Meneghini R Michael, Elston Addison S, Chen Antonia F, Kheir Michael M, Fehring Thomas K, Springer Bryan D
1Department of Orthopaedic Surgery, Indiana University School of Medicine, Fishers, Indiana 2School of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana 3The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania 4OrthoCarolina Hip and Knee Center, Charlotte, North Carolina.
J Bone Joint Surg Am. 2017 Jan 18;99(2):99-105. doi: 10.2106/JBJS.16.00060.
The direct anterior approach for total hip arthroplasty (THA) is marketed with claims of superiority over other approaches. Femoral exposure can be technically challenging and potentially lead to early failure. We examined whether surgical approach is associated with early THA failure.
A retrospective review of 478 consecutive early revision THAs performed within 5 years after the primary THAs at 3 academic centers from 2011 through 2014 was carried out. Exclusion criteria resulted in a final analysis sample of 342 early-failure THAs. The surgical approach of the primary operation that was revised, the time to the revision, and the etiology of the failure leading to the revision were documented.
Analysis of the revisions due to early femoral failure showed them to be more common in patients who had undergone the direct anterior approach (57/112; 50.9%) than in those treated with the direct lateral (39/112; 34.8%) or the posterior (16/112; 14.3%) approach (p = 0.001). In multivariate regression analysis controlling for age, sex, laterality, Dorr bone type, body mass index (BMI) at revision, bilateral procedure (yes/no), and femoral stem type, the direct anterior approach remained a significant predictor of early femoral failure (p = 0.007). The majority of early revisions due to instability were associated with the posterior (19/40; 47.5%) or direct anterior (15/40; 37.5%) approach (p = 0.001 for the comparison with the direct lateral approach [6/40; 15.0%]).
Despite claims of earlier recovery and improved outcomes with the direct anterior approach for THA, our findings indicate that that approach may confer a greater risk of early femoral failure and, along with the posterior approach, confer a greater risk of early instability compared with the direct lateral approach.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
全髋关节置换术（THA）的直接前路手术宣称比其他手术方式更具优势。股骨暴露在技术上具有挑战性，且可能导致早期失败。我们研究了手术方式是否与THA早期失败相关。
对2011年至2014年在3个学术中心进行的478例初次THA术后5年内连续进行的早期翻修THA进行回顾性研究。排除标准导致最终分析样本为342例早期失败的THA。记录了翻修的初次手术的手术方式、翻修时间以及导致翻修的失败病因。
对因早期股骨失败而进行的翻修分析显示，与采用直接外侧入路（39/112；34.8%）或后外侧入路（16/112；14.3%）的患者相比，采用直接前路手术的患者更常见（57/112；50.9%）（p = 0.001）。在多因素回归分析中，控制年龄、性别、侧别、Dorr骨型、翻修时的体重指数（BMI）、双侧手术（是/否）和股骨柄类型后，直接前路手术仍然是早期股骨失败的显著预测因素（p = 0.007）。因不稳定导致的大多数早期翻修与后外侧入路（19/40；47.5%）或直接前路入路（15/40；37.5%）相关（与直接外侧入路[6/40；15.0%]相比，p = 0.001）。
尽管宣称THA的直接前路手术能实现更早康复并改善预后，但我们的研究结果表明，与直接外侧入路相比，该手术方式可能会带来更高的早期股骨失败风险，并且与后外侧入路一样，会带来更高的早期不稳定风险。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
