Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2019 Nov;34(11):2681-2685. doi: 10.1016/j.arth.2019.06.046. Epub 2019 Jun 27.
The choice of surgical approach during total hip arthroplasty (THA) remains highly controversial. The aim of the present study was to compare 30-day major and minor complications, following primary THA between the direct anterior, lateral, and posterior approaches.
Our hospital performs primary THAs using all 3 aforementioned approaches based on surgeon preference. Patients who underwent primary THA from August 2010 to August 2017 were identified using our institution's total joint registry, and their data were combined with prospectively collected data from the National Surgical Quality Improvement Program database (which evaluates a random sample of approximately 20% of all surgical patients in our hospital). Baseline characteristics, operative variables, and postoperative complications were then compared between the three groups.
The analysis comprised 1967 primary THAs (1913 patients), whereby 56%, 29%, and 15% were performed through a posterior, lateral, and direct anterior approach, respectively. Thirty-day major and minor complications occurred in 3.9% and 9.4% of surgeries, respectively. After adjusting for baseline patient characteristics, there was no significant difference in major or minor perioperative complications between the 3 approaches.
This study compared perioperative complications between the 3 most commonly used approaches for THA utilizing a synthesis of our institutional total joint registry and high-quality National Surgical Quality Improvement Program data. Thirty-day major and minor complications were similar regardless of the surgical approach employed, which may help surgeons and patients simplify the multiple considerations taken into account when deciding on surgical approach for primary THA.
Therapeutic, Level III.
全髋关节置换术（THA）过程中手术入路的选择仍存在较大争议。本研究旨在比较直接前侧入路、外侧入路和后侧入路在初次 THA 后 30 天内主要和次要并发症的发生情况。
我们医院根据外科医生的偏好，采用上述三种方法进行初次 THA。通过我们医院的关节置换登记处确定了 2010 年 8 月至 2017 年 8 月期间接受初次 THA 的患者，并将其数据与国家手术质量改进计划数据库（该数据库评估我们医院约 20%的所有手术患者的随机样本）中前瞻性收集的数据相结合。然后比较三组患者的基线特征、手术变量和术后并发症。
本分析纳入了 1967 例初次 THA（1913 例患者），其中 56%、29%和 15%分别通过后侧、外侧和直接前侧入路进行。30 天内主要和次要并发症的发生率分别为 3.9%和 9.4%。在调整基线患者特征后，三种入路之间主要或次要围手术期并发症无显著差异。
本研究通过综合使用我们医院的关节置换登记处和高质量的国家手术质量改进计划数据，比较了三种最常用于 THA 的手术入路的围手术期并发症。无论采用哪种手术入路，30 天内的主要和次要并发症均相似，这可能有助于外科医生和患者在决定初次 THA 的手术入路时简化需要考虑的多个因素。
治疗性，III 级。
