Clinical effects comparison of total hip arthroplasty with different approaches for treatment of femoral head necrosis

doi:10.3877/cma.j.issn.1674-134X.2021.02.005

Abstract

Abstract:

Objective

To compare the clinical outcomes of direct anterior approach (DAA) and posterior approaches (PA) for primary unilateral total hip arthroplasty (THA) in the treatment of femoral head necrosis.

Methods

A total of 160 Ficat stageⅢ、Ⅳfemoral head necrosis patients who were undergoing primary unilateral THA were included into this study. Patients with bilateral surgery, preoperative hip disease, and previous trauma history were excluded. All the patients were divided into two groups by the random method. The operations were performed according to DAA and PA approaches. The complications, prosthesis location, Harris score, the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, short-form 36 item health survey questionnaire (SF-36) and forgotten joint score-12 were observed and compared between the two groups one and two years after operation. Independent sample t test and repeated measures analysis of variance were used for statistical analysis.

Results

A total of 128 patients were followed up for more than two years. There was no significant difference in baseline data between the two groups (P>0.05). There was no significant difference in acetabular anteversion, acetabular abduction and femoral off-set and complications between the two groups at two years post-operatively (t=0.834, 0.883, 1.733, all P>0.05; Fisher exact test P=1.000). There was no significant difference in Harris score between the two groups one and two years after operation(F=2.309, 2.965, both P>0.05). There were significant differences in WOMAC(F=4.699, P=0.034), mental component summary (MCS)(F=8.906, P=0.004) and physical component summary (PCS)(F=4.525, P=0.037) between the two groups at one year after operation.The WOMAC, MCS and PCS in DAA group were significantly higher than those in PA group. There was no significant difference in WOMAC, MCS and PCS scores between the two groups two years after operation (F=2.349, 2.608, 0.513, all P>0.05). There was significant difference in forgotten joint score-12 between the two groups one and two years after operation (F=4.832, P=0.032). The forgotten joint score-12 of DAA group was significantly higher than PA group.

Conclusions

Compared with PA approach, DAA approach has no difference in postoperative complications and prosthesis position, but it has some advantages in functional recovery, especially subjective feeling, within one year after operation. Two years after operation DAA still shows an advantage in self-perception. Long term differences in outcome requires further observation and more comprehensive evaluation.

Key words: Arthroplasty, replacement, hip, Surgical wound, Femur head necrosis

Qiliang Zhang, Yu Yu, Jian Zhou, Xueren Teng, Guoqing Ren. Clinical effects comparison of total hip arthroplasty with different approaches for treatment of femoral head necrosis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(02): 157-162.

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Figures/Tables 3

References 20

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		DAA组	PA组	统计值	P值
例数		62	66
年龄[岁，(±s)]		61.7±7.1	63.3±8.2	t＝1.199	>0.05
性别(男/女)		35/27	40/26	χ²＝0.227	>0.05
BMI[%，(±s)]		24.6±3.0	25.0±3.4	t＝0.758	>0.05
股骨头坏死
	FicatⅢ期	21	19	χ²＝0.384	>0.05
	FicatⅣ期	41	47	χ²＝0.384	>0.05
ASA分级
	Ⅰ级	15	19	χ²＝0.400	>0.05
	Ⅱ级	34	35
	Ⅲ级	13	12
术前合并症
	高血压	19	21	χ²＝0.020	>0.05
	冠心病	13	12	χ²＝0.158	>0.05
	糖尿病	10	13	χ²＝0.276	>0.05
	COPD	4	3	χ²＝0.007	>0.05
	其他	7	9	χ²＝0.161	>0.05

		DAA组	PA组	统计值	P值
例数		62	66
年龄[岁，(±s)]		61.7±7.1	63.3±8.2	t＝1.199	>0.05
性别(男/女)		35/27	40/26	χ²＝0.227	>0.05
BMI[%，(±s)]		24.6±3.0	25.0±3.4	t＝0.758	>0.05
股骨头坏死
	FicatⅢ期	21	19	χ²＝0.384	>0.05
	FicatⅣ期	41	47	χ²＝0.384	>0.05
ASA分级
	Ⅰ级	15	19	χ²＝0.400	>0.05
	Ⅱ级	34	35
	Ⅲ级	13	12
术前合并症
	高血压	19	21	χ²＝0.020	>0.05
	冠心病	13	12	χ²＝0.158	>0.05
	糖尿病	10	13	χ²＝0.276	>0.05
	COPD	4	3	χ²＝0.007	>0.05
	其他	7	9	χ²＝0.161	>0.05

		DAA组	PA组	F值	P值
例数		62	66
Harris评分
术前		43.5±5.2	44.3±6.3	0.145	>0.05
	术后1年	92.2±3.0	91.4±3.6	2.309	>0.05
	术后2年	93.3±2.0	92.8±2.1	2.965	>0.05
WOMAC评分
	术前	69.8±6.9	70.4±7.0	0.139	>0.05
	术后1年	3.7±0.8	4.1±0.9	4.699	0.034
	术后2年	1.7±0.3	1.8±0.4	2.349	>0.05
PCS评分
	术前	27.0±7.4	27.5±7.0	0.174	>0.05
	术后1年	47.2±5.4	44.8±5.5	8.906	0.004
	术后2年	52.7±6.4	50.6±6.9	0.513	>0.05
MCS评分
	术前	48.7±7.4	50.1±8.5	2.524	>0.05
	术后1年	54.8±6.9	51.9±6.6	4.525	0.037
	术后2年	56.2±6.1	55.2±6.5	2.608	>0.05
FJS评分
	术后1年	70.5±19.4	61.2±21.5	0.059	>0.05
	术后2年	75.3±15.5	68.2±22.3	4.832	0.032

		DAA组	PA组	F值	P值
例数		62	66
Harris评分
术前		43.5±5.2	44.3±6.3	0.145	>0.05
	术后1年	92.2±3.0	91.4±3.6	2.309	>0.05
	术后2年	93.3±2.0	92.8±2.1	2.965	>0.05
WOMAC评分
	术前	69.8±6.9	70.4±7.0	0.139	>0.05
	术后1年	3.7±0.8	4.1±0.9	4.699	0.034
	术后2年	1.7±0.3	1.8±0.4	2.349	>0.05
PCS评分
	术前	27.0±7.4	27.5±7.0	0.174	>0.05
	术后1年	47.2±5.4	44.8±5.5	8.906	0.004
	术后2年	52.7±6.4	50.6±6.9	0.513	>0.05
MCS评分
	术前	48.7±7.4	50.1±8.5	2.524	>0.05
	术后1年	54.8±6.9	51.9±6.6	4.525	0.037
	术后2年	56.2±6.1	55.2±6.5	2.608	>0.05
FJS评分
	术后1年	70.5±19.4	61.2±21.5	0.059	>0.05
	术后2年	75.3±15.5	68.2±22.3	4.832	0.032

分组	例数	髋臼假体外翻角度(°)	髋臼假体前倾角度(°)	股骨柄偏心距(mm)
DAA组	62	43±6	24±4	38±4
PA组	66	44±7	24±4	39±4
t值		0.834	0.883	1.733
P值		>0.05	>0.05	>0.05

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