Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada; Department of Orthopaedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada.
Orthop Traumatol Surg Res. 2021 Dec;107(8):102709. doi: 10.1016/j.otsr.2020.08.011. Epub 2020 Oct 31.
Greater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections?
Our hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA.
A secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the anterior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach. Study outcomes were Modified Harris Hip Score (MHHS), satisfaction score, pain when lying on the affected side, and requiring an injection. Hip offset, femur lateralization and leg lengthening were measured before and after surgery.
Forty-five patients were available for complete follow-up at a mean of 62 months (range: 48-74). The incidence of GTP was higher in the posterior approach [PA: 6/21 (29%) vs DAA 4/24 (17%)) (p=0.3). Patients operated through a PA experienced more pain [5/21 (24%) of patients; VAS=mean 5.3] when lying on their operated side, compared to DAA patients [2/24 (8%) of patients; VAS=mean 2) (p=0.2)]. However, MHHS, patient satisfaction with surgery, radiological assessment for hip offset, femur lateralization or leg lengthening, and injections required were similar for both approaches. Overall, satisfaction and functional outcome with surgery was significantly lower in GTP patients, regardless of the approach.
GTP impacts patient satisfaction and functional outcome in total hip arthroplasty patients. PA patients reported more trochanteric pain than DAA patients, which affected their clinical outcome.
III.
全髋关节置换术后大转子疼痛（GTP）是髋关节外侧残留疼痛的常见原因，无论采用何种手术入路。我们的研究目的是评估直接前路（DAA）与后路（PA）两种手术入路后 GTP 的情况，以及两种入路的临床结果，并回答以下问题：1）两种不同手术入路初次全髋关节置换术后大转子疼痛的发生率是多少？2）GTP 患者的功能结果如何？3）有多少 GTP 患者需要接受转子周围注射治疗？
我们的假设是两种入路都存在 GTP，但后路的满意度较低。
对一项先前发表的临床试验进行二次分析，该试验共纳入 55 例全髋关节置换术患者，随机分为两种手术入路之一：27 例患者接受改良 Hueter 前路，另一组 28 例患者采用后路。研究结果为改良 Harris 髋关节评分（MHHS）、满意度评分、患侧卧位疼痛以及是否需要注射。术前和术后测量髋关节偏心距、股骨外侧化和下肢延长。
45 例患者完成了平均 62 个月（48-74 个月）的随访。后路入路的 GTP 发生率较高[PA：21 例（6 例，29%）与 DAA：24 例（4 例，17%）（p=0.3）]。与 DAA 患者相比，行 PA 手术的患者在患侧卧位时疼痛更明显[21 例（5 例，24%）患者；VAS=均值 5.3]，而 DAA 患者[24 例（2 例，8%）患者；VAS=均值 2）（p=0.2）]。然而，MHHS、患者对手术的满意度、髋关节偏心距、股骨外侧化或下肢延长的放射学评估以及所需的注射治疗在两种入路之间相似。总体而言，无论手术入路如何，GTP 患者的手术满意度和功能结果均显著降低。
GTP 影响全髋关节置换术患者的满意度和功能结果。PA 患者报告的转子区疼痛比 DAA 患者多，这影响了他们的临床结果。
III。
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