daa- does it make a difference?
TRANSCRIPT
DAA-DOES IT MAKE A
DIFFERENCE?ANTHONY S UNGER, MD
WASHINGTON, DC
YESAFFIRMATIVE
THE DAA HIP
LESS DISLOCATIONSBETTER ABILITY TO EQUALIZE LL
QUICKER RECOVERY
DR.- WHY DO YOU PERFORM DAA?
POSTERIOR 1-3%ANTEROLATERAL 1-2%22-44% of DISLOCATIONS REQUIRE ADDITIONAL SURGERY
DISLOCATION RISK
Matta et al---0.61%Siguier et al----0.96%Unger 2006-2014 0.3%, none in last 500 cases
DAA- LESS DISLOCATION
WHY???◦Pelvis is in a reproducible position when pt is supine
◦DAA—C-arm guidance◦Preserve posterior capsule
DAA- LESS DISLOCATIONS
Precise with PT supine—”CAN FEEL THE MALLEOLI”
X-ray GUIDANCE OPTION
LL Equalization
Kennon/Keggi 2003Masonis 2002Restrepo 2010Berend 2008Barrett 2013Unger 2006-2014 My experience—1500 cases
DAA-FASTER RECOVERY
Creatine Kinase Differences between Anterior and Posterior MIS
THA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
5.5X5.5X 1.4X1.4X 1.8X1.8X
-200
-100
0
100
200
300
400
CRP IL-6 IL-1B TNF-a
DAA
MPA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
-200
-100
0
100
200
300
400
CRP IL-6 IL-1B TNF-a
DAA
MPA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
Creatine Kinase Differences between Anterior and Posterior MIS
THA
2 DAA SURGEONS and 2 POSTERIOR SURGEONS
ALL USED SAME PATHWAY/PROTOCOL
COMMUNITY HOSPITAL WITH SNF UNIT
DATA FROM 2013-2014
MY EXPERIENCE
Demographics
AA 1 AA 2 PA 1 PA 2MEAN AGE 70.8 66.6 72.4 69.1
FEMALE 79 16 23 13MALE 49 7 12 16
MEAN BMI 26.4 27.9 26.9 28.1%
MEDICARE 71.1 60.9 71.4 62.1% NON-
MEDICARE 28.9 39.1 28.6 37.9
Ave. age Ave. BMI0
10
20
30
40
50
60
70
80
POST
POST
POST
POST
DAA
DAA
DAA
DAA
Series1Series2Series3Series4
AVG AGE/AVG BMI
% Medicare % non-Medicare0
10
20
30
40
50
60
70
80
post
post
51
DAA
DAA Series1Series2Series3Series4
%Medicare/Non-Medicare
Length of Stay (LOS)
Procedure LOS (Days)AA 2.58 ± 0.73PA 3.43 ± 1.39
LOS Medicare LOS non-Medicare0.0
1.0
2.0
3.0
4.0
5.0
6.0
DAA<p0.05
2.5
DAA P<0.05
Series1Series2Series3Series4
LOS MEDICARE/NON-MEDICARE
AA 1 AA 2 PA 1 PA 2TOTAL
SURGERIES 128 23 35 29COMPLICATION
RATE (%) 7.03 8.70 20.00 13.79
% discharged home0
10
20
30
40
50
60
70
80
DAA p<.05
Series1Series2Series3Series4
% Discharged Home
DISCHARGE STATUS
1 2 3 40
1
2
3
4
5
6
7
8
9
DAA p <.05
% home in 24 hrs
% home in 24 hrs
%Home in 24 HR
DAA◦LESS DISLOCATION◦MORE PRECISE LL EQUALIZATION◦FASTER RECOVERY
“I ADVOCATE FOR THE DAA HIP REPLACEMENT”
CONCLUSION