Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, 518036 Shenzhen, PR China
Jt Dis Relat Surg. 2023;34(1):32-41. doi: 10.52312/jdrs.2022.763. Epub 2022 Nov 18.
This study aims to investigate the possible association and comparison between anterolateral approach (ALA) and posterolateral approach (PLA) and postoperative lower limb discrepancy (LLD) in selective total hip arthroplasty (THA).
April 2021 and July 2021, a total of 266 consecutive patients (126 males, 140 females; mean age: 46.7±13.6 years; range, 22 to 60 years) who underwent unilateral primary THA via the ALA or the PLA were retrospectively analyzed. The operations were performed by a single surgical team. All patients were divided into two groups according to the approach: ALA group (n=66) and PLA group (n=200). Relevant data were recorded. Diagnosis including hip osteoarthritis, developmental dysplasia of the hip (DDH), aseptic avascular necrosis (AVN), and inflammatory arthritis were noted. Perioperative follow-up radiographs were evaluated and measured to compare the postoperative LLD and offset. The association between two approaches and postoperative LLD and offset was analyzed using the univariate and multivariate linear regression analysis.
The mean follow-up was 20±3.7 (range, 16 to 25) months. Univariate analysis revealed that the postoperative LLD, the postoperative acetabular offset, and hospital costs were lower in the ALA group than the PLA group (p<0.01). However, the offset and length of stay were comparable between the two groups (p>0.05). Multivariate analysis revealed that the PLA (β=4.71; 95% confidence interval [CI]: 1.78 to 7.64), preoperative LLD (β=0.29; 95% CI: 0.21 to 0.37), DDH (β=5.01; 95% CI: 1.47 to 8.55), and AVN (β=3.81; 95% CI: 0.50 to 7.12) were the main contributors to the postoperative LLD.
Our study results suggest that the ALA may be superior to the PLA in controlling the postoperative LLD among some of the selective unilateral primary THA patients. Both the ALA and the PLA were comparable in terms of the restoration of offset.
本研究旨在探讨选择性全髋关节置换术（THA）中前外侧入路（ALA）和后外侧入路（PLA）与术后下肢不等长（LLD）之间的可能关联和比较。
2021 年 4 月至 2021 年 7 月，回顾性分析了 266 例（男 126 例，女 140 例；平均年龄：46.7±13.6 岁；范围：22 岁至 60 岁）单侧初次接受 ALA 或 PLA 行选择性单侧初次 THA 的连续患者。所有手术均由单一手术团队完成。根据手术入路将所有患者分为两组：ALA 组（n=66）和 PLA 组（n=200）。记录相关数据。诊断包括髋关节骨关节炎、发育性髋关节发育不良（DDH）、无菌性股骨头坏死（AVN）和炎性关节炎。评估和测量围手术期随访 X 线片，比较术后 LLD 和偏移。使用单变量和多变量线性回归分析评估两种方法与术后 LLD 和偏移的关系。
平均随访时间为 20±3.7（范围：16 至 25）个月。单变量分析显示，ALA 组术后 LLD、髋臼外移和住院费用均低于 PLA 组（p<0.01）。然而，两组之间的偏移和住院时间无差异（p>0.05）。多变量分析显示，PLA（β=4.71；95%置信区间[CI]：1.78 至 7.64）、术前 LLD（β=0.29；95% CI：0.21 至 0.37）、DDH（β=5.01；95% CI：1.47 至 8.55）和 AVN（β=3.81；95% CI：0.50 至 7.12）是术后 LLD 的主要影响因素。
我们的研究结果表明，在某些选择性单侧初次 THA 患者中，ALA 可能优于 PLA 控制术后 LLD。ALA 和 PLA 在恢复外移方面相似。
