Email Alert | RSS

Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (2): 268-272. doi: 10.19723/j.issn.1671-167X.2019.02.013

Previous Articles     Next Articles

Early functional recovery of direct anterior approach versus anterolateral approach for total hip arthroplasty

Sen-lei LI,Xian-teng YANG,Xiao-bin TIAN,Li SUN()   

  1. Department of Orthopaedics, Guizhou Provincial people's Hospital, Guiyang 550002, China
  • Received:2017-03-28 Online:2019-04-18 Published:2019-04-26
  • Contact: Li SUN E-mail:sunly999@qq.com
  • Supported by:
    the Science Foundation of Guizhou Province[No. (2015) 3044];the Subsidy Fundation of National Natural Science Fundation of Guizhou Provincial People’s Hospital (Guizhou Science and Technology Platform [2017]5724])

RICH HTML

 8   

PDF (PC)

295

Abstract:

Objective: To evaluate the early clinical effects of direct anterior approach (DAA) versus anterolateral approach (ALA) on safety and functional recovery following total hip arthroplasty (THA).Methods: Between January 2015 and May 2016, a randomized clinical trial was performed at Guizhou Provincial People’s Hospital. A total of 50 patients who underwent THA were allocated for either the DAA (n=25) or ALA (n=25). DDA group had 25 patients (25 hips), including 16 males and 9 females, with the mean age of (62±2) years, BMI of (23.26 ±4.95) kg/m 2(range: 19.6 to 29.5), and preoperative Harris score of (33.4 ±15.5) (range: 17.9 to 48.9). Eleven cases were diagnosed as primarily hip osteoarthritis, 4 were developmental dysplasia of the hip (DDH, Crowe 2) and 10 were hip avascular necrosis (AVN, Stages 3 to 4). ALA group had 25 patients (25 hips), including 18 males and 7 females, with the mean age of (59±3) years, BMI of (25.35 ±5.8) kg/m 2(range: 18.2 to 29.8), and preoperative Harris score of (38.6 ± 16.7) (range: 23.1 to 56.5). Ten cases were diagnosed as primarily hip osteoarthritis, 3 were developmental dysplasia of the hip (DDH, Crowe 2) and 12 were hip avascular necrosis (AVN, Stages 3 to 4). Operation time, incision length, intra-operative blood loss and functional recovery of hip postoperatively were compared between the two groups.Results: The surgical incision of both groups were stageⅠhealing. The mean follow-up was 6 months. There was no significant difference regarding operation time, incision length, and intra-operative blood loss between the two groups. However, we also found that there was no significant difference in the Harris score 3 months and 6 months postoperatively. In addition, two patients in ALA group suffered claudication (physical examination: abduction dysfunction of hip). We also found that DAA group resulted in better recovery of abductor strength and gait than ALA group during early follow-up.Conclusion: Both DAA and ALA could obtain good results of early curative effect following THA. Moreover, DAA resulted in better gait than ALA during early follow-up.

Key words: Total hip arthroplasty, Direct anterior approach, Anterolateral approach

CLC Number: 

  • R687.4

Figure 1

Localization of incision for DAA"

Figure 2

Exposure for the acetabulum"

Figure 3

The intraoperative position for patients"

Figure 4

Implanting the femoral prosthesis"

Table 1

Statistical result of operation time, incision length, and intra-operative blood loss comparing DAA and ALA for total hip arthroplasty"

Items DAA ALA t P
x?±s Range x?±s Range
Operation time/min 108.3±18.5 98-135 103.3±15.5 85-116 3.741 0.306
Incision length/cm 10.3±1.8 8.7-12.2 9.6±1.7 7.9-11.2 -1.581 0.092
Blood loss/mL 210±135 130-400 230±145 160-450 -6.072 0.178

Table 2

Harris score comparing pre-operation and 3-months-post-operation of DAA and ALA for total hip arthroplasty"

Group Harris score of pre-operation Harris score of post-operation t P
DAA 33.4 ±15.5 88.7 -18.215 <0.01
ALA 38.6 ± 16.7 86.5 -17.831 <0.01

Table 3

Harris score comparing DAA and ALA for total hip arthroplasty at 3-months post-operatively and 6-months post-operatively"

