yielded 44 pairs of DAA and PLA patients. CK was significantly higher (p < 0.001) in the DAA than in the PLA group on postoperative day (POD) 2, 5 and 10. The POD2, POD5 and POD10 CK/preoperative CK ratio was 12.9, 5.0 and 0.8 in DAA and 8.8, 3.3 and 0.6 in PLA (p = 0.017, p = 0.012 and p = 0.025, respectively). The POD2, POD5 and POD10 CRP/preoperative CRP ratio was 95.1, 65.6 and 22.8 in PLA and 34.7, 23.3 and 8.9 in DAA (p < 0.001, p = 0.002 and p < 0.001, respectively). Conclusion: PSM analysis of early postoperative CK and CRP values demonstrated that the DAA should be considered as a less stressful approach, not as a muscle-sparing or a minimally invasive THA approach. [ABSTRACT FROM AUTHOR]

Abstract Background The total hip arthroplasty (THA) has gained popularity in in the treatment of severe developmental dysplasia of the hip (DDH). the posterior lateral approach (PLA) has good clinical efficacy and has been confirmed by the majority clinicians. Nevertheless, controversy exists regarding longer-term benefits of the direct anterior approach (DAA). The objective of this study was to investigate the clinical efficacy and placement of S-ROM prosthesis in the treatment of severe DDH by The total hip arthroplasty (THA) with different surgical approaches. Methods A retrospective analysis was performed on 42 patients with severe DDH admitted to our hospital from August 2015 to February 2022, who were treated with S-ROM prosthesis for total hip arthroplasty and subtrochanteric osteotomy of the femur. They were divided into DAA group and PLA group according to different surgical approaches. Perioperative indicators and imaging data were collected. Results The surgery time, intraoperative blood loss, and creatine kinase difference in DAA group and PLA group was without a statistically significant difference (P > 0.05). The postoperative length of hospitalization was shorter in the DAA group than in the PLA group (6.50 ± 3.15 vs 9.18 ± 4.93, P = 0.045). The acetabular abduction angles、the acetabular anteversion angles, the safe area ratio, The difference of femoral eccentricity, and the vertical difference of rotation center in DAA group and PLA group, there was no statistical significance (P > 0.05). Statistically significant differences were detected the horizontal difference of rotation center (P = 0.044). Conclusions Total hip arthroplasty with S-ROM prosthesis is a feasible procedure for severe dysplastic DDH. The clinical efficacy and prosthesis placement parameters of DAA approach are advantage to those of PLA approach.

