Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, St. Albans, Australia; School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.
J Arthroplasty. 2019 Nov;34(11):2676-2680. doi: 10.1016/j.arth.2019.05.057. Epub 2019 Jun 26.
The surgical approach for total hip arthroplasty (THA) has the potential to affect the immediate postoperative recovery; however, there is limited published data comparing the 3 most common surgical approaches. The purpose of the study was to investigate postoperative pain and subsequent opioid consumption between surgical approaches (anterior-AA, lateral-LA, and posterior-PA) in those undergoing primary elective THA.
A retrospective cohort study assessed patient demographics (age, sex, and body mass index), American Society of Anesthesiologists grade, opioid naivety, operative details (anesthetic method, fixation method, and local infiltration analgesia), pain scores, and length of stay. Statistical analysis was performed with a 1-way analysis of variance 3 × 1 table with a P value < .05.
A total of 560 patients were included in the analysis (335 females and 225 males). The cohort consisted of 179 AA, 178 LA, and 203 PA patients. The average postoperative opioid usage was 63.05 (standard deviation [SD] = 42.97), 79.81 (SD = 56.10), and 77.50 (SD = 54.52) oral morphine equivalent daily dose (oMEDD) for the AA, LA, and PA, respectively. The mean difference was 16.8 oMEDD lower in the AA compared with the LA (P < .01) and 14.5 oMEDD lower in the AA compared with the PA (P = .02).
The direct anterior approach was associated with lower daily opioid usage and pain scores after elective THA in the early postoperative period. This represents a potential 21% reduction in daily opioid dosage when compared with LA patients and 18.7% reduction in PA patients.
全髋关节置换术（THA）的手术入路有可能影响术后的早期恢复，但目前关于三种最常见手术入路的比较数据有限。本研究旨在调查初次择期 THA 患者的三种手术入路（前路-AA、外侧-LA 和后侧-PA）之间的术后疼痛和随后的阿片类药物使用情况。
一项回顾性队列研究评估了患者的人口统计学特征（年龄、性别和体重指数）、美国麻醉医师协会分级、阿片类药物初治情况、手术细节（麻醉方法、固定方法和局部浸润镇痛）、疼痛评分和住院时间。采用方差分析 3×1 表进行单因素分析，P 值<0.05。
共纳入 560 例患者（女性 335 例，男性 225 例）。队列包括 179 例 AA、178 例 LA 和 203 例 PA 患者。术后平均阿片类药物使用量分别为 63.05（标准差 [SD] = 42.97）、79.81（SD = 56.10）和 77.50（SD = 54.52）的口服吗啡等效日剂量（oMEDD）。AA 组比 LA 组的 oMEDD 平均差值低 16.8，差异有统计学意义（P <0.01）；AA 组比 PA 组的 oMEDD 平均差值低 14.5，差异有统计学意义（P =0.02）。
与 LA 患者相比，直接前路入路与择期 THA 后早期每日阿片类药物使用量和疼痛评分较低相关，与 LA 患者相比，每日阿片类药物剂量减少 21%，与 PA 患者相比，减少 18.7%。
