George Nicole E, Gwam Chukwuweike U, Etcheson Jennifer I, Smith Spencer S, Semenistyy Anton A, Delanois Ronald E
1 Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, USA.
2 Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.
Hip Int. 2019 Sep;29(5):504-510. doi: 10.1177/1120700018812717.
Although total hip arthroplasty (THA) is among the most successful orthopaedic procedures, it is not without complications. As such, finding the optimal surgical approach has become an area of particular interest. In this study, we compare: (1) pain intensity; (2) opioid consumption; (3) lengths of stay (LOS); (4) complication rates; (5) discharge destination; and (6) ambulatory function between patients who underwent THA via the supine muscle-sparing anterolateral (MS-ALA) and conventional direct lateral (DLA) approaches.
A retrospective analysis was conducted on 220 consecutive patients who received primary THA using the supine MS-ALA ( = 101) or DLA ( = 119) between 1 January 2014 and 31 December 2016. Outcomes included postoperative pain intensity, opioid consumption, LOS, discharge destination, complications, additional procedures, and time to independent ambulation.
We demonstrated significantly lower opioid consumption on postoperative days (POD) 1 and 2 (mean differences, -32.0 and -28.4 mg, respectively; ⩽ 0.001) and decreased pain intensity during the second 24 hours of the hospital stay (mean difference, -22.0; < 0.001) in patients receiving the MS-ALA. Relative to the DLA cohort, patients in the MS-ALA cohort were 2.04 times more likely to be discharged to home ( = 0.028) and 1.91 times less likely to experience postoperative abductor insufficiency ( = 0.039).
The present study is the 1st to compare postoperative outcomes, particularly pain intensity and opioid consumption, between the supine muscle-sparing anterolateral and direct lateral THA approaches. Further research should investigate the effect of surgical approach on quality and cost of care, include larger sample sizes, and involve longer-term follow-up.
尽管全髋关节置换术（THA）是最成功的骨科手术之一，但仍存在并发症。因此，寻找最佳手术入路已成为一个特别受关注的领域。在本研究中，我们比较了通过仰卧位肌肉保留前外侧（MS-ALA）和传统直接外侧（DLA）入路接受THA的患者之间的：（1）疼痛强度；（2）阿片类药物消耗量；（3）住院时间（LOS）；（4）并发症发生率；（5）出院去向；以及（6）步行功能。
对2014年1月1日至2016年12月31日期间连续接受初次THA的220例患者进行回顾性分析，其中采用仰卧位MS-ALA入路（n = 101）或DLA入路（n = 119）。结果包括术后疼痛强度、阿片类药物消耗量、LOS、出院去向、并发症、额外手术以及独立行走时间。
我们发现接受MS-ALA入路的患者在术后第1天和第2天的阿片类药物消耗量显著更低（平均差异分别为-32.0和-28.4 mg；P⩽0.001），并且在住院的第二个24小时内疼痛强度降低（平均差异为-22.0；P<0.001）。相对于DLA队列，MS-ALA队列中的患者出院回家的可能性高2.04倍（P = 0.028），术后外展肌无力的可能性低1.91倍（P = 0.039）。
本研究首次比较了仰卧位肌肉保留前外侧和直接外侧THA入路术后的结果，特别是疼痛强度和阿片类药物消耗量。进一步的研究应调查手术入路对护理质量和成本的影响，纳入更大的样本量，并进行长期随访。