Introduction: Posterolateral approach has been advocated for the treatment of ankle fractures involving the posterior malleolus and satisfactory results were demonstrated in several studies. The Bartonicek classification based on 3-dimensional CT scanning was commonly used for treatment recommendation of posterior malleolar fracture (PMF). The aim of this retrospective study was to evaluate the clinical effect of the posterolateral approach for the treatment of PMF and present outcomes of patients with different types of Bartonicek classification. Method: We retrospectively reviewed the clinical outcomes of 72 patients with ankle fractures involving posterior malleolus (PM) from January 2016 to December 2018. Posterior malleolus fractures (PMFs) were all directly reduced and fixed by a posterolateral approach using lag screws and/or buttress plates. AOFAS score and VAS pain score were used as the primary functional outcome measures. The radiographic evaluation included the quality of the reduction and Kellgren–Lawrence (KL) osteoarthritis classification. According to the CT-based Bartonicek classification, all patients were classified into three groups: 42 type II, 18 type III and 12 type IV. Bartonicek type II patients were further divided into subtype IIa 19 cases, subtype IIb 16 cases and subtype IIc 7 cases. The radiological and functional outcomes were analyzed among different types and subtypes of Bartonicek classification. Results: Sixty-eight patients (94.5%) achieved good or excellent reduction of PMF after surgery. The mean AOFAS score was 81.35 ± 6.15 at 6 months and 90.56 ± 4.98 at the final follow-up, respectively. The VAS score was 6.62 ± 1.03 one week after surgery, and 1.20 ± 0.92 at the final follow-up. Radiological evaluation at the final follow-up showed that primary bone union was achieved in all patients and 65 patients (88.9%) got no (KL grade 0) or just doubtable (KL grade 1) post-traumatic osteoarthritis. AOFAS scores decreased significantly with the severity of Bartonicek classification at 6 month (p < 0.001) and final follow-up (p < 0.05), while there was no statistical difference of VAS pain score among different types of Bartonicek classification. Reduction quality and the presence of osteoarthritis was not correlated to Bartonicek classification either. Besides, AOFAS scores at the final follow-up were statistically different among three subtypes of Bartonicek type II fractures (p < 0.05), and Bartonicek subtype IIa fractures had the highest AOFAS scores as 93 ± 4.99. Presence and severity of osteoarthritis was lower in patients with subtype IIa PMF compared to other subtype groups, this finding was statistically significant (p < 0.05). Conclusion: The posterolateral approach could achieve good clinical outcomes in the treatment of posterior malleolus fracture. Patients with a Bartonicek type II fracture had a better functional outcome measured by the AOFAS score compared to other types. Bartonicek type IIa fractures got a higher AOFAS score and a lower incidence of osteoarthritis at the final follow-up than the other two subtypes. Classification of PMFs according to the Bartonicek classification was reliable. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to retrospectively analyze the clinical efficacy of the direct anterior approach (DAA) vs. posterolateral approach (PLA) in primary total hip arthroplasty (THA). PATIENTS AND METHODS: A total of 382 patients who underwent primary THA in our hospital from March 2016 to March 2021 were identified as research subjects, with 183 patients in the DAA group and 199 in the PLA group. Outcome measures included operation time, intraoperative blood loss, postoperative creatine kinase (CK), Harris score, visual analogue scale (VAS), postoperative hospital stay, and postoperative complications. RESULTS: DAA resulted in significantly longer operative time but lower intraoperative bleeding volume vs. PLA. Three months postoperatively, patients receiving DAA showed significantly lower visual analogue scale (VAS) scores and higher Harris scores than those given PLA. No hip dislocation was observed in the DAA group. CONCLUSIONS: DAA results in less intraoperative hemorrhage and muscle damage, better postoperative recovery, and a lower incidence of hip dislocation. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this investigation was to compare different techniques to improve visualization and reduction in tibial plateau fractures involving the central lateral segments. Methods: Matched pairs of pre-fractured cadaveric tibial plateau fractures that include the central lateral segments were treated by either an anterolateral approach (supine) or PL approach (prone). Reduction was stepwise extended by additional fracturoscopy (FS), nanoscopy (NS) and lastly by epicondyle osteotomy (ECO). Reduction was analyzed by 3D scan and visualization of the lateral plateau was quantified. Results: Ten specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were analyzed. Fracture steps involving the antero-latero-central (ALC) segment were insufficiently reduced after fluoroscopy using both approaches (AL 2.2 ± 1.2 mm vs PL 2.2 ± 1.0 mm, p 0.95). Additional NS and ECO achieved optimized fracture reduction in the ALC segment (NS AL 1.6 ± 1.3 mm vs PL 0.8 ± 0.9 mm, p 0.32). NS provided visualization of the entire lateral plateau (PL 102.9% ± 7.4, AL 108.8 ± 19.2%), while fracturoscopy only allowed visualization of the ALL segment and partially of PLL and ALC segments (PL 22.0 ± 23.4%, AL 29.7 ± 18.3%). Conclusion: Optimized reduction of tibial head fractures with involvement of latero-central segments requires additional video-assisted reduction or extended approaches. Nanoscopy helps visualizing of the entire lateral plateau, when compared to fracturoscopy and may become a valuable reduction aid. [ABSTRACT FROM AUTHOR]

Background: Controversies remain on the best surgical approaches for unilateral total hip arthroplasty (THA). There are little data on simultaneous bilateral THA via direct anterior approach (SimBDAA-THA) or posterolateral approach (SimBPA-THA). Purpose: We sought to assess differences in perioperative outcomes and early medical and surgical complications between SimBDAA-THA and SimBPA-THA. Methods: This retrospective study involved patients who underwent either SimBDAA-THA in a supine position (n = 73) or SimBPA-THA in a lateral position (n = 162) at our institution from January 2015 to November 2021. The 2 groups were compared in terms of clinical and demographic characteristics, surgical parameters, and complications during 6-months of follow-up. Results: There were no differences in clinical and demographic characteristics between the 2 groups prior to surgery. Simultaneous bilateral THA via direct anterior approach significantly shortened the length of both the operation (117.50 ±19.42 vs 143.97 ± 32.20 min) and the hospitalization (140.64 ± 43.22 vs 156.24 ± 56.64 h) but increased perioperative loss of hemoglobin (3.28 ± 1.01 vs 3.21 ± 2.26 g/dL). There were no significant differences between the two groups in transfusion rate; levels of interleukin-6, C-reactive protein or creatine kinase; or complications. Conclusion: This retrospective study of patients at a single institution found minimal differences in perioperative outcomes or early medical and surgical complications between SimBDAA-THA and SimBPA-THA except operative time and length of hospitalization. Larger studies with longer follow-up should be conducted to identify whether a direct anterior approach is superior to a posterolateral one. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical results of the direct anterior approach (DAA) and posterolateral approach (PLA) in total hip arthroplasty (THA) patients. Methods From January 2017 to September 2019, 80 patients who received primary THA in our hospital were retrospectively selected based on the propensity score matching (PSM) method. Baseline characteristics of patients who underwent the DAA and PLA were collected. Moreover, the incision length, intraoperative blood loss, operative time, length of stay, and Harris hip score were compared between patients in the two groups. The CK level was used to assess muscle damage between patients in the DAA and PLA groups. The complications of these two approaches were also evaluated at patients' 12‐month follow‐up evaluation. Results There was no significant difference in baseline characteristics between patients in the two groups (p > 0.05). The patients in the DAA group had a shorter incision length (9.2 ± 0.2 vs 14.7 ± 0.5, respectively; p 0.05). Conclusion DAA was superior to the PLA in improving hip function after THA. Compared with the PLA, the DAA could reduce muscle damage, which is negatively correlated with hip function. Further multi‐institution studies are required with longer follow‐up durations, and larger patient populations are needed to provide more definitive conclusions.

