Early effects of direct anterior approach versus posterolateral approach in total hip arthroplasty

doi:10.3969/j.issn.2095-4344.1003

Abstract

Abstract:

BACKGROUND: Minimally invasive total hip arthroplasty is becoming the most popular procedure for total hip arthroplasty. Direct anterior approach has the advantages of small soft tissue injury and quick recovery after operation, so it is called the best approach of total hip replacement according to the minimally invasive surgical criteria. However, it is difficult to operate and the learning curve is long, and early curative effect remains controversial.

OBJECTIVE: To compare the tissue injury and early clinical effect between direct anterior approach and posterolateral approach in total hip arthroplasty．

METHODS: Clinical data of 64 patients undergoing total hip arthroplasty in the Department of Orthopedics, the Second Hospital of Anhui Medical University from October 2016 to August 2017, were analyzed retrospectively. The patients were divided into direct anterior approach group (n=31) and posterolateral approach group (n=33) according to the operative approach. The incision length, operation time, intraoperative blood loss, hospitalization time, drainage volume, serum creatine kinase, C-reactive protein, erythrocyte sedimentation rate, interleukin-6, Visual Analogue ScaIe score, the Harris hip score, and complications were compared between two groups.

RESULTS AND CONCLUSION: (1) The direct anterior approach group showed significant longer operation time, more intraoperative blood loss, shorter incision length and shorter hospitalization time than those in the posterolateral approach group (P < 0.05). The drainage volume showed no significant difference between two groups (P > 0.05). (2) The levels of creatine kinase, C-reactive protein, and interleukin-6, and erythrocyte sedimentation rate at 1, 2, 3, and 4 days postoperatively in the direct anterior approach group were significantly lower than those in the posterolateral approach group (P < 0.05). (3) The Visual Analogue Scale scores at postoperative 24, 48, and 72 hours in the direct anterior approach group were significantly lower than those in the posterolateral approach group (P < 0.05). (4) The Harris hip scores at 1, 3 and 6 months postoperatively in the direct anterior approach group were significantly superior to those in the posterolateral approach group (P < 0.05). (5) There was no significant difference in the anteversion or abduction angles of acetabular prosthesis between two groups (P > 0.05). (6) The surgical complications showed no significant differences between two groups (P=1.00). (7) To conclude, there is no significant difference in 6-month complications between direct anterior approach and posterolateral approach. Direct anterior approach in total hip arthroplasty achieves less muscle damage, better early-term clinical effect and better functional recovery compared with the posterolateral approach.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Hip, Surgical Operation, Invasive, Tissue Engineering

CLC Number:

R459.9

Zha Xiaowei, Cheng Wendan, Lü Hao, Li Ziyu, Liu Wei, Qi Lei, Yu Shuisheng, Jing Juehua. Early effects of direct anterior approach versus posterolateral approach in total hip arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(35): 5583-5589.

Figures/Tables 7

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