Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York, USA.
Bone Joint J. 2019 Jun;101-B(6):646-651. doi: 10.1302/0301-620X.101B6.BJJ-2018-1474.R1.
A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications.
The electronic medical records of all patients who underwent primary elective THA at a single large-volume arthroplasty centre, between 2011 and 2016, with at least two years of follow-up, were reviewed. After exclusion, 3574 consecutive patients were included in the study. There were 1571 men (44.0%) and 2003 women (56.0%). Their mean age and body mass index (BMI) was 63.0 years (sd 11.8) and 29.1 kg/m (sd 6.1), respectively. Data gathered included the age of the patient, BMI, the American Society of Anesthesiologists (ASA) score, estimated blood loss (EBL), length of stay (LOS), operating time, the presence of intra- or postoperative complications, type of complication, and the surgical approach. The approaches used during the study were posterior, anterior, direct lateral, anterolateral, and the northern approach. The complications that were recorded included prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture. Finally, the need for re-operation was recorded. Means were compared using analysis of variance (ANOVA) and Student's -tests where appropriate and proportions were compared using the chi-squared test.
A total of 248 patients had 263 complications related to the surgery, with an incidence of 6.94%. The anterior approach had the highest incidence of complications (8.5% (113/1329)) and the posterior approach had the lowest, at 5.85% (97/1657; p = 0.006). Most complications were due to deep infection (22.8%), periprosthetic fracture (22.4%), and prolonged wound drainage (21.3%). The rate of dislocation was 0.84% (14/1657) with the posterior approach and 1.28% (17/1329) with the anterior approach (p = 0.32).
Overall, THA has a relatively low complication rate. However, the surgical approach plays a role in the incidence of complications. We found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate. Periprosthetic fracture and surgical site infection contributed most to the early complication rates. Cite this article: 2019;101-B:646-651.
全髋关节置换术 (THA) 有多种手术入路，每种入路都有其优缺点。无论采用哪种手术入路，THA 后都会发生一些常见的并发症。本研究旨在比较 5 种常用手术入路与手术相关并发症的发生率。
回顾性分析 2011 年至 2016 年在一家大型关节置换中心接受初次择期 THA 的所有患者的电子病历，随访时间至少 2 年。排除后，共纳入 3574 例连续患者。其中男性 1571 例（44.0%），女性 2003 例（56.0%）。平均年龄和体重指数（BMI）分别为 63.0 岁（标准差 11.8）和 29.1kg/m（标准差 6.1）。收集的数据包括患者年龄、BMI、美国麻醉医师协会（ASA）评分、估计失血量（EBL）、住院时间（LOS）、手术时间、围手术期并发症的存在、并发症类型和手术入路。研究中使用的入路为后路、前路、直接外侧入路、前外侧入路和北方入路。记录的并发症包括无感染的伤口引流延长、浅表感染、深部感染、脱位、无菌性松动和假体周围骨折。最后，记录了再次手术的需要。使用方差分析（ANOVA）和学生 t 检验比较均值（如果适用），使用卡方检验比较比例。
共有 248 例患者发生 263 例与手术相关的并发症，发生率为 6.94%。前路入路并发症发生率最高（8.5%（113/1329）），后路入路最低，为 5.85%（97/1657；p=0.006）。大多数并发症是深部感染（22.8%）、假体周围骨折（22.4%）和伤口引流延长（21.3%）。后路入路的脱位率为 0.84%（14/1657），前路入路为 1.28%（17/1329）（p=0.32）。
总体而言，THA 的并发症发生率相对较低。然而，手术入路在并发症的发生中起着一定的作用。我们发现，后路入路的总体并发症发生率明显低于前路入路，且脱位率相同。假体周围骨折和手术部位感染是导致早期并发症的主要原因。
2019;101-B:646-651.