The migration of a prosthetic head during total hip arthroplasty (THA) is a rare complication. Few cases are described in the literature, offering different solutions and surgical approaches for prosthetic head retrievement. Here, we present a case of successful laparoscopic transperitoneal retrieval of a prosthetic head migrated above the right iliac vein after THA with a posterolateral approach.

ObjectiveTo explore the clinical outcomes of a 3D printing-assisted posterolateral approach for the treatment of ankle fractures involving the posterior malleolus.MethodsA total of 51 patients with ankle fractures involving the posterior malleolus admitted to our hospital from January 2018 to December 2019 were selected. The patients were divided into 3D printing group (28 cases) and control group (23 cases). 3D printing was performed for ankle fractures, followed by printing of a solid model and simulation of the operation on the 3D model. The operation was then performed according to the preoperative plan, including open reduction and internal fixation via the posterolateral approach with the patient in the prone position. Routine x-ray and CT examinations of the ankle joint were performed, and ankle function was evaluated using the American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score.ResultsAll patients underwent x-ray and CT examinations. All fractures healed clinically, without loss of reduction or failure of internal fixation. Good clinical effects were achieved in both groups of patients. The operation time, intraoperative blood loss and intraoperative fluoroscopy frequency in the 3D printing group were significantly less than those in the control group (p 0.05).ConclusionThe 3D printing-assisted posterolateral approach is effective in the treatment of ankle fractures involving the posterior malleolus. The approach can be well planned before the operation, is simple to perform, yields good fracture reduction and fixation, and has good prospects for clinical application.

Introduction: The direct anterior approach (DAA) for total hip arthroplasty (THA) is considered less invasive than the posterolateral approach (PLA), possibly leading to earlier mobilization, faster recovery, and lower levels of thrombogenic markers. The purpose of the current study was to prospectively compare readiness for discharge, rehabilitation milestones, markers of thrombosis and inflammation at 6 weeks postoperatively between DAA and PLA. Methods: A total of 40 patients (20 anterior and 20 posterolateral) were prospectively enrolled. Readiness for discharge, length of stay (LOS), and related outcomes were additionally documented. Blood was drawn at baseline, wound closure, 5-h post-closure, and 24-h post-closure for assays of interleukin-6 (IL-6), PAP (plasmin anti-plasmin), a marker of fibrinolysis, and PF1.2 (Prothrombin fragment 1.2), a marker of thrombin generation. Results: Compared to the PLA group, the DAA group was ready for discharge a mean 13 h earlier (p = 0.03), while rehabilitation milestones were met a mean 10 h earlier (p = 0.04), and LOS was 13 h shorter (p = 0.02) on average. Pain scores at all study timepoints and patient satisfaction at 6 weeks were similar (p > 0.05). At 24 h postoperatively, PAP levels were 537.53 ± 94.1 µg/L vs. 464.39 ± 114.6 µg/L (p = 0.05), and Il-6 levels were 40.94 ± 26.1 pg/mL vs. 60.51 ± 33.0 pg/mL (p = 0.03), in DAA vs. PLA, respectively. Conclusions: In the immediate postoperative period, DAA patients were ready for discharge before PLA patients. DAA patients had shorter LOS, a lower inflammatory response, and higher systemic markers of fibrinolysis. However, these differences may not be clinically significant. Future studies with larger study populations are warranted to confirm the validity and significance of these findings. Level of evidence: Level II, Therapeutic Study. [ABSTRACT FROM AUTHOR]

