Abstract
BackgroundTotal hip arthroplasty (THA) is one of the most successful orthopedic surgeries. There are many common surgical approaches for THA. The direct anterior approach (DAA) and posterolateral approach (PLA) were compared, leading to controversial results.MethodsWe report on a prospective randomized study which compared the changes of perioperative hemoglobin (Hb), the Harris hip score (HHS) and a visual analog scale (VAS) pain score following THA using DAA or PLA. A total of 130 participants were randomly divided into two groups (65 DAA versus 65 PLA). Perioperative ΔHb and other clinical outcomes were recorded.ResultsA total of 130 participants completed follow-up, while 14 patients were not recorded in blood outcomes due to blood transfusions and complications. The average Hb decrease immediately after surgery in the DAA group was greater than that in the PLA group (21.1 versus 15.8 g/L, P < .001). However, post-operative Hb descent velocity was slower in the DAA group, and the lowest point was reached earlier. No significant differences in ΔHb levels could be observed after 1 month in the two groups. When compared with the PLA group, the DAA group had a shorter incision (9.1 versus 13.5 cm, P < .001) and shorter hospital stay (4.2 versus 4.7 days, P = .004). However, the operation time of the DAA group was longer (88.0 versus 66.8 min, P < .001). The DAA group had a better HHS and VAS pain score at 6 weeks post-surgery. However, no significant differences were observed at later time points.ConclusionWe concluded that DAA performed better on enhanced recovery after surgery (ERAS) than PLA in THA, while both DAA and PLA could result in a positive, similar result after 3 months.Trial registrationThe study was registered by the Chinese Clinical Trial Registry (ChiCTR1900020770, 19 January 2019).
Highlights
Total hip arthroplasty (THA) is one of the most successful orthopedic surgeries
Sixty-five patients were assigned to the direct anterior approach (DAA) group, while the others were assigned to the posterolateral approach (PLA) group
Fourteen patients were not involved in the statistical analysis of blood outcomes due to postoperative blood transfusions and complications; these people totaled seven in the DAA group and seven in the PLA group
Summary
Total hip arthroplasty (THA) is one of the most successful orthopedic surgeries. There are many common surgical approaches for THA. In order to reduce this trauma, surgeons are exploring minimally invasive approaches on the basis of traditional surgical approaches of THA, including the anterior approach, the lateral approach, the posterolateral approach (PLA), the Hardinge approach and the Watson-Jones approach. A new series of minimally invasive surgical approaches has been proposed, including the posterior two incision approach, the direct anterior approach (DAA) and the supercapsular percutaneously assisted total hip approach [4,5,6]. Many studies have reported that DAA is associated with better outcomes of gait analysis, muscle damage, early functional recovery, and pain relief [7,8,9,10]. A study has reported that DAA was associated with higher complication rate in the early phase [14]. Another study has pointed out the risk of revision was higher with DAA, especially due to stem loosening [15]
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