ArticleBMC musculoskeletal disorders2024
Impact of surgical approaches on stem position and hidden blood loss in total hip arthroplasty: minimally invasive vs. posterolateral.
Article in BMC musculoskeletal disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Hidden blood loss and its risk factors after hip hemiarthroplasty for hip fracture in the elderly.Joint diseases and related surgery · 2026Article
- Perioperative blood transfusion and adverse events in total hip and knee arthroplasty: a TriNetX-based analysis.Frontiers in medicine · 2026Article
- Effects of preoperative systemic administration of tranexamic acid alone on postoperative inflammation and pain in total hip arthroplasty: a retrospective cohort study.Arthroplasty (London, England) · 2025Article
- Mid-term Clinical and Radiographic Outcomes of the Actis Total Hip System: A Retrospective Study.Cureus · 2025Article
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5 authors.
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Abstract
backgroundThe 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).
methodsA 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).
resultsThere 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).
conclusionMinimally 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.
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