Clinical evaluation of modified direct anterior approach for total hip arthroplasty
Zhou Huajun1,2, Zhu Chen1,2, Shang Xifu2, Zhou Zhangwu3, Fang Shiyuan2, Ma Ruixiang2, Zhang Linlin2, Li Qianming2
1Department of Graduate, Wannan Medical College, Wuhu 241002, China; 2Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China; 3Department of Orthopedics, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China
Abstract：Objective To analyze the clinical outcomes, feasibility, and reliability of a modified direct anterior approach in lateral decubitus position for total hip arthroplasty (THA).Methods This retrospective cohort study enrolled 364 patients (181 males and 183 females) aged 46-79 (56±11) years, who were randomly selected for primary unilateral THA between January 2015 and January 2018 in the Department of Orthopedics in Anhui Provincial Hospital, the First Affiliated Hospital of the University of Science and Technology of China. The patients were divided into the modified direct anterior approach in lateral decubitus position group (LDAA group, n=184) and the posterolateral approach group (PLA group, n=180). General information [ gender, age, body mass index(BMI), and visual analog scale (VAS)score) ], blood loss, length of stay, 48-hour discharge rate, transfusion rate, and total complication rate were analyzed. Harris score was used in the clinical outcome evaluation during the 1 month and 1 year follow-up. Radiographic assessment was performed by measuring anteversion, inclination, safe zone of cup, transparent line score, stem position, and lower limb discrepancy on the pelvic X-ray 1 month postoperation.Results Preoperative comparison of general information (gender, age, BMI, and VAS) exhibited no statistical significance (all P values>0.05). The intraoperative blood loss, transfusion rate, length of stay, and 48-hour discharge rate of the LDAA group were (250±123) mL, 1.09%, (47.5±2.5) h, and 85.87%, respectively; and those of the PLA group were (370±184) mL, 17.78%, (66.5±3.5) h, and 6.11%, respectively. The LDAA group exhibited less blood loss, lower transfusion rate, shorter hospital stay, and higher 48-hour discharge rate compared with the PLA group (all P values<0.05). However, the incidence of total complications between the two groups was not statistically different (P>0.05). The follow-up period ranged from 11 months to 14 months (average: 12 months). The Harris score of both groups improved at 1 month and 1 year postoperation (F=6.380 , 9.170, all P values<0.05). The Harris scores between the two groups at different time points were insignificantly different (all P values>0.05). The radiographic assessment of anteversion, inclination, safe zone of cup, transparent line score, stem position, and lower limb discrepancy on the pelvic X-ray 1 month postoperation presented no statistical significance (all P values>0.05).Conclusions The use of modified LDAA in lateral decubitus position for THA is feasible, reliable, and recover faster.
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Zhou Huajun, Zhu Chen, Shang Xifu, Zhou Zhangwu, Fang Shiyuan, Ma Ruixiang, Zhang Linlin, Li Qianming. Clinical evaluation of modified direct anterior approach for total hip arthroplasty. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 146-151.
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2020, Vol. 25 
