Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI.
J Arthroplasty. 2020 Jun;35(6):1658-1661. doi: 10.1016/j.arth.2020.01.082. Epub 2020 Feb 5.
The direct anterior (DA) approach is becoming increasingly popular for primary total hip arthroplasty (THA). The aim of this study is to evaluate early postoperative complication and revision rates based on surgical approach, comparing DA, posterolateral (PL), and direct superior (DS) approaches.
After institutional review board approval, a total joint arthroplasty database from a single institution was used to identify all patients who underwent elective primary THA between July 2013 and November 2017 with a DA, PL, or DS hip approach. Patients were followed for complications out to 90 days postsurgery. Patients were divided into groups based on surgical approach and compared on length of stay, discharge disposition, and 90-day complication and revision rates.
There were 5341 THA procedures performed, with 3162 PL, 1846 DA, and 333 DS approaches. Length of stay was shorter for DS (1.7 ± 0.9 days) and DA (1.8 ± 0.9 days) than for PL approaches (2.3 ± 1.4 days, P < .001) The DS approach had the highest rate of home discharges (93.1%), but the highest short-term revision rate (1.5%, P = .011). The DA approach had the lowest intraoperative fracture rate (0.1%, P = .019) but the highest incidence of postoperative fractures (1.3%, P = .021). There were no differences in readmission (P = .056), 90-day events (P = .062), emergency department visits (P = .210), dislocations (P = .090), combined perioperative fractures (P = .289), venous thromboembolic events (P = .059), or acute infection rates (P = .287).
In the era of bundled payments, the DA, PL, and DS approaches can all be effectively used.
Level III; retrospective comparative study.
直接前方（DA）入路在初次全髋关节置换术（THA）中越来越受欢迎。本研究旨在评估基于手术入路的术后早期并发症和翻修率，比较 DA、后外侧（PL）和直接上方（DS）入路。
经机构审查委员会批准，使用单机构的全关节置换数据库，确定 2013 年 7 月至 2017 年 11 月期间接受择期初次 THA 的所有患者，这些患者采用 DA、PL 或 DS 髋关节入路。患者在术后 90 天内随访并发症。根据手术入路将患者分为不同的组，并比较住院时间、出院去向以及 90 天并发症和翻修率。
共进行了 5341 例 THA 手术，其中 PL 入路 3162 例，DA 入路 1846 例，DS 入路 333 例。DS（1.7±0.9 天）和 DA（1.8±0.9 天）入路的住院时间短于 PL 入路（2.3±1.4 天，P<0.001）。DS 入路的出院回家率最高（93.1%），但短期翻修率最高（1.5%，P=0.011）。DA 入路的术中骨折发生率最低（0.1%，P=0.019），但术后骨折发生率最高（1.3%，P=0.021）。再入院率无差异（P=0.056），90 天事件发生率无差异（P=0.062），急诊就诊率无差异（P=0.210），脱位率无差异（P=0.090），围手术期合并骨折发生率无差异（P=0.289），静脉血栓栓塞事件发生率无差异（P=0.059），急性感染率无差异（P=0.287）。
在打包支付时代，DA、PL 和 DS 入路均可有效应用。
III 级；回顾性比较研究。
