Treatment Outcome of Hip Arthrosis by a Mini-Open Direct Anterior Approach (DAA) in Patients with American Society of Anaestesiology Scale III (ASA III)

Abstract

Introduction: Osteoarthrosis (OA), often followed by femoroacetabular impingement (FAI) is a recognized condition that purportedly contributes to full degenerative changes of the hip (OA). The standard procedure for advanced degenerative joint disease is total hip replacement. This is a procedure with an increased risk of cardiovascular events for the patients. The risk of deep vein thrombosis (DVT), fat embolism, cardiological abnormalities in the course of the procedure and the consequences of interference in the pelvic girdle and the femoral cavity of the femur, significantly increases [1,2]. Because of the above risks in patients with ASA III, it was decided to use a less invasive procedure in bone and muscle tissue without interfering into the spongy bone of the femur and the bone acetabulum. We used minimally invasive direct anterior approach (MIS DAA) to remove massive bone osteophosphites, discard the joint and improve the range of the joint motion (Range of Motion, ROM). The aim of the present study was to describe the outcomes of the miniopen DAA in treating patients with arthorosis and FAI and compare them to the reported outcomes of other approaches. Materials and methods: This is a retrospective review of 21 patients (17 males, 4 females, mean age 51.4 [range 43 to 55] years) who were treated for OA by the miniopen DAA. The mean follow-up was 35 months (range 21 to 51).Preoperative osteoarthritis was assessed according to the Tonnis score. Preoperative and postoperative pain levels were assessed by a 10-point visual analog scale (VAS) score. The functional outcomes of hip joint were evaluated by the Short-Form 36 Health Survey (SF-36) and the Harris Hip Score (HHS). Results: There was a significant improvement in the HHS score (p<0.00001), the VAS score (p<0.001) and the SF-36 score (p<0.001) at the final follow-up compared to the preoperative status of our patients. Fifteen of patients returned to their previous activities. No major cardiac complications occurred. All patients were done with spinal anesthesia. One patient developed heterotopic ossification after 6 month post op and two other patients had temporary postoperative meralgia paresthetica. Two patients were referred to total hip arthroplasty due to severe osteoarthritis after 2 years post MIS DAA treating. Conclusions: The MIS DDA (minimal invasive anterior hip approach) is a safe and effective procedure for patients with OA and cardiac disease (ASA III) and may be considered as an alternative to primary total hip replacement for the treatment of early and middle AO and FAI. Further research in a larger cohort of AO and ASA II, III and IV patients with a longer follow-up period is recommended.