The advantages of a single use retractor for soft tissue protection in direct anterior approach total hip arthroplasty: the preliminary experience
Keywords:
soft tissue protection, retractor, anterior approach, hip arthroplastyAbstract
The anterior hip approach is a procedure with increasing popularity in hip replacement surgery due to its many benefits and the number of surgeons using it is steadily increasing around the world. Less pain, better results in the first few weeks, reduced dislocation rate are the prerogatives of this approach.
We analyzed in a group of 26 patients the use of a soft tissue retractor, Alexis Orthopedic Protector, the CPK values in the first third and fifth postoperative day. The results obtained, normalized, demonstrate a slight reduction in tissue damage using the device compared to a control group. In addition to blood values, improved exposure, distribution of leverage, cleanliness of the field and a potential reduction in infectious risk are advantages for the use of an orthopedic surgery retractor.
We believe that the adoption of the Alexis Orthopedic Protector provides numerous improvements during the hip arthroplasty surgical procedure, especially when adopting the direct anterior approach, because it distributes the traction forces around the surgical path resulting in greater visibility. However, the small number of patients is not sufficient to perform an accurate statistical analysis and further studies on larger samples will be required.
References
Meermans G, Konan S, Das R, Volpin A, Haddad FS, Meermans NG. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2017;99-B(6):732–40.
Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. In: Clinical Orthopaedics and Related Research. Lippincott Williams and Wilkins; 2005. p. 115–24.
Chechik O, Khashan M, Lador R, Salai M, Amar E. Surgical approach and prosthesis fixation in hip arthroplasty worldwide. Arch Orthop Trauma Surg. 2013 Nov 1;133(11):1595–600.
Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013 Oct;28(9):1634–8.
Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective Randomized Study of Two Surgical Approaches for Total Hip Arthroplasty. J Arthroplasty. 2010;25(5):671-679.e1.
Sheth D, Cafri G, Inacio MCS, Paxton EW, Namba RS. Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk. Clin Orthop Relat Res. 2015 Nov 1;473(11):3401–8.
Miller LE, Gondusky JS, Bhattacharyya S, Kamath AF, Boettner F, Wright J. Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review With Meta-Analysis. J Arthroplasty. 2018 Apr;33(4):1296-1302.
Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: Perioperative findings. J Orthop Traumatol. 2011 Sep;12(3):123–9.
Bremer AK, Kalberer F, Pfirrmann CWA, Dora C, Surgeon O. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg. 2011;93(7):886–9.
Minetto MA, Oprandi G, Saba L et al. Serum interleukin-6 response to elective total hip replacement surgery. Int Orthop. 2006 Jun;30(3):172–6.
Bergin PF, Doppelt JD, Kephart CJ et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg. 2011 Aug 3;93(15):1392–8.
Aprato A, Cambursano S, Artiaco S, Bevilacqua S, Catalani P, Massè A. Heterotopic ossification in primary total hip arthroplasty: risk factor analysis. Eur J Orthop Surg Traumatol. 2023 May;33(4):1037-1041.
Di Benedetto P, Zangari A, Magnanelli S et al. Heterotopic ossification in primary total hip arthroplasty: Which is the role of drainage? Acta Biomed. 2019;90:92–7.
Horiuchi T, Tanishima H, Tamagawa K et al. Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma. 2007 Jan;62(1):212–5.
Horiuchi T, Tanishima H, Tamagawa K et al. A wound protector shields incision sites from bacterial invasion. Surg Infect (Larchmt). 2010 Dec 1;11(6):501–3.
Hinkson L, Siedentopf JP, Weichert A, Henrich W. Surgical site infection in cesarean sections with the use of a plastic sheath wound retractor compared to the traditional self-retaining metal retractor. Eur J Obstet Gynecol Reprod Biol. 2016 Aug 1;203:232–8.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Stefano Giaretta, Pietro Spolettini, Marco Raimondi, Alberto Momoli
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
