Direct anterior approach versus anterolateral approach in total hip arthroplasty: comparison of early
postoperative patient’s perception

doi:10.3969/j.issn.2095-4344.2469

Abstract

Abstract:

BACKGROUND: Total hip arthroplasty can significantly alleviate pain in patients with end-stage hip disease and improve the joint function. Different surgical approaches have their own advantages and disadvantages. As a popular approach, direct anterior approach is to expose the hip joint through the fascia lata muscle and the sartorius muscle gap, which is in line with the concept of minimally invasive surgery, and has the advantages of small damage to soft tissue and quick recovery after arthroplasty. However, it has a certain learning curve, which requires the surgeons to have certain experience.

OBJECTIVE: To compare the perception of the elderly with unilateral femoral head fracture undergoing total hip arthroplasty through direct anterior approach and anterolateral approach.

METHODS: Forty-two patients (42 hips) with unilateral femoral head fracture in Orthopedic Center, Xinjiang Uygur Autonomous Region People’s Hospital from January 2017 to June 2018 were enrolled, and all patients underwent total hip arthroplasty. The patients were randomized into two groups, including 21 patients (21 hips) in anterolateral approach group and 21 patients (21 hips) in direct anterior approach group. The patients signed the informed consents and the study was approved by the Hospital Ethics Committee. The incision length, operation time and blood loss were recorded. The Harris hip joint score, and Oxford Hip scores at 1 week, 1 and 3 months postoperatively were compared. The prosthesis location and complications were observed.

RESULTS AND CONCLUSION: (1) The hospitalization time in the direct anterior approach group was significantly shorter than that in the anterolateral approach group (P < 0.001). The incision length in the direct anterior approach group was significantly less than that in the anterolateral approach group (P < 0.001). The operation time and intraoperative blood loss in the direct anterior approach group were significantly lower than those in the anterolateral approach group (P < 0.001). (2) The 1-minute walking distance in the direct anterior approach group was longer than that in the anterolateral approach group at postoperative 1 and 2 days (P < 0.001). The Visual Analogue Scale scores at postoperative 1 and 2 days in the direct anterior approach group were significantly lower than those in the anterior approach group (P < 0.05). (3) After 3-month follow-up, the acetabular prosthesis abduction angle and anteversion angle showed no significant difference between two groups (P > 0.05). (4) The Harris hip and Oxford Hip scores at 1 week after surgery in the direct anterior approach group were significantly higher than those in anterolateral approach group (P < 0.05). The scores at postoperative 3 months showed no significant difference between two groups (P > 0.05). (5) One case in the direct anterior approach group and two cases in the anterolateral approach group appeared with bursitis surrounding with the incision and pain, which disappeared after local sealing. One patient in the direct anterior approach group developed subcutaneous hematoma, and healed at postoperative 3 weeks. One case in the direct anterior approach suffered from inner thigh skin numbness. (6) These results indicate that at early postoperative period, patients in anterolateral approach group are feeling better than those in direct anterior approach group. Although direct anterior approach has the advantages of small incision, less pain at the early postoperative period and fast recovery, it has a certain learning curve, with a longer operation time and more blood loss.

Key words: total hip arthroplasty, direct anterior approach, anterolateral approach, learning curve, prosthesis position, complications

CLC Number:

Milalimmu•Multiza, Zhao Wei, Varesjiang•Nyyaz, Yuan Hong, Wang Li. Direct anterior approach versus anterolateral approach in total hip arthroplasty: comparison of early postoperative patient’s perception [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1318-1323.

Figures/Tables 6

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