Comparative study on direct anterior approach in lateral decubitus position versus posterolateral approach for unilateral total hip arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2019.01.005

Abstract

Abstract:

Objective

To compare the clinical efficacy of the direct anterior approach in lateral decubitus position (L-DAA) and posterolateral approach (PLA) for unilateral total hip arthroplasty.

Methods

A retrospective study was conducted on 93 patients who underwent primary unilateral total hip arthroplasty in Department of Joint Surgery, Suining Central Hospital between August 2016 and December 2017. The patients who underwent primary unilateral replacement were included and who underwent bilateral replacement or intolerance of surgery were excluded. There were 45 cases underwent L-DAA and 48 cases underwent PLA. The body mass index(BMI), operation time, intraoperative blood loss, preoperative hemoglobin of the postoperative first day and the seventh day, incision length, hospital stay, preoperative and post operative Harris score, preoperative and postoperative VAS score, radiological evaluation, intraoperative and postoperative complication were recorded and analyzed by t test and chi-square test.

Results

All the patients were followed up for six to 16 months, with an average of (11.7±1.6)months. No deep vein thrombosis, infection or other serious complication occurred. No significant difference was found in BMI, operation time, preoperative Harris score, preoperative Hb, incision length, radiological evaluation, preoperative or postoperative VAS score, nor in hospital stay (P>0.05). Significant differences were detected in intraoperative blood loss, postoperative Hb levels on the first day and the seventh day, more blood loss and lower hemoglobin levels were found in PLA group (t=0.361, 0.484; both P<0.05). In postoperative three months, the Harris score was higher in L-DAA group than PLA group(t=0.572, P<0.05); while in the postoperative six months, there was no significant difference between the two groups(P>0.05). No postoperative complication was found in L-DAA group, while two cases of postoperative hip dislocation were observed in the PLA group, the difference was statistically significant (χ²=0.465, P<0.05). During the operation, two cases of proximal femoral fracture occurred in L-DAA group while non in PLA group (χ²=0.587, P<0.05).

Conclusion

Compared with the posterolateral approach, the L-DAA approach has the advantages of less trauma and faster postoperative recovery, which is a safe surgical approach and can benefit the rapid rehabilitation of patients.

Key words: Arthroplasty, replacement, hip, Patient positioning

Wenbo Zhao, Yongjie Ye, Wei Huang, Yi Yin, Zhiqiang Wang, Guanjun Sun, Xu Peng. Comparative study on direct anterior approach in lateral decubitus position versus posterolateral approach for unilateral total hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(01): 23-28,85.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2019.01.005

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2019/V13/I01/23

Figures/Tables 7

References 20

[1]	Drescher W, Pufe T, Smeets R, et al. Avascular necrosis of the hip-diagnosis and treatment[J]. Z Orthop Unfall, 2011, 149(2): 231-240; quiz 241-242.
[2]	Khan R, Fick D, Khoo P, et al. Less invasive total hip arthroplasty：description of a new technique[J]. J Arthroplasty, 2006, 21(7): 1038-1046.
[3]	Kennon R, Keggi J, Zatorski LE, et al. Anterior approach for total hip arthroplasty: beyond the minimally invasive technique[J]. J Bone Joint Surg Am, 2004, 86-A(Suppl 2): 91-97.
[4]	Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs[J]. J Bone Joint Surg Br, 1999, 81(3): 431-435.
[5]	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties[J]. J Bone Joint Surg Am, 1978, 60(2): 217-220.
[6]	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.
[7]	Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal human adults[J]. Surgery, 1962, 51(2): 224-232
[8]	Melman WP, Mollen BP, Kollen BJ, et al. First experiences with the direct anterior approach in lateral decubitus position：learning curve and 1 year complication rate[J]. Hip Int, 2015, 25(3): 251-257.
[9]	Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to hip[J]. Orthop Clin North Am, 2009, 40(3): 311-320.
[10]	Smith-Petetsen MM. A new supra articular subperiosteal approach to the hip joint [J]．Am J Orthop Surg, 1917, 15(8): 592-595.
[11]	桑伟林，朱力波，陆海明，等．直接前入路与后外侧入路全髋关节置换术的对比研究[J/CD]．中华关节外科杂志(电子版)，2015，9(5):584-588.
[12]	綦珂，李甲，李全，等．直接前方入路与后外侧入路在初次全髋关节置换术中的疗效分析[J/CD]．中华关节外科杂志(电子版)，2016，10(3):260-264.
[13]	Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage marker[J]. J Bone J Surg Am, 2011, 93(15): 1392-1398.
[14]	Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty[J]. J Arthroplasty, 2013, 28(9): 1634-1638.
[15]	Brennan S, Khan F, Kiernan C, et al. Dislocation of primary total hip arthroplasty and the risk redislocation[J]. Hip Int, 2012, 22(5): 500-504.
[16]	Bouchet R, Mercier N, Saragaglia D. Posterior approach and dislocation rate：a 213 total hip replacement case control study comparing the dual mobility cup with a conventional 28 mm metal head polyethylene prosthesis[J]. Orthop Traumatol Surg Res, 2011, 97(1): 2-7.
[17]	Meek RM, Allan DB, Mcphillips G, et al. Epidemiology of dislocation after total hip arthroplasty[J]. Clin Orthop Relat Res, 2006, 447(1): 9-18.
[18]	Hoell S, Sander M, Gosheger G, et al. The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty：is dislocation still a major issue？A case control study[J]. BMC Musculoskelet Disord, 2014, 15(2): 80-81.
[19]	罗正亮，尚希福，胡飞，等．全髋关节置换术治疗创伤性股骨头缺血性坏死的疗效分析[J]．中华医学杂志，2014，94(23):1773-1776.
[20]	陈朦村，杨述华，叶树楠，等．直接前路与微创后外侧入路初次全款关节置换术早期临床疗效比较[J/CD]．中华关节外科杂志(电子版)，2017, 11(4) :344-351.

