Facultad de Medicina, Universidad Icesi, Cali, Colombia.
Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
J Orthop Surg Res. 2023 Oct 31;18(1):816. doi: 10.1186/s13018-023-04291-6.
The anterior minimally invasive (AMI) approach reduces soft tissue damage, risk of dislocation and enhances recovery, but it is associated with certain complications. The aim of this study is to compare the outcomes of patients who underwent total hip arthroplasty (THA) through posterolateral (PL) and AMI approaches performed by the same surgeon, in order to determine the learning curve associated with this new approach.
This retrospective cohort study included patients who underwent THA via PL and AMI approach between 2017 and 2022, with a minimum follow-up of 1 year. Hip fracture and oncologic patients were excluded. Demographic variables, functional scores and perioperative complications were assessed. A bivariate analysis was performed to identify differences between groups.
Data of 124 AMI and 120 PL patients were analyzed. Demographic characteristics among groups were homogeneous. Functional outcomes at 3 months were superior for AMI (Oxford: 43 vs. 38; p < 0.05), no dislocations were identified (0% vs. 4.2%; p < 0.05) and no differences in the transfusion rate were found (6.5% AMI vs. 6.7% PL; p = 0.996). Infection rate was 4% for AMI and 3.4% for PL (p = 0.572). Surgical time was shorter for the PL approach, but the median surgical time of the last 25 AMI cases was shorter.
The AMI approach is an excellent alternative for patients requiring THA. Although surgical time and perioperative bleeding were greater during the learning curve, this approach offers improved functional outcomes and a lower dislocation rate, without significant differences in transfusion and infection outcomes, demonstrating that responsible innovation and safe implementation of new techniques is possible.
前路微创（AMI）入路减少了软组织损伤、脱位风险并促进了康复，但也存在一定的并发症。本研究旨在比较由同一位外科医生行全髋关节置换术（THA）的患者，通过后外侧（PL）和 AMI 入路的治疗效果，以确定与这种新入路相关的学习曲线。
本回顾性队列研究纳入了 2017 年至 2022 年期间接受 PL 和 AMI 入路 THA 的患者，随访时间至少 1 年。排除髋部骨折和肿瘤患者。评估了患者的人口统计学变量、功能评分和围手术期并发症。进行了双变量分析以确定组间差异。
共分析了 124 例 AMI 和 120 例 PL 患者的数据。组间的人口统计学特征具有同质性。3 个月时 AMI 组的功能评分更优（牛津：43 分比 38 分；p<0.05），未发生脱位（0%比 4.2%；p<0.05），输血率也无差异（6.5% AMI 比 6.7% PL；p=0.996）。AMI 组的感染率为 4%，PL 组为 3.4%（p=0.572）。PL 入路的手术时间更短，但最后 25 例 AMI 病例的中位手术时间更短。
AMI 入路是需要接受 THA 的患者的一个极好选择。虽然在学习曲线期间手术时间和围手术期出血较多，但该入路提供了更好的功能结果和较低的脱位率，在输血和感染结果方面没有显著差异，这表明负责任的创新和新手术技术的安全实施是可能的。
