Total hip arthroplasty by direct anterior approach in the lateral position in the treatment of ankylosed hips: early therapeutic effects

doi:10.3969/j.issn.2095-4344.1337

Abstract

Abstract:

BACKGROUND: Total hip arthroplasty in the treatment of advanced hip ankylosis can restore the motion function of hip joint, relieve pain and improve the quality of life of patients. However, due to the special anatomical and pathophysiological abnormalities of ankylosing hip joint, it is particularly difficult to expose the acetabular side and install the prosthesis correctly. To obtain good acetabular exposure, lateral approach combined with greater trochanter osteotomy and anterior-posterior combined approach were used to obtain full exposure. However, these approaches inevitably damaged the long-term disused atrophic peri-hip muscles of ankylosing hip patients. The direct anterior approach is through the gap between tensor fasciae latae and sartorius muscle. It is the most minimally invasive approach for total hip arthroplasty. The acetabular side is fully exposed. At the same time, it has the advantages of less soft tissue injury and fast recovery after replacement.

OBJECTIVE: To investigate the clinical efficacy of total hip arthroplasty with direct anterior approach in the lateral position in the treatment of ankylosis hip.

METHODS: A retrospective analysis was performed on the clinical data of 12 patients (17 hips) who underwent total hip arthroplasty with direct anterior approach in the lateral position for the treatment of hip ankylosis from November 2016 to May 2018. Length of incisions, operation time, intraoperative blood loss, prosthesis position, straight leg-raising time, visual analogue scale score, range of motion, Harris hip score and adverse reactions were recorded. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (approval number: (2018)7).

RESULTS AND CONCLUSION: (1) The average incision length, operative time, intraoperative blood loss and straight leg-raising time of 12 patients (17 hips) were (11.12±1.69) cm, (122.47±25.40) minutes, (279.41±135.85) mL and (9.59±4.62) days, respectively. (2) The prosthesis was in good position. The average forward angle was (15.76±2.84)°; average abducent angle was (40.00±3.45)°. (3) Compared with that before replacement, Harris score and range of motion remarkably increased, but visual analogue scale score obviously decreased, after replacement, and gradually improved with prolonged time. (4) One case of proximal femur fracture occurred and was fixed with wire binding intraoperatively; the fracture healed and the hip function recovered well 3 months later. No complications occurred such as infection, deep vein thrombosis, fat embolism, prosthesis loosening, limb length inequality and joint dislocation. (5) Total hip arthroplasty with direct anterior approach in the treatment of hip ankylosis in the lateral position is safe and effective, which has the advantages of small trauma, quick recovery of hip function, and can expose acetabulum fully and installed prosthesis properly, and the early clinical efficacy is satisfied.

Key words: direct anterior approach, lateral position, hip ankylosis, total hip arthroplasty, clinical efficacy, visual analogue scale, Harris hip score, surgical approach

CLC Number:

R458|R682.3|R318

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R458|R682.3|R318

Cheng Wendan, Wu Han, Zhang Jisen, Zhang Xin, Zhang Shuo, Li Ziyu, Wu Yibo, Bai Wenyi, Jing Juehua. Total hip arthroplasty by direct anterior approach in the lateral position in the treatment of ankylosed hips: early therapeutic effects[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4429-4434.

Figures/Tables 3

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