组别	例数	年龄[岁，(±s)]	男性例数(%)	BMI[kg/m²，(±s)]	术前HHS评分(±s)	术前VAS评分(±s)
L-DAA组	45	70.4±10.2	22(48.9)	25.7±2.9	34.5±8.1	6.7±1.2
PLA组	48	70.9±15.1	29(60)	25.4±4.8	33.9±10.2	7.0±1.3
统计值	?	t ＝0.536	χ²＝0.521	t ＝0.538	t ＝0.518	t ＝0.527
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	年龄[岁，(±s)]	男性例数(%)	BMI[kg/m²，(±s)]	术前HHS评分(±s)	术前VAS评分(±s)
L-DAA组	45	70.4±10.2	22(48.9)	25.7±2.9	34.5±8.1	6.7±1.2
PLA组	48	70.9±15.1	29(60)	25.4±4.8	33.9±10.2	7.0±1.3
统计值	?	t ＝0.536	χ²＝0.521	t ＝0.538	t ＝0.518	t ＝0.527
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	手术时间(min)	切口长度(cm)	失血量(ml)	术前Hb(g/L)	术后第1天Hb(g/L)	术后第7天Hb(g/L)
L-DAA组	45	60.7±9.6	9.5±2.3	100.9±9.5	126.6±11.3	111.2±9.7	95.3±10.2
PLA组	48	61.2±8.9	9.7±1.4	119.3±9.7	125.2±10.4	97.6±15.2	88.6±11.5
t值	?	0.561	0.433	0.312	0.467	0.361	0.484
P值	?	>0.05	>0.05	<0.05	>0.05	<0.05	<0.05

组别	例数	手术时间(min)	切口长度(cm)	失血量(ml)	术前Hb(g/L)	术后第1天Hb(g/L)	术后第7天Hb(g/L)
L-DAA组	45	60.7±9.6	9.5±2.3	100.9±9.5	126.6±11.3	111.2±9.7	95.3±10.2
PLA组	48	61.2±8.9	9.7±1.4	119.3±9.7	125.2±10.4	97.6±15.2	88.6±11.5
t值	?	0.561	0.433	0.312	0.467	0.361	0.484
P值	?	>0.05	>0.05	<0.05	>0.05	<0.05	<0.05

组别	例数	HHS评分		VAS评分
组别	例数	术后3个月	术后6个月	术后3个月	术后6个月
L-DAA组	45	90.61±9.74	90.74±9.23	1.12±0.29	1.03±0.11
PLA组	48	83.65±8.82	89.91±8.38	1.15±0.17	1.04±0.21
t值	?	0.572	0.627	0.568	0.513
P值	?	<0.05	>0.05	>0.05	>0.05

Please choose a citation manager

Content to export