This study reviews the current evidence on the indications and outcomes of the posterolateral approach in the treatment of posterior malleolar fractures. PubMed and Google Scholar search engines were used to construct a review of the literature for all studies detailing the posterolateral approach for posterior malleolar fracture fixation. A total of 11 studies met our inclusion criteria. In total, 332 fractures were identified. Overall superficial infection occurred in 4.5%, skin necrosis in 4.5%, and nerve injury in 4.5%. Hardware irritation that required removal occurred in 13.6%. None of the hardware removals involved posterior malleolus fixation. A total of 51 (15.4%) cases of arthritis were reported, follow-up ranged from a mean of 5.3 months to a mean 7.9 years. Regardless the majority of patient reported outcomes were excellent/good at final follow-up. Thresholds for joint reduction were not uniformly described or even quantified at all in some of the included studies. Variable indications for fixation were reported without reference to posterior malleolus fracture morphology. The posterolateral approach provides a satisfactory approach for fracture reduction with similar complication rates to that reported for other ankle fracture approaches. Further research is required on posterior malleolus fracture morphology, optimal fracture fixation and longer term functional and radiological outcomes. Levels of Evidence: Level III: Systematic review of retrospective cohort studies [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of direct anterior approach and posterolateral approach total hip arthroplasty in the treatment of femoral neck fracture and analysis of the influencing factors of postoperative hip function. Methods: A total of 96 patients with femoral neck fracture who were treated with total hip arthroplasty in the Affiliated Hospital of Xuzhou Medical University from May 2019 to December 2021 were selected, and they were divided into direct anterior approach group (n=48) and posterolateral approach group (n=48) according to different surgical methods. Perioperative indicators and complications of the two groups were observed, and Harris score and visual analog scale (VAS) were compared between the two groups before and after treatment. The influencing factors of postoperative hip function were analyzed by univariate and multivariate Logistic regression. Results: The time to get out of bed, the length of incision and the length of hospital stay in the direct anterior approach group were significantly shorter than those in the posterolateral approach group, the intraoperative blood loss and postoperative drainage volume were significantly lower than those in the posterolateral approach group, and the operation time was significantly longer than that in the posterolateral approach group (P<0.05) .Harris score at 1, 3 months after surgery in the direct anterior approach group was significantly higher than in the posterolateral approach group, and VAS score was lower than that in the posterolateral approach group (P<0.05) . There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in the excellent and good rate of hip function between the two groups after 6 months of treatment (P>0.05). Multivariate Logistic regression analysis showed that body mass index ≥24 kg/m², postoperative exercise time <3 h/d and combined with osteoporosis were the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement (P<0.05). Conclusion: The direct anterior approach total hip arthroplasty has obvious advantages over total hip arthroplasty with posterolateral approach in the short term, which is manifested as less trauma to patients and less postoperative pain, which is beneficial to the recovery of patients’ hip function. Body mass index ≥24 kg/m², postoperative exercise time <3 h/d, combined with osteoporosis are the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to compare the reduction quality of the anterolateral (AL) and modified posterolateral approach (PL) in lateral tibial plateau fractures involving the posterior column and central segments. Methods: Matched pairs of pre-fractured cadaveric tibial plateau fractures were treated by either AL approach (supine position) or PL approach (prone position). Reduction was controlled by fluoroscopy and evaluated as satisfying or unacceptable. Afterwards, the reduction was examined by 3D scan. Results: 10 specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were evaluated. PL approach achieved significantly (p 0.00472) better fracture reduction results (0.4 ± 0.7 mm) of the posterior column compared to the AL group (2.1 ± 1.4 mm). Fracture steps involving the central area of the lateral plateau were insufficiently reduced after fluoroscopy using both approaches. Conclusion: Optimal reduction of displaced tibial plateau fractures involving the posterolateral column necessitates a posterior approach, which can be conducted in prone or lateral positioning. The anterolateral approach is indicated in fractures with minor displacement of the posterolateral rim but fracture extension in the latero-central segments. In these cases, an additional video-assisted reduction or extended approaches are helpful. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of the posterior fragment in trimalleolar fractures differs from hospital to hospital in the Netherlands. A nationwide survey was performed to evaluate the fixation criteria and practice variation. Methods: An online cross-sectional survey amongst (orthopaedic) trauma surgeons was performed in the Netherlands. It consisted of three sections: a general section, a section showing preoperative images of six cases and a section with postoperative images of nine cases. Results: A total of 151 surgeons completed the online survey. 45% of the respondents indicated that they fixated the posterior fragment if smaller than 25% of the intra-articular surface. 48% preferred an open posterior approach to fixate the posterior fragment. There was good consensus in treatment for the two cases with Bartonicek type 4 fractures (operative treatment in 73 and 72% respectively). Little consensus was found for Bartonicek type 2 and 3 fractures (88% opted for operative treatment in one case, but 89% for conservative treatment in the second case). Reoperation was mostly considered in cases with a step-off of more than 1 mm (by 33–38% of the respondents). There was great variation in the choice of treatment if only the size of the posterior fragment was considered. Other fixation criteria such as postoperative step-off or instability after fixation of the lateral and medial malleoli are taken into account. In cases where fixation was needed, a percutaneous approach and an open posterolateral approach were equally preferred. Conclusions: There is much variation in treatment of the posterior malleolar fracture amongst orthopaedic and trauma surgeons in the Netherlands. The percutaneous approach and open posterolateral approach to fixate the posterior malleolar fracture seem to be equally used in the Netherlands. Still, there is no uniformity in treatment of posterior malleolar fracture, especially for Bartonicek 2 and Bartonicek 3 fractures. Reoperation is considered by less than half of the surgeons in case of postoperative persistent step-off of more than 1 mm. [ABSTRACT FROM AUTHOR]

