Michael Meneghini, MD, spearheads research aimed at improving hip replacement outcomes

  • Jan. 10, 2018

One of the most marketed surgical approaches to a common orthopaedic procedure may not provide the best long-term outcomes for patients. A study led by Michael Meneghini, MD, orthopaedic faculty surgeon at IU School of Medicine, compares different approaches to a total hip arthroplasty (THA), or hip replacement procedure.

In recent years, the direct anterior approach has been promoted as an innovative, minimally-invasive technique to the THA with rapid recovery. This approach involves a making an incision on the front of the hip, allowing the joint to be replaced by moving muscles without detaching any tendons; however, a study conducted by Dr. Meneghini and partnering colleagues from across the country is one of the first to prove potentially higher complication rates utilizing this approach.

Investigations performed at IU Health Saxony Hospital (Fishers, Indiana), the Rothman Institute at Thomas Jefferson University (Philadelphia, Pennsylvania), and OrthoCarolina Hip and Knee Center (Charlotte, North Carolina) reviewed more than 300 patients facing early THA failure, or complications within five years of the initial surgery taking place. Relevant complications include fracture of the bone with insertion, loosening of the implant due to failure of bone ingrowth and the hip popping out of the socket.

In addition to the surgical approach of the primary operation, the amount of time between the initial operation and the revision, as well as the underlying cause leading to early failure were reviewed and documented.

“As surgeons, our goal is to provide the safest and most effective long-term care for our patients,” said Dr. Meneghini. “Hip replacements should last roughly 20 years. The fact that so many patients are requiring a second operation in less than five years is concerning. Our team wanted to understand why this was happening and how to improve patient outcomes across the board.”

Results of the analysis proved early revisions due to femoral failure to be more common in patients whose initial surgeon had utilized the direct anterior approach for THA.  “Femoral exposure is often technically challenging when the direct anterior approach is used that may lead to early failure,” Meneghini explained. “With this research, we’re hoping to introduce new techniques to reduce the risk of failure and the potential for patient harm in operating rooms across the globe.”

Other investigators for this research include Addison Elston; Antonia Chen, MD, MBA; Michael Kheir; Thomas Fehring, MD; and Bryan Springer, MD. The study has been published in the Journal of Bone and Joint Surgery.