Rush University Medical Center, Chicago, Illinois, USA.
Washington University Orthopedics, Barnes Jewish Hospital, St. Louis, Missouri, USA.
Bone Joint J. 2019 Jun;101-B(6_Supple_B):31-36. doi: 10.1302/0301-620X.101B6.BJJ-2018-1575.R1.
Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study's purposes were to determine differences in pain based on surgical approach (direct anterior (DA) posterolateral (PL)) and PL approach incision length.
This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year's follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80).
A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% 21%; p < 0.001) and groin pain (19% 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7).
A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: 2019;101-B(6 Supple B):31-36.
全髋关节置换术（THA）中患者报告的疼痛是否因手术入路不同而不同尚不清楚。本研究的目的是确定基于手术入路（直接前入路（DA）和后外侧入路（PL））和 PL 入路切口长度的疼痛差异。
这是来自两个中心和七位外科医生（三位 DA，三位 PL，一位两者兼而有之）的原发性 THA 的回顾性研究。PL 患者根据切口长度（6cm 至 8cm、8cm 至 12cm、12cm 至 15cm）进行分类。所有患者均采用非骨水泥股骨和髋臼固定，至少随访 1 年，且固定良好。患者完成疼痛绘图问卷，根据解剖图识别疼痛的位置和强度。根据需要的 800 例患者的功率分析，每个队列均有足够的检测 4%疼痛差异的能力（α=0.05，β=0.80）。
共纳入 1848 例患者（982 例 DA，866 例 PL）。PL 患者更年轻（59.4 岁，标准差 12.9 62.7 岁，标准差 9.7；p<0.001）且随访时间更短（3.3 年，标准差 1.3 3.7 年，标准差 1.3；p<0.001）。与 PL 患者相比，DA 患者报告的转子间（14% 21%；p<0.001）和腹股沟疼痛（19% 24%；p=0.004）明显减少。两组患者在前侧、外侧或后侧大腿、背部或臀部疼痛方面无差异（p=0.05 至 0.7）。PL 入路切口长度不影响疼痛的发生率或严重程度（p=0.3 至 0.7）。
无论手术入路如何，相当一部分患者在 THA 后仍会出现持续性疼痛。与 PL 患者相比，DA 患者报告的转子间和腹股沟疼痛更少。PL 切口长度不影响患者报告的疼痛的发生率或严重程度。
2019；101-B（6 增刊 B）：31-36。
