High preservation rates of the ascending branch of the lateral femoral circumflex artery during total hip arthroplasty through the direct anterior approach

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-30 DOI:10.1002/jeo2.70066
Christian Matar, Camille Vorimore, ReSurg, Frederic Laude
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Abstract

Purpose

(i) To investigate the rate of preservation of the ascending branch of the lateral femoral circumflex artery (a-LFCA) during total hip arthroplasty (THA) through a direct anterior approach (DAA), and (ii) to study factors that contribute to its successful preservation.

Methods

All patients who underwent primary THA between 1 September 2023 and 29 February 2024 were reviewed. One-hundred seventy-two patients were included in the study, 91 females and 81 males, aged 63.2 ± 12.6, with a body mass index of 26.1 ± 4.6 kg/m2. THA was performed through a minimally invasive DAA in all patients, using either a standard vertical DAA or a Bikini incision. Patients were stratified by the preservation of the a-LFCA (preserved, ligated/electrocauterized due to obstruction of the surgical field during dissection, electrocauterized due to bleeding during femoral broaching or stem insertion). Descriptive statistics were used to summarise the data. Logistic regression analyses were performed to explore possible factors associated with the preservation of a-LFCA.

Results

The a-LFCA was preserved in 130 patients (75.6%), had to be ligated/electrocauterized due to obstruction of the surgical field during dissection in 31 patients (18.0%), and had to be electrocauterized due to bleeding during femoral broaching or stem insertion in 11 patients (6.4%). Multivariable logistic regression analyses revealed that preservation of a-LFCA was significantly more likely in female patients (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.1–4.6; p = 0.029), as well as in patients with younger age (OR = 0.97; 95% CI = 0.9–1.0; p = 0.036) and lower weight (OR = 0.97; 95% CI = 0.9–1.0; p = 0.005).

Conclusions

Preservation of the a-LFCA is possible in the majority of patients (75.6%) undergoing THA through minimally invasive DAA. Furthermore, preservation of the a-LFCA is more likely in female patients, younger patients and patients with lower weight.

Level of Evidence

Level IV.

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通过直接前路进行全髋关节置换术时,股外侧环状动脉升支的保留率很高。
目的:(i) 探讨通过直接前路(DAA)进行全髋关节置换术(THA)时股外侧环动脉升支(a-LFCA)的保留率,(ii) 研究有助于成功保留股外侧环动脉升支的因素:对 2023 年 9 月 1 日至 2024 年 2 月 29 日期间接受初次 THA 的所有患者进行回顾性研究。研究共纳入172例患者,其中女性91例,男性81例,年龄(63.2±12.6)岁,体重指数(26.1±4.6)kg/m2。所有患者均采用标准垂直 DAA 或 Bikini 切口,通过微创 DAA 进行 THA 手术。根据患者a-LFCA的保留情况进行分层(保留、因解剖时手术视野受阻而结扎/电灼、因股骨拉床或股骨柄插入时出血而电灼)。描述性统计用于总结数据。进行了逻辑回归分析,以探讨与保留a-LFCA相关的可能因素:130名患者(75.6%)保留了a-LFCA,31名患者(18.0%)因解剖时手术视野受阻而不得不结扎/电灼,11名患者(6.4%)因股骨拉床或股骨柄插入时出血而不得不电灼。多变量逻辑回归分析显示,女性患者保留a-LFCA的几率明显更高(几率比[OR] = 2.22;95% 置信区间[CI] = 1.1-4.6;P = 0.029),年龄较小(OR = 0.97;95% CI = 0.9-1.0;P = 0.036)和体重较轻(OR = 0.97;95% CI = 0.9-1.0;P = 0.005)的患者保留a-LFCA的几率也更高:大多数(75.6%)通过微创DAA接受THA手术的患者都能保留a-LFCA。此外,女性患者、年轻患者和体重较轻的患者更有可能保留 a-LFCA:证据等级:IV 级。
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来源期刊
Journal of Experimental Orthopaedics
Journal of Experimental Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
3.20
自引率
5.60%
发文量
114
审稿时长
13 weeks
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