Comparison of 12-month follow-up results of primary total hip arthroplasty between modified direct anterior approach and direct anterior approach
Ke Yuqi, Chen Changjian, Wu Hao, Zheng Lianjie
Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
Abstract: BACKGROUND: Direct anterior total hip arthroplasty can lead to increased muscle tension and contusion, especially in male patients with high body mass index and strong physique. Then, inflammatory reaction and early postoperative complications occurred.
OBJECTIVE: To explore the difference in early curative effect of modified direct anterior approach and direct anterior approach in total hip arthroplasty.
METHODS: The clinical data of 68 patients undergoing direct anterior approach for total hip arthroplasty admitted to the Second Affiliated Hospital of Dalian Medical University from June 2019 to August 2020 were collected and randomly divided into the modified group (modified direct anterior approach) and the traditional group (direct anterior approach) (n=34). Blood routine, creatine kinase, C-reactive protein, hemoglobin content and ultrasonic thickness of hip-related muscles were detected before operation and 2 days after operation. The hip flexion and abduction muscle strength were evaluated at 2 days and 1 month after the operation. The visual analogue scale score and Harris score of the hip joint were evaluated preoperatively, 2 days, 1, 6, and 12 months postoperatively.
RESULTS AND CONCLUSION: (1) Within 12 months of follow-up, no periprosthetic infection, periprosthetic osteolysis, prosthesis loosening or periprosthetic fracture occurred in 68 patients. (2) The changes in creatine kinase, tensor fascia lata thickness, vastus lateralis muscle thickness, and vastus intermedius thickness before and after surgery in the modified direct anterior approach group were all lower than those in the direct anterior approach group (P < 0.05). There was no significant difference in hip flexion and abductor strength ratings at 2 days and 1 month after operation between the two groups (P > 0.05). (3) Before surgery and at 2 days, 1, 6, and 12 months after surgery, there was no significant difference between the two groups in the visual analogue scale score and Harris score of the hip joint (P > 0.05). Among the 34 patients in the direct anterior approach group, 14 patients had mild iliac crest pain after surgery, and the pain disappeared 1 month after surgery. (4) The results conclude that compared with the traditional direct anterior approach, the modified direct anterior approach is helpful to reduce the injury of soft tissue such as tensor fascia lata. Although the iliac crest pain is increased, it does not affect the early pain score and rehabilitation function training of patients. The modified approach is especially suitable for patients with strong physique and high soft tissue tension.
Key words: total hip arthroplasty, modified direct anterior approach, direct anterior approach, tensor fascia lata release, muscle damage, early postoperative efficacy