Stock Laura A, Johnson Andrea H, Brennan Jane C, MacDonald James, Turcotte Justin J, King Paul J
Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA.
Orthopedics, Anne Arundel Medical Center, Annapolis, USA.
Cureus. 2023 Sep 18;15(9):e45456. doi: 10.7759/cureus.45456. eCollection 2023 Sep.
Background While multiple studies have compared outcomes between the direct anterior approach (DAA) and posterolateral (PL) total hip arthroplasty (THA), the debate over the optimal approach remains. Proponents of the DAA suggest that its muscle-sparing properties and unrestricted rehabilitation facilitate a more rapid return to function. The majority of studies demonstrate that patient-reported outcomes (PROs) are similar between approaches beyond the one-year timeframe, but results are mixed when evaluating earlier time points. The purpose of this study was to compare clinical outcomes and PROs between DAA and PL THAs at six weeks postoperatively. Methods A retrospective review of 749 primary THAs (151 PL, 598 DAA) from March 2020 to November 2022 was performed. All surgeries were performed by one of the five board-certified and fellowship-trained orthopedic surgeons. All patients completed Patient Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) questionnaires preoperatively and at six weeks postoperatively. A univariate comparison of clinical outcomes (length of stay (LOS), home discharge rate, 90-day ED returns, and readmissions) and six-week PROMIS-PF scores between approaches was performed. Multivariate analysis was performed to evaluate the effect of the approach on outcomes after adjusting for baseline differences between groups. Results Patients undergoing DAA THA experienced significantly shorter average LOS (0.71 vs. 1.36 days, p<0.001), higher rates of home discharge (99.0 vs. 92.1%, p<0.001), and lower rates of 90-day readmissions (0.7 vs. 6.0%, p<0.001) than those undergoing the PL approach. At six weeks postoperatively, DAA patients achieved higher average PROMIS-PF scores (42.2 vs. 39.9, p=0.001). After adjusting for the Charlson Comorbidity Index and baseline physical function, the DAA was significantly associated with shorter LOS (β=-0.52, p<0.001), increased odds of home discharge (OR=5.70, p=0.001), reduced risk of 90-day readmission (OR=0.14, p=0.001), and higher PROMIS-PF scores at six weeks postoperatively (β=1.37, p=0.045). Conclusion In comparison to patients undergoing PL THA, those treated using the DAA experienced improved clinical and PROs over the six-week postoperative period. While both approaches resulted in satisfactory outcomes, these results support the assertion that DAA THA may result in more rapid recovery and return to function.
尽管多项研究比较了直接前路（DAA）和后外侧（PL）全髋关节置换术（THA）的手术效果，但关于最佳手术入路的争论仍在继续。DAA的支持者认为，其保留肌肉的特性和不受限制的康复过程有助于更快地恢复功能。大多数研究表明，在一年时间之后，两种手术入路的患者报告结局（PROs）相似，但在评估早期时间点时结果不一。本研究的目的是比较DAA和PL THA术后六周的临床结局和PROs。方法：对2020年3月至2022年11月期间的749例初次THA（151例PL，598例DAA）进行回顾性分析。所有手术均由五位获得董事会认证且接受过专科培训的骨科医生之一进行。所有患者在术前和术后六周完成患者报告结局测量信息系统-身体功能（PROMIS-PF）问卷。对两种手术入路的临床结局（住院时间（LOS）、家庭出院率、90天急诊复诊率和再入院率）和六周PROMIS-PF评分进行单变量比较。进行多变量分析以评估手术入路在调整组间基线差异后对结局的影响。结果：与接受PL手术入路的患者相比，接受DAA THA的患者平均LOS显著缩短（0.71天对1.36天，p<0.001），家庭出院率更高（99.0%对92.1%，p<0.001），90天再入院率更低（0.7%对6.0%，p<0.001）。术后六周，DAA患者的平均PROMIS-PF评分更高（42.2对39.9，p=0.001）。在调整Charlson合并症指数和基线身体功能后，DAA与较短的LOS显著相关（β=-0.52，p<0.001），家庭出院几率增加（OR=5.70，p=0.001），90天再入院风险降低（OR=0.14，p=0.001），以及术后六周更高的PROMIS-PF评分（β=1.37，p=0.045）。结论：与接受PL THA的患者相比，接受DAA治疗的患者在术后六周内临床结局和PROs得到改善。虽然两种手术入路都取得了令人满意的结果，但这些结果支持了DAA THA可能导致更快恢复和功能恢复的观点。
