Bendich Ilya, Landy David C, Do Huong, Krell Ethan, Diane Alioune, Boettner Friedrich, Rodriguez Jose, Alexiades Michael, Gonzalez Della Valle Alejandro
Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2021 Aug;36(8):2829-2835. doi: 10.1016/j.arth.2021.03.046. Epub 2021 Mar 26.
Proponents of the direct anterior approach (DAA) for total hip arthroplasty (THA) claim a faster recovery, whereas critics claim an increased risk of early femoral complications. This study analyzed intraoperative and postoperative complications requiring reoperation within one year after THA through the DAA and posterior approach (PA).
A total of 2348 elective, unilateral DAA THAs in patients with osteoarthritis performed between 2016 and 2019 were matched 1:1 for age (±5 years), gender, body mass index (±5), and femoral fixation with 2348 patients who underwent PA THA during the same period. Mixed-effects logistic regression was used. Odds ratios were reported for the occurrence of intraoperative femoral fracture, postoperative femoral fracture, infection, dislocation, and other etiologies requiring reoperation within one year.
Intraoperative femoral fracture occurred in 12 DAA (0.5%) and 14 PA (0.6%) patients. Twenty-five patients (1.06%) in the DAA and 28 (1.19%) in the PA group underwent reoperation within the first year. Reoperations were due to periprosthetic fracture (40%), infection (28%), dislocation (23%), and other (9%). Regression analysis revealed no difference in intraoperative femoral fracture (odds ratio (OR): 0.86, 95% confidence interval (CI): 0.40-1.86, P = .69), postoperative femoral fracture (OR: 1.10, 95% CI: 0.47-2.60, P = .83), infection (OR: 1.50, 95% CI: 0.53-5.23, P = .44), or reoperation within one year for other reasons (OR: 1.50, 95% CI: 0.25-9.00, P = .65). DAA had fewer dislocations requiring reoperation (OR: 0.20, 95% CI: 0.04-0.91, P = .02).
This comparative study did not find differences in intraoperative or postoperative fracture or infection between DAA and PA. DAA was associated with a lower likelihood of reoperation for dislocation within one year of surgery.
全髋关节置换术（THA）直接前路入路（DAA）的支持者称其恢复更快，而批评者则称早期股骨并发症风险增加。本研究分析了通过DAA和后路入路（PA）进行THA术后一年内需要再次手术的术中及术后并发症。
对2016年至2019年间进行的2348例骨关节炎患者的择期单侧DAA THA，按照年龄（±5岁）、性别、体重指数（±5）和股骨固定情况与同期进行PA THA的2348例患者进行1:1匹配。采用混合效应逻辑回归分析。报告了术中股骨骨折、术后股骨骨折、感染、脱位及其他需要在一年内再次手术的病因的比值比。
12例（0.5%）DAA患者和14例（0.6%）PA患者发生术中股骨骨折。DAA组25例（1.06%）患者和PA组28例（1.19%）患者在第一年接受了再次手术。再次手术原因包括假体周围骨折（40%）、感染（28%）、脱位（23%）和其他（9%）。回归分析显示，术中股骨骨折（比值比（OR）：0.86，95%置信区间（CI）：0.40 - 1.86，P = 0.69）、术后股骨骨折（OR：1.10，95% CI：0.47 - 2.60，P = 0.83）、感染（OR：1.50，95% CI：0.53 - 5.23，P = 0.44）或因其他原因在一年内再次手术（OR：1.50，95% CI：0.25 - 9.00，P = 0.65）方面无差异。DAA组需要再次手术的脱位较少（OR：0.20，95% CI：0.04 - 0.91，P = 0.02）。
这项比较研究未发现DAA和PA在术中或术后骨折或感染方面存在差异。DAA与术后一年内因脱位而再次手术的可能性较低有关。
