Total hip arthroplasty via a direct anterior minimally invasive approach aided by lower extremity tractor for hip diseases

Abstract

Objective To evaluate the short-term clinical results of total hip arthroplasty(THA) through a direct anterior minimally invasive approach aided by lower extremity tractor for hip diseases. Methods Between August 2013 and August 2015, 115 patients (138 hips) were admitted for hip diseases. They were 71 men and 44 women, aged from 28 to 77 years (average, 59.4 years). Their body mass indexes ranged from 19.7 kg/m2 to 28.9 kg/m2, averaging 24.7 kg/m2. Their hip diseases included avascular necrosis of the femoral head in 56 cases (with an average disease course of 15.7 months), hip osteoarthritis in 35 cases (with an average disease course of 12.6 months), hip dysplasia in 14 cases (with an average disease course of 2.8 years) and inflammatory arthritis in 10 cases (with an average disease course of 6.8 years). All the patients were treated by primary THA through a direct anterior minimally invasive approach and assistance of lower extremity tractor. Results All the 115 patients (138 hips) were followed up for an average of 31.6 months (from 12 to 40 months). Their average length of incision was 9.4 cm, average operative time 115.9 min, av-erage blood loss 210.2 mL, and average hospital stay 7.5 days. Their postoperative imaging results were as follows: the angles of acetabular abduction averaged 41.6° (from 37° to 56°) and the angles of acetabular an-teversion 18.1° (from 11° to 23°). Their average Harris hip score one year postoperatively was 91.4 points (from 80 to 96 points). Split fracture of the proximal femur happened in one patient (one hip) (0.7%) intraopera-tively; injury to lateral femoral cutaneous never was observed in 6 patients (7 hips) (5.1%). Complications like deep infection, hip dislocation, deep vein thrombosis or prosthetic loosening were not observed during fol-low-ups. Conclusions THA with assistance of lower extremity tractor through a direct anterior minimally invasive approach can lead to fine short-term clinical results, including quick recovery of hip function and de-creased intraoperative and postoperative complications. Key words: Arthroplasty, replacement, hip; Femur head necrosis; Osteoarthritis; Surgical approach; Surgical procedures, minimally invasive