Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes
Background/Objectives: Total hip arthroplasty (THA) remains a widely utilized and effective intervention for patients with end-stage hip osteoarthritis. Although multiple surgical approaches and fixation techniques are available, their application in non-tertiary clinical settings is less frequently...
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2025-05-01
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| author | Roland Fazakas Laura Ioana Bondar Csongor Toth Brigitte Osser Iosif Ilia Gabriel Roberto Marconi Victor Niculescu Ramona Nicoleta Suciu Liviu Gavrila-Ardelean Alexandru Pop |
| author_facet | Roland Fazakas Laura Ioana Bondar Csongor Toth Brigitte Osser Iosif Ilia Gabriel Roberto Marconi Victor Niculescu Ramona Nicoleta Suciu Liviu Gavrila-Ardelean Alexandru Pop |
| author_sort | Roland Fazakas |
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| description | Background/Objectives: Total hip arthroplasty (THA) remains a widely utilized and effective intervention for patients with end-stage hip osteoarthritis. Although multiple surgical approaches and fixation techniques are available, their application in non-tertiary clinical settings is less frequently documented. This study primarily aims to provide an educational overview of stepwise THA procedures using intraoperative visual documentation, with a secondary, exploratory assessment of postoperative outcomes related to surgical approach and fixation strategy. Methods: A prospective observational study was conducted at Arad Clinical Emergency County Hospital between March 2023 and March 2024, involving 23 patients undergoing primary THA. Patients received either cemented or uncemented femoral components based on intraoperative bone quality. Procedures were documented using stepwise intraoperative photographs and postoperative radiographs. Recovery was assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at both six weeks and six months postoperatively. Results: Both lateral (Hardinge) and posterolateral approaches provided adequate exposure with reproducible results. Cemented implants allowed for immediate full weight-bearing and were preferred in elderly patients with poor bone quality, while uncemented components were used in younger patients with good bone density, requiring a delayed weight-bearing protocol. Functional scores improved in both groups between six weeks and six months. At six weeks, the mean HHS was 87.6 ± 6.2 and WOMAC 18.3 ± 4.8; by six months, these improved to 91.8 ± 5.1 and 12.7 ± 3.9, respectively. Cemented fixation demonstrated slightly better outcomes at both time points; however, intergroup differences remained below the Minimal Clinically Important Difference (MCID) thresholds. Conclusions: Tailored surgical approaches and fixation strategies, guided by intraoperative assessment, result in favorable short- and mid-term recovery profiles in THA. The integration of intraoperative visual documentation and patient-reported outcome measures (PROMs) enhances procedural transparency while supporting evidence-based decision-making and surgical training. |
| format | Article |
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| institution | Kabale University |
| issn | 2075-1729 |
| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-7be13fa5668d4d60b4a8435861179cfb2025-08-20T03:27:33ZengMDPI AGLife2075-17292025-05-0115683810.3390/life15060838Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional OutcomesRoland Fazakas0Laura Ioana Bondar1Csongor Toth2Brigitte Osser3Iosif Ilia4Gabriel Roberto Marconi5Victor Niculescu6Ramona Nicoleta Suciu7Liviu Gavrila-Ardelean8Alexandru Pop9Doctoral School of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, RomaniaDepartment of Biology and Life Sciences, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, RomaniaDoctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, RomaniaDoctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, RomaniaFaculty of Physical Education and Sport, “Aurel Vlaicu” University of Arad, 310130 Arad, RomaniaFaculty of Physical Education and Sport, “Aurel Vlaicu” University of Arad, 310130 Arad, RomaniaDoctoral School, University of Medicine and Pharmacy “Carol Davila” Bucuresti, 020021 București, RomaniaDepartment of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, RomaniaProsthetic Dentistry, Faculty of Dental Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, RomaniaDoctoral School of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, RomaniaBackground/Objectives: Total hip arthroplasty (THA) remains a widely utilized and effective intervention for patients with end-stage hip osteoarthritis. Although multiple surgical approaches and fixation techniques are available, their application in non-tertiary clinical settings is less frequently documented. This study primarily aims to provide an educational overview of stepwise THA procedures using intraoperative visual documentation, with a secondary, exploratory assessment of postoperative outcomes related to surgical approach and fixation strategy. Methods: A prospective observational study was conducted at Arad Clinical Emergency County Hospital between March 2023 and March 2024, involving 23 patients undergoing primary THA. Patients received either cemented or uncemented femoral components based on intraoperative bone quality. Procedures were documented using stepwise intraoperative photographs and postoperative radiographs. Recovery was assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at both six weeks and six months postoperatively. Results: Both lateral (Hardinge) and posterolateral approaches provided adequate exposure with reproducible results. Cemented implants allowed for immediate full weight-bearing and were preferred in elderly patients with poor bone quality, while uncemented components were used in younger patients with good bone density, requiring a delayed weight-bearing protocol. Functional scores improved in both groups between six weeks and six months. At six weeks, the mean HHS was 87.6 ± 6.2 and WOMAC 18.3 ± 4.8; by six months, these improved to 91.8 ± 5.1 and 12.7 ± 3.9, respectively. Cemented fixation demonstrated slightly better outcomes at both time points; however, intergroup differences remained below the Minimal Clinically Important Difference (MCID) thresholds. Conclusions: Tailored surgical approaches and fixation strategies, guided by intraoperative assessment, result in favorable short- and mid-term recovery profiles in THA. The integration of intraoperative visual documentation and patient-reported outcome measures (PROMs) enhances procedural transparency while supporting evidence-based decision-making and surgical training.https://www.mdpi.com/2075-1729/15/6/838acetabular reamingcemented hip prosthesisintraoperative documentationlateral approachmid-term outcomespatient-reported outcome measures |
| spellingShingle | Roland Fazakas Laura Ioana Bondar Csongor Toth Brigitte Osser Iosif Ilia Gabriel Roberto Marconi Victor Niculescu Ramona Nicoleta Suciu Liviu Gavrila-Ardelean Alexandru Pop Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes Life acetabular reaming cemented hip prosthesis intraoperative documentation lateral approach mid-term outcomes patient-reported outcome measures |
| title | Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes |
| title_full | Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes |
| title_fullStr | Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes |
| title_full_unstemmed | Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes |
| title_short | Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes |
| title_sort | stepwise total hip arthroplasty with lateral and posterolateral approaches intraoperative imaging fixation strategy and early functional outcomes |
| topic | acetabular reaming cemented hip prosthesis intraoperative documentation lateral approach mid-term outcomes patient-reported outcome measures |
| url | https://www.mdpi.com/2075-1729/15/6/838 |
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