A comparison of peri-operative effects of modified Bikini minimally invasive approach versus direct lateral approach for total hip arthroplasty

Abstract

Objective To compare the perio-perative effects of modified bikini minimally invasive approach versus direct lateral approach for total hip arthroplasty(THA). Methods A total of 60 patients(70 hips), including 45 males(49 hips)and 15 females(21 hips)aged(54.9±6.1)years(range from 38 to 63 years)who underwent THA for the first time at joint surgery department of our hospital were retrospectively analyzed from October 2015 to May 2017.Thirty patients(34 hips)underwent modified bikini approach THA(the modified bikini group), and 30 patients(36 hips)received direct lateral approach THA(the direct lateral group). The comparisons were performed between the two groups in the orthopaedic pelvic films, disease stages, Harris scores before and after operation, intra-operative blood loss, postoperative drainage, blood transfusion rate, 24-h visual analog scale(VAS)scores for pain after operation, operation time and incision length.The straight leg elevation time, recovery time of hip abduction muscle strength, average hospitalization days and subjective satisfaction of patients were evaluated.Relevant surgical complications were recorded. Results Postoperative X-ray examinations showed that the position of prosthesis was good in both groups.There were no statistically significant difference between the two groups in operation time, intraoperative blood loss, postoperative drainage, blood transfusion rate, straight leg elevation time and subjective satisfaction(P>0.05). There were statistically significant differences between the modified bikini group and the direct lateral group in the incision length[(9.2±1.9) cm vs.(18.5±3.3) cm], recovery time of hip abductor muscle strength[(1.6±0.8) d vs. (12.1±3.9) d], Harris scores[(87.1±5.9) vs.(86.8±7.1)], 24-hour VAS scores[(4.6±2.3) vs.(7.0±3.6)]and average hospitalization days[(7.4±1.8) vs.(10.8±2.4)]after operation between the modified bikini group and the direct lateral group(P<0.05). One case with lateral femoral cutaneous nerve injury and 1 case of posterior cortical perforation of proximal femur were found in the modified bikini group, and 1 case of dislocation of hip prosthesis was observed in the direct lateral group. Conclusions Both of the modified bikini minimally invasive approach and direct lateral approach for THA can achieve better postoperative effect, while the modified bikini approach achieves faster recovery. Key words: Arthroplasty; Replacement, hip; Surgical procedures, minimally invasive