Large posterolateral tibial fragments, known as Volkmann fractures, are common in ankle fracture-dislocations and typically require open reduction and fixation with interfragmentary screws and often buttress plates using a prone posterolateral approach. In this setting, fibula plating often necessitates dissection of the lateral window between the peroneal tendons and the skin, increasing wound-related complications. In recent years, intramedullary nailing of fibula fractures has gained popularity as a minimally invasive technique that allows load-sharing stabilization. However, this procedure has traditionally been performed in the supine position, which can pose challenges if a Volkmann-type fracture is present, requiring repositioning and losing access to the fibula through the posterolateral approach. Our objective is to describe a technique for fixing ankle fracture-dislocations with large posterolateral fragments using tibial buttress plates and fibula nails through a prone posterolateral approach without dissecting the lateral window. Additionally, we will present a case series with preliminary results. [ABSTRACT FROM AUTHOR]

Background: The treatment of the third malleolus has evolved in recent years, and surgical treatment can be carried out with traditional percutaneous osteosynthesis using anteroposterior screws or ORIF with a posterolateral plate. Methods: Our study included 54 patients divided into two groups based on the intervention type (screw or plate). Instrumental assessments comprised pre- and post-operative X-rays and pre-operative CT scans to evaluate joint step-off. The mean follow-up duration was 1 year and 9 months. Results: Radiographic control revealed no loss of reduction or mobilization of the synthesis devices, and all patients achieved fracture healing. Articular step-off > 2 mm was observed in 21 patients (38.9%), including 4 in the plate group and 17 in the screw group, with a statistically significant likelihood of step-off presence in the latter. The mean AOFAS score was 90 points, negatively correlated with age, and lower in patients with joint step-off and a 15° reduction in ROM. Conclusions: The management of posterior malleolus fractures has changed with anatomical studies and an understanding of ankle stability through CT scans. ORIF with a posterior plate is advantageous for anatomical reduction of the tibial plafond but is disadvantageous in terms of surgical invasiveness and technical difficulty.

Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty via DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty via DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty via PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group (p 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.

PurposeThe aim of this study was to explore the treatment outcomes of a novel single lateral approach via fibular fracture line for patients with posterior pilon fractures.Patients and methodsFrom January 2020 to December 2021, a total of 41 patients with posterior pilon fractures who received surgical treatment in our hospital were retrospectively reviewed. Twenty patients (Group A) were treated with open reduction and internal fixation (ORIF) via posterolateral approach. Twenty-one patients (Group B) were treated with ORIF using a simple single lateral approach via stretching fibular fracture line. Clinical assessments, including operation time, intraoperative blood loss, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and the active range of motion (ROM) of the ankle at the final follow-up visit after surgery, were performed in all patients. Radiographic outcome was evaluated by using the criteria proposed by Burwell and Charnley.ResultsThe mean follow-up time was 21 months (range 12–35). The average operation time and intraoperative blood loss in the Group B were significantly less than those in the Group A. Moreover, the AOFAS score and ankle ROM in the Group B were significantly higher than those in the Group A at the final follow-up visit. Eighteen cases (90%) in Group A and 19 cases (90.5%) in Group B achieved anatomical reduction of the fracture.ConclusionThe single lateral approach via stretching fibular fracture line is a simple and effective technique for reduction and fixation of posterior pilon fractures.