Analysis of the early results of using the direct anterior approach with a skin incision “bikini” in primary hip arthroplasty

Abstract

BACKGROUND: The use of less invasive techniques in hip arthroplasty is on the rise, which has led to an increased interest in direct anterior access and contributed to a significant expansion of its use over the past two decades. From an anatomical point of view, the use of direct anterior access in hip arthroplasty is associated with less soft tissue trauma.
 AIM: To evaluate the results of primary hip arthroplasty using direct anterior access with a "bikini" skin incision.
 MATERIAL AND METHODS: 163 patients with coxarthrosis were enrolled in the study, including 71 men and 92 women, who were then randomised into 2 groups: group 1 (comparison) — 78 patients in whom a standard (lateral) access was used for primary hip arthroplasty, and group 2 (main) — 85 patients in whom a direct anterior access was used for primary hip arthroplasty. To study the effectiveness of the proposed approach to hip arthroplasty, we used the results obtained by dynamic assessment of complaints (severity of pain syndrome) and functional status of the affected joint using Harris Hip Score and Western Ontario and McMaster Universities osteoarthritis Index WOMAC scales. When analysing the surgical treatment safety, the incidence of postoperative complications was taken into account.
 RESULTS: In total, 3 cases of complications (3.9%) were noted in the comparison group, whereas in the main group the number of complications in the early postoperative period after endoprosthesis was lower — 1 case (1.2%). The assessment of inpatient treatment duration showed that in the comparison group the value of this index was equal to 5–6 days, whereas in the main group it was lower, being 2–3 days. Studying the dynamics of the pain syndrome assessment index by the patients according to the visual analogue scale showed that a day after the operation the index value in group 2 was 7.94±0.41 points which was statistically significantly lower (p 0.05) than the corresponding index in group 1 — 8.21±0.39 points.
 CONCLUSION: In the postoperative period, the use of direct anterior access in hip arthroplasty is associated with a lower severity of pain syndrome, faster recovery of hip joint functionality, and shorter in-patient stay compared with anterolateral access.