ABSTRACT
Objective:To investigate the effects of SuperPATH approach versus conventional posterolateral approach in total hip replacement on inflammatory response, hip function, and quality of life in patients with hip diseases. Methods:The clinical data of 140 patients with hip diseases who underwent total hip replacement in Shanxian Central Hospital from March 2017 to May 2019 were retrospectively analyzed. These patients were divided into SuperPATH approach ( n = 70) and posterolateral approach ( n = 70) groups. Operation-related indexes, inflammatory response indexes, hip function, quality of life, and pain were compared between the two groups. Results:Intraoperative blood loss was significantly less in the SuperPATH approach group than in the posterolateral approach group [(105.40 ± 15.11) mL vs. (196.89 ± 24.26) mL, t = 26.74, P < 0.001]. Incision length, postoperative time to getting out of bed, length of hospital stay in the SuperPATH approach group were (6.85 ± 1.42) cm, (2.92 ± 0.28) days, and (6.67 ± 1.36) days, respectively, which were significantly shorter than those in the posterolateral approach group [(13.07 ± 1.89) cm, (8.36 ± 1.45) days, (10.91 ± 1.34) days, t = 19.36, 30.82, 18.58, P < 0.001]. Operative time was significantly longer in the SuperPATH approach group than in the posterolateral approach group [(69.38 ± 8.62) minutes vs. (60.45 ± 7.79) minutes, t = 6.43, P < 0.001). The scores of social role functioning, general health perceptions, vitality, mental health, bodily pain, emotional role functioning, physical functioning, and physical functioning measured 6 months after surgery were significantly higher in the SuperPATH approach group than in the posterolateral approach group ( t = 9.12, 11.80, 11.64, 11.69, 6.45, 11.79, 6.04, 10.74, all P < 0.001). There were no significant differences in C-reactive protein and erythrocyte sedimentation rate measured 3 and 14 days after surgery between the two groups (both P > 0.05). Harris score used for evaluation of hip function 1 month after surgery was significantly higher in the SuperPATH approach group than in the posterolateral approach group [(76.42 ± 4.17) points vs. (69.37 ± 5.11) points, t = 8.94, P < 0.001]. The Visual Analog Scale score 3 days after surgery was significantly lower in the SuperPATH approach group than in the posterolateral approach group [(3.18 ± 0.21) points vs. (4.26 ± 0.29) points, t = 25.23, P < 0.001]. Conclusion:Compared with the conventional posterolateral approach, the SuperPATH approach for total hip arthroplasty takes longer operative time, but it can better reduce early postoperative pain, promote hip function recovery, and improve quality of life.
ABSTRACT
BACKGROUