Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, 221002, Jiangsu, People's Republic of China.
J Orthop Traumatol. 2021 Nov 13;22(1):46. doi: 10.1186/s10195-021-00611-w.
Several studies have compared clinical results of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA); however, the effect of the surgical approach on outcome of THA remains controversial. Most of these studies used two distinct groups of patients, and THAs were performed by different surgeons, using different designs of prosthesis. These confounding factors may limit the strength of the conclusions. The purpose of this prospective, simultaneous bilateral randomized study was to investigate whether patients would perceive the difference between the direct anterior approach (DAA) and the posterolateral approach (PLA) after THA.
Among 20 patients scheduled to undergo same-day bilateral THA between October 2017 and August 2019, one hip was randomly assigned to DAA and the other to PLA. Patient-reported outcome measures [Hip disability and Osteoarthritis Outcome Score (HOOS), patients' hip pain on mobilization] and physician-assessed measures [Harris Hip Score (HHS), operative time, intraoperative blood loss, cup abduction, cup anteversion, stem orientation, and incidence of complications (intraoperative fracture, nerve damage, incisional problem, or postoperative dislocation)] were compared.
All patients were followed up for 12 months. Hip pain was significantly less with DAA-THA compared with PLA-THA at postoperative 1, 3, and 7 days (p < 0.05). There was no clinical difference between DAA-THA and PLA-THA in terms of the VAS, HOOS, or HSS at 6 weeks and 3, 6, and 12 months postoperatively (p > 0.05). DAA-THA had a longer operative time and shorter length of incision compared with PLA-THA. There was no statistical difference between DAA-THA and PLA-THA in terms of intraoperative blood loss, cup abduction, cup anteversion, stem orientation, and perioperative complications (p > 0.05).
This study demonstrates that DAA-THA and PLA-THA could provide comparable HHS and HOOS at all follow-ups. Compared with PLA-THA, DAA-THA is associated with less hip pain within postoperative 7 days and shorter incision length, but longer operative time.
Level I, therapeutic study. Trial registration Chinese Clinical Trail Registry, ChiCTR1800019816. Registered 30 November 2018-retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=30863.
多项研究比较了全髋关节置换术（THA）中直接前入路（DAA）和后外侧入路（PLA）的临床结果；然而，手术入路对 THA 结果的影响仍存在争议。这些研究大多使用两组不同的患者，并且由不同的外科医生使用不同设计的假体进行 THA。这些混杂因素可能限制了结论的强度。本前瞻性、同期双侧随机研究的目的是调查患者在接受 THA 后是否会感知到直接前入路（DAA）和后外侧入路（PLA）之间的差异。
2017 年 10 月至 2019 年 8 月期间，计划同期行双侧 THA 的 20 例患者中，随机将一侧髋关节分配至 DAA 组，另一侧至 PLA 组。比较患者报告的结果测量（髋关节残疾和骨关节炎结果评分（HOOS）、患者髋关节活动时的疼痛）和医生评估的结果测量（Harris 髋关节评分（HHS）、手术时间、术中失血量、髋臼外展、髋臼前倾角、柄的方向以及并发症发生率（术中骨折、神经损伤、切口问题或术后脱位）。
所有患者均随访 12 个月。与 PLA-THA 相比，DAA-THA 在术后 1、3 和 7 天时髋关节疼痛明显减轻（p<0.05）。在术后 6 周和 3、6 和 12 个月时，DAA-THA 和 PLA-THA 在 VAS、HOOS 或 HHS 方面无临床差异（p>0.05）。与 PLA-THA 相比，DAA-THA 的手术时间更长，切口更短。在术中失血量、髋臼外展、髋臼前倾角、柄的方向和围手术期并发症方面，DAA-THA 与 PLA-THA 无统计学差异（p>0.05）。
本研究表明，DAA-THA 和 PLA-THA 在所有随访中均可提供相似的 HHS 和 HOOS。与 PLA-THA 相比，DAA-THA 在术后 7 天内髋关节疼痛较轻，切口较短，但手术时间较长。
I 级，治疗研究。试验注册中国临床试验注册中心，ChiCTR1800019816。2018 年 11 月 30 日注册-回顾性注册，http://www.chictr.org.cn/showproj.aspx?proj=30863。
