From the Department of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland (Moerenhout); Division of Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Coeur de Montréal, Montreal, Que. (Moerenhout, Derome, Laflamme, Leduc, Benoit); and Department of Orthopedic Surgery, Hull Hospital, Gatineau, Que. (Gaspard).
Can J Surg. 2020 Sep-Oct;63(5):E412-E417. doi: 10.1503/cjs.012019.
The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time.
A prospective, randomized, multicentre clinical study was conducted between February 2011 and July 2013, with an average follow-up of 55 months. Patients undergoing the direct anterior or posterior approach for THA were enrolled. Hospital length of stay, surgical time and complications were documented. The Harris Hip Score and visual analogue scale were used to monitor functional outcome and pain until 5 years postoperatively. Radiologic analysis was used to assess implant position.
Fifty-five patients (28 undergoing the direct anterior approach, 27 undergoing the posterior approach) were enrolled in this study. Length of stay, functional outcome, pain, implant position and complications were similar for the 2 approaches. There was a trend toward a better functional outcome for patients who underwent the direct anterior approach in the first 3 months postoperatively, with a peak at 4 weeks (Harris Hip Score 76.7 v. 68.7; = 0.08). Average surgical time for the direct anterior approach was significantly longer (69.9 v. 45.7 min; = 0.002).
The direct anterior approach for THA appears to be a safe and effective option. However, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches.
Clinicaltrials.gov, no. NCT03673514.
全髋关节置换术（THA）的理想方法应该对软组织友好，并发症发生率最低，且易于复制。尽管在过去十年中，人们已经尝试了几种方法来寻找 THA 的最佳方法，但仍未得出明确的答案。我们进行了一项前瞻性研究，比较了直接前侧和后侧入路在 THA 中的住院时间、功能结果、疼痛、植入物位置、并发症和手术时间方面的差异。
2011 年 2 月至 2013 年 7 月进行了一项前瞻性、随机、多中心临床研究，平均随访 55 个月。招募了接受直接前侧或后侧入路进行 THA 的患者。记录住院时间、手术时间和并发症。使用 Harris 髋关节评分和视觉模拟评分（VAS）在术后 5 年内监测功能结果和疼痛。使用放射学分析评估植入物位置。
本研究共纳入 55 例患者（28 例接受直接前侧入路，27 例接受后侧入路）。两种方法的住院时间、功能结果、疼痛、植入物位置和并发症相似。在前 3 个月，直接前侧入路的患者功能结果有改善的趋势，术后 4 周达到高峰（Harris 髋关节评分 76.7 比 68.7； = 0.08）。直接前侧入路的平均手术时间明显更长（69.9 比 45.7 分钟； = 0.002）。
THA 的直接前侧入路似乎是一种安全有效的选择。然而，两种方法在住院时间或术后恢复方面没有显著差异。
Clinicaltrials.gov，编号 NCT03673514。
