Comparison of early functional recovery between direct anterior approach and posterolateral approach in the lateral decubitus position for total hip arthroplasty

Abstract

Objective To compare the early clinical effect of posterolateral approach(PLA) and direct anterior approach(DAA) for total hip arthroplasty. Methods Retrospective cohort study was conducted. A total of 153 patients, including 64 males and 89 females, aged between 21 and 81 years old, who were treated with total hip replacement in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from April 2017 to June 2018. They were divided into the DAA group (79 cases) and the PLA group (74 cases) according to different surgical approaches. The operative time, incision length, visual analog score(VAS), Harris score, postoperative hospitalization time, independent walking time without walker and complications rate were compared and analyzed between the two groups. On the first postoperative day, the pelvic anterior radiograph was taken, and the PACS image processing system was used to measure the prosthetic angle . Then the position of the femoral prosthesis was determined according to the Nakata method ( the femoral false body curl over 3°- 3° for fixed prosthesis was centricity fixed). and the acetabular abduction angle and anteversion angle were measured according to the Pradhan method ( the acetabulum abduction angle of 30°-50°, the anteversion angle of 5°- 25°, which was the safe range of acetabular prostheses). Results Compared with the PLA group, the DAA group had longer operative time [(68.61±7.15)min vs (63.45±8.82)min], shorter incision length[(10.47±0.88)cm vs (12.06±0.91)cm], less intraoperative blood loss [(131.40±42.83)mL vs (155.70±48.09)mL], and shorter postoperative hospital stay[(3.94±0.92)d vs (4.79±0.95)d]. The walking time away from the walker was shorter[(3.91±1.09)d vs (6.34±1.35)d], and the postoperative VAS was lower at 1st and 3rd day after surgery(4.05±0.70 vs 4.38±0.75, 2.47±0.80 vs 2.82±0.88). The Harris scores were higher in the first and third month after operation (82.46±3.82 and 77.59±4.78, 89.11±3.61 and 85.82±3.18), and the differences were statistically significant (all P values 0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusions Compared with the PLA, the DAA with lateral decubitus is a safe and effective minimally invasive approach with less trauma, less postoperative pain and faster recovery . Key words: Arthroplasty, replacement, hip; Direct anterior approach; Posterolateral approach; Rehabilitation