Comparative study of direct anterior and posterior approaches in total hip arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2019.01.006

Abstract

Abstract:

Objective

To observe the clinical effects and the recovery of joint function between direct anterior approach (DAA) of total hip replacement and conventional posterior approach (PA) surgery.

Methods

Cases of total hip arthroplasty in the orthopaedics department of Chengdu Fifth People’s Hospital from January 2016 to December 2017 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative drainage volume, haemoglobin concentration, acetabular abduction angle and joint function scores were compared between the two groups by chi-square test or independent t test.

Results

According to the inclusion and exclusion criteria, 55 patients treated with DAA (group DAA) and 57 patients treated with PA (group PA) were enrolled in the study. The operation time of DAA group was longer than that of PA group (t=2.64), the amount of bleeding during operation (t=17.47) and of drainage after operation (t=22.06) were less than that of PA group, the abduction angle of acetabulum was less than that of PA group (all P<0.05); the concentration of haemoglobin concentration in DAA group was significantly higher than that of PA group (t=3.44, P<0.05); the Harris and Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC) scores in DAA group were significantly higher than those in PA group one month after operation (t=4.44, 5.73; both P<0.05); but the WOMAC score in DAA group was lower than that in PA group at the last follow-up(t=5.96, P<0.05).

Conclusion

Total hip replacement with DAA approach has little blood loss and maintains better joint stability, and it is conducive to postoperative function recovery.

Key words: Arthroplasty, replacement, hip, Recovery of function

Zhengjiang Li, Yongkui Li, Zhaonan Ban, Shuxing Xing, Yan Zhang. Comparative study of direct anterior and posterior approaches in total hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(01): 29-32,121.

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References 20

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组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	病因(例)
组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	股骨颈骨折	股骨头坏死	骨关节炎	类风湿性关节炎
DAA组	55	22/33	64±5	25±4	23	10	16	6
PA组	57	25/32	65±6	24±4	26	13	11	7
统计值	?	t＝0.171	t＝0.828	t＝0.794	χ²＝1.54
P值	?	>0.05	>0.05	>0.05	>0.05

组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	病因(例)
组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	股骨颈骨折	股骨头坏死	骨关节炎	类风湿性关节炎
DAA组	55	22/33	64±5	25±4	23	10	16	6
PA组	57	25/32	65±6	24±4	26	13	11	7
统计值	?	t＝0.171	t＝0.828	t＝0.794	χ²＝1.54
P值	?	>0.05	>0.05	>0.05	>0.05

组别	例数	手术时间(min)	术中出血量(ml)	术后引流量(ml)	术后髋臼外展角(°)	术前Hb浓度(g/L)	术后Hb浓度(g/L)
DAA组	55	56±6	59±7	54±7	43±2	127±14	91±10
PA组	57	53±5	86±9	106±16	44±2	126±14	85±9
t值	?	2.64	17.47	22.06	2.15	0.38	3.44
P值	?	<0.05	<0.05	<0.05	<0.05	>0.05	<0.05

组别	例数	手术时间(min)	术中出血量(ml)	术后引流量(ml)	术后髋臼外展角(°)	术前Hb浓度(g/L)	术后Hb浓度(g/L)
DAA组	55	56±6	59±7	54±7	43±2	127±14	91±10
PA组	57	53±5	86±9	106±16	44±2	126±14	85±9
t值	?	2.64	17.47	22.06	2.15	0.38	3.44
P值	?	<0.05	<0.05	<0.05	<0.05	>0.05	<0.05

组别	例数	Harris评分			WOMAC评分
组别	例数	术前	术后1个月	末次随访	术前	术后1个月	末次随访
DAA组	55	42.4±5.3	84.5±7.6	89.5±7.4	79.6±6.9	28.8±5.8	14.4±2.5
PA组	57	43.3±5.8	78.4±6.9	88.2±7.2	79.6±6.7	35.5±6.4	17.2±2.5
t值	?	0.77	4.44	0.94	0.05	5.73	5.96
P值	?	>0.05	<0.05	>0.05	>0.05	<0.05	<0.05

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