Rhea Evan B, Iman Drew J, Wilke Benjamin K, Sherman Courtney E, Ledford Cameron K, Blasser Kurt E
Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Arthroplast Today. 2020 Sep 8;6(4):792-795. doi: 10.1016/j.artd.2020.07.015. eCollection 2020 Dec.
The utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) continues to markedly increase. Despite proposed advantages, there are limited data regarding outcomes of staged bilateral THA via 2 different approaches in the same patient. The purpose of this study was to elucidate patient perspective on the THA approach in a crossover cohort of patients who underwent consecutive THAs via the posterolateral approach (PLA) followed by a contralateral DAA.
A retrospective chart review and telephone interview were performed on 37 patients who underwent both THA approaches by a single surgeon from 2009 to 2019. Perioperative outcomes, complications/reoperations, and the patient-preferred approach were collected. The mean clinical follow-up was 105 and 44 months after PLA and DAA, respectively.
After DAA THA, patients demonstrated lower postoperative day 1 visual analog scale pain scores (1.8 vs 2.9, = .016) and ambulation (239 feet vs 31 feet, < .001). The length of stay was significantly less ( < .001) for the DAA (1.9 days) compared with the PLA (3.1 days). There were no major complications or reoperations in either cohort. Most patients (26/37, 70%) preferred the DAA and stated that it was easier to recover from (30/37, 81%).
In the same patient direct comparison, the DAA for THA may lead to less pain and improved ambulation in the early postoperative period. Furthermore, most patients prefer the DAA and believe it is easier to recover from than the PLA.
全髋关节置换术（THA）中直接前路入路（DAA）的应用持续显著增加。尽管有诸多潜在优势，但关于同一患者通过两种不同入路分期进行双侧THA的疗效数据有限。本研究的目的是在一组连续接受后路入路（PLA）随后对侧DAA的THA患者交叉队列中，阐明患者对THA入路的看法。
对2009年至2019年由同一位外科医生实施两种THA入路的37例患者进行回顾性病历审查和电话访谈。收集围手术期结果、并发症/再次手术情况以及患者偏好的入路。PLA和DAA术后的平均临床随访时间分别为105个月和44个月。
DAA THA术后，患者术后第1天的视觉模拟量表疼痛评分较低（1.8对2.9，P = 0.016），行走距离更远（239英尺对31英尺，P < 0.001）。与PLA（3.1天）相比，DAA的住院时间显著更短（P < 0.001）（1.9天）。两组均未出现重大并发症或再次手术情况。大多数患者（26/37，70%）更喜欢DAA，并表示从DAA恢复更容易（30/37，81%）。
在同一患者的直接比较中，THA采用DAA可能导致术后早期疼痛减轻、行走能力改善。此外，大多数患者更喜欢DAA，并且认为与PLA相比，从DAA恢复更容易。
