Lu Yang, Li Xiang, Hu Yihe, Zhao Fengchao
Department of Orthopedics, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
PLoS One. 2025 Feb 25;20(2):e0318953. doi: 10.1371/journal.pone.0318953. eCollection 2025.
Leg length discrepancy (LLD) after total hip arthroplasty (THA) is a clinical entity that deteriorates clinical outcomes and patients' satisfaction. Few articles have compared LLD after THA by different surgical approaches.
A total of 358 consecutive patients who underwent primary THA between January 2016 and November 2018 were retrospectively reviewed. All 4 surgeons performed THA through both direct anterior approach (DAA) and posterior lateral approach (PLA). The primary outcome measurement was LLD. LLD was measured on post-operative anteroposterior bilateral hip radiograph. The secondary outcomes were acetabular abduction, acetabular anteversion, perceived LLD (pLLD) and HHS at 6 weeks, 1 year and 5 years. Intergroup analyses were performed using the Chi-square test for enumeration data and the independent sample t-test for quantitative data.
There was no inter-group difference in terms of patients' demographics. The DAA group had decreased LLD compared to the PLA group (3.0 ± 5.9mm vs. 4.2 ± 4.5mm, p = 0.027). Meanwhile, the DAA group had a smaller acetabular anteversion than the PLA group (12.9 ± 2.9 vs. 18.4 ± 2.9, p < 0.01). At 6-week follow-up, the DAA group had higher HHS (82.2 + 6.2 vs. 80.5 + 6.6, p = 0.015) and less pLLD (P = 0.001) compared to the PLA group.
DAA results in more accurate leg length equalization, reduced pLLD, and improved short-term outcomes compared with PLA.
全髋关节置换术（THA）后肢体长度不等（LLD）是一种会降低临床疗效和患者满意度的临床情况。很少有文章比较不同手术入路的THA术后的LLD情况。
回顾性分析了2016年1月至2018年11月期间连续接受初次THA的358例患者。所有4位外科医生均通过直接前路入路（DAA）和后外侧入路（PLA）进行THA手术。主要结局指标为LLD。在术后双侧髋关节前后位X线片上测量LLD。次要结局指标为髋臼外展、髋臼前倾角、主观肢体长度不等（pLLD）以及术后6周、1年和5年时的髋关节Harris评分（HHS）。对于计数资料采用卡方检验进行组间分析，对于定量资料采用独立样本t检验进行组间分析。
患者人口统计学特征方面不存在组间差异。与PLA组相比，DAA组的LLD降低（3.0±5.9mm vs. 4.2±4.5mm，p = 0.027）。同时，DAA组的髋臼前倾角小于PLA组（12.9±2.9 vs. 18.4±2.9，p<0.01）。在术后6周的随访中，与PLA组相比，DAA组的HHS更高（82.2 + 6.2 vs. 80.5 + 6.6，p = 0.015）且pLLD更少（P = 0.001）。
与PLA相比，DAA能实现更精确的肢体长度均衡，减少pLLD，并改善短期疗效。
