Direct anterior approach total hip arthroplasty with an orthopedic traction table.

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Abstract

[Indexed for MEDLINE] 20. Orthop Traumatol Surg Res. 2024 Oct;110(6):103964. doi: 10.1016/j.otsr.2024.103964. Epub 2024 Jul 27. Anterior-approach total hip arthroplasty in patients with poliomyelitis: Long-term outcomes. Rougereau G(1), Hollier-Larousse B(2), Bauer T(3), Genêt F(4), Salga M(4), Cale F(2). Author information: (1)Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France; Département de chirurgie orthopédique et traumatologique, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France. Electronic address: greg.rougereau@gmail.com. (2)Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France. (3)Département de chirurgie orthopédique et traumatologique, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France. (4)UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France; Université Versailles Saint-Quentin-en-Yvelines (UVSQ), UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France. OBJECTIVE: In patients with residual poliomyelitis-related impairments, total hip arthroplasty (THA) is challenging due to the high frequency of risk factors such as hip dysplasia, dislocation, muscle weakness, and fracture. The objective of this study was to assess the long-term functional and radiographic outcomes of anterior-approach THA with a ceramic-ceramic, dual-mobility, or constrained implant in patients with poliomyelitis sequelae. HYPOTHESIS: THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable technique that is not associated with excess risks of instability or aseptic loosening. MATERIAL AND METHODS: This single-centre retrospective study included consecutive patients with poliomyelitis sequelae who underwent THA between January 1998 and September 2019 via the anterior approach, with implantation of a ceramic-ceramic, dual-mobility, or constrained implant. The Harris Hip Score (HHS), implant position, and complications (e.g., infection and loosening) were collected during the most recent in-person visit. RESULTS: The study included 19 patients (23 hips). Mean follow-up was 5.2 ± 4.2 years (range, 2.0-10.6 years). Only six of the 23 procedures were done on the side with greater muscle weakness. The mean HHS at last follow-up was 80.4 ± 10.4. A single procedure (1/23, 4%) was followed by a complication, consisting in intra-prosthetic dislocation 2 years after implantation of a dual-mobility cup. At last follow-up, the HHS was not associated with psoas and gluteus muscle strength (rs = 0.35, p = 0.11 and rs = 0.37, p = 0.09, respectively) and was not significantly different between the weaker vs. stronger side (82.7 ± 8.0 vs. 79.5 ± 11.3, respectively; p = 0.53). Cup position was more horizontal, thereby optimising function, when the procedure was done on the weaker vs. the stronger side (39.9° ± 4.3 vs. 45.0° ± 6.8, respectively; p = 0.02). CONCLUSION: THA is a good option for improving function in patients with poliomyelitis sequelae. THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable method that is not associated with an excess risk of instability or loosening. LEVEL OF EVIDENCE: IV. Copyright © 2024 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2024.103964