A new study finds a certain type of hip replacement surgery may place patients at a higher risk of complications. The study, which looked at anterior total hip arthroplasty on a fracture table, was authored by Brian A. Jewett, MD, and Dennis K. Collis, MD, of the Slocum Orthopedic Center, in Eugene, Ore.
The anterior approach for total hip replacement is a surgical approach to the hip that has been used for over 30 years for total hip replacement in Europe and more recently in the United States. The purported advantage of the surgery is that it provides a truly “minimally invasive” way to perform the hip replacement. No muscle is cut with the operation, providing a very stable hip with minimal damage to the soft-tissues of the hip. There are no bending or positional precautions after the surgery. The procedure utilizes a special table called a “fracture table” to perform the operation. It allows the surgeon to position the leg during the operation and helps to expose both the socket and the femur.
This latest study, which was presented at the Hip Society Meetings, reviewed 800 primary total hip arthroplasties performed during a 5-year period. All procedures were performed on a fracture table. The investigators recorded all intraoperative and postoperative complications. The patients had an average follow-up of 1.8 years. The investigators excluded patients with severe acetabular deformities or severe flexion contractures; these surgeries were done through a lateral approach.
The study recorded the following complications that occurred during surgery:
â€¢ 19 trochanteric fractures
â€¢ Three femoral perforations
â€¢ One femoral fracture
â€¢ One acetabular fracture
â€¢ One bleeding complication
â€¢ One cardiovascular collapse
Post-operative complications recorded by the study included:
â€¢ Seven dislocations
â€¢ Seven deep infections
â€¢ One delayed femur fracture
â€¢ 37 wound complications (13 of which had a subsequent wound debridement)
â€¢ 14 deep venous thrombosis
â€¢ Two pulmonary emboli
â€¢ 31 other nonfatal medical complications.
“The main intraoperative complications of trochanteric fractures and perforations occurred mostly early in the series, while the main postoperative complications related to wound healing were prevalent throughout the entire series,” the authors wrote. “Despite potential advantages of use of a fracture table, surgeons should be aware of the potential complications of trochanteric fractures, perforations, and wound-healing problems associated with this technique.”