Time point DAA ALA t P
3-months 88.7±10.8 86.5±10.2 1.601 0.137
6-months 93.5±11.6 90.9±11.1 0.352 0.527
[1] Mccrory JL, White SC, Lifeso RM . Vertical ground reaction forces: objective measures of gait following hip arthroplasty[J]. Gait Posture, 2001,14(2):104-109.
doi: 10.1016/S0966-6362(01)00140-0
[2] Morrey BF . Difficult complications after hip joint replacement. Dislocation[J]. Clin Orthop Relat Res, 1997(344):179.
[3] Brennan SA, Khan F, Kiernan C , et al. Dislocation of primary total hip arthroplasty and the risk of redislocation[J]. Hip Int, 2012,22(5):500-504.
doi: 10.5301/HIP.2012.9747
[4] Van Warmerdam JM, Mcgann WA, Donnelly JR , et al. Achilles allograft reconstruction for recurrent dislocation in total hip arthroplasty[J]. J Arthroplasty, 2011,26(6):941-948.
doi: 10.1016/j.arth.2010.12.014
[5] White RE, Forness TJ, Allman JK , et al. Effect of posterior capsular repair on early dislocation in primary total hip replacement[J]. Clin Orthop Relat Res, 2001(393):163-167.
[6] Goldstein WM, Gleason TF, Kopplin M , et al. Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy[J]. J Bone Joint Surg Am, 2001,83(A Suppl):2-7.
doi: 10.2106/00004623-200100021-00002
[7] Pellicci PM, Bostrom M, Poss R .Posterior approach to total hip replacement using enhanced posterior soft tissue repair[J]. Clin Orthop Relat Res, 1998(355):224-228.
[8] 张先龙, 蒋垚, 陈云苏 . 人工髋关节外科学 [M]. 北京: 人民军医出版社, 2009: 431-432.
[9] 吕厚山 . 现代人工关节外科学 [M]. 北京: 人民卫生出版社, 2006: 520.
[10] Siguier T, Siguier M, Brumpt B . Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements[J]. Clin Orthop Relat Res, 2004(426):164-173.
[11] Matta JM, Shahrdar C, Ferguson T . Single-incision anterior approach for total hip arthroplasty on an orthopaedic table[J]. Clin Orthop Relat Res, 2005(441):115-124.
[12] Nakata K, Nishikawa M, Yamamoto K , et al. A Clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series[J]. J Arthroplasty, 2009,24(5):698-704.
doi: 10.1016/j.arth.2008.04.012
[13] Restrepo C, Parvizi J, Pour AE , et al. Prospective randomized study of two surgical approaches for total hip arthroplasty[J]. J Arthroplasty, 2010,25(5):671-679.
doi: 10.1016/j.arth.2010.02.002
[14] 沈军, 邹天明, 王东来 , 等. 改良外侧小切口全髋关节置换术的疗效分析[J]. 中国骨与关节损伤杂志, 2012,27(10):876-878.
[15] Lachiewicz PF . Abductor tendon tears of the hip: evaluation and management[J]. J Am Acad Orthop Surg, 2011,19(7):385-391.
doi: 10.5435/00124635-201107000-00001
[16] Van Oldenrijk J, Hoogervorst P, Schaap GR , et al. Two-incision minimally invasive total hip arthroplasty-results and complications[J]. Hip Int, 2011,21(1):81-86.
doi: 10.5301/hip.2011.6302
[17] 桑伟林, 朱力波, 马金忠 , 等. 微创直接前入路全髋关节置换术[J]. 国际骨科学杂志, 2010,31(5):266-267.
[1] KE Yan,ZHANG Qiang,MA Yun-qing,LI Ru-jun,TAO Ke,GUI Xian-ge,LI Ke-peng,ZHANG Hong,LIN Jian-hao. Short-term outcomes of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with spondyloepiphyseal dysplasia [J]. Journal of Peking University (Health Sciences), 2021, 53(1): 175-182.
[2] TANG Jing, LV Ming, ZHOU Yi-xin, ZHANG Ji. Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 221-225.
[3] XU Jie， ZHUANG Wei-da， LI Xin-wei， YU Guo-yu， LIN Yuan， LUO Fen-qi， XIAO Yu-hua. Comparison of the effects of total hip arthroplasty via direct anterior approach and posterolateral piriformis-sparing approach [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 214-220.
[4] LV Ming, ZHANG Jin-qing, WANG Xing-shan, HUANG Ye, LI Wei, ZHANG Chun-yu. Surgical technique and early clinical outcomes of direct anterior approach to total hip arthroplasty [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 206-213.
[5] ZHANG Yong-jin, LI Jia, QI Ke, XUE Chen-chen, XU Wei-dong. Comparison of efficacy and safety between the anterior and the posterior approaches to total hip arthroplasty [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 201-205.
[6] WANG Hao-yang, KANG Peng-de, NIE Yong, ZHAO Hai-yan, YANG Zhou-yuan, PEI Fu-xing. Gait analysis at the early stage after direct anterior approach in total hip arthroplasty [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 196-200.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] Author. English Title Test[J]. Journal of Peking University(Health Sciences), 2010, 42(1): 1 -10 .
[2] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 188 -191 .
[3] . [J]. Journal of Peking University(Health Sciences), 2009, 41(3): 376 -379 .
[4] . [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 459 -462 .
[5] . [J]. Journal of Peking University(Health Sciences), 2010, 42(1): 82 -84 .
[6] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 319 -322 .
[7] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 333 -336 .
[8] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 337 -340 .
[9] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 225 -328 .
[10] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 346 -350 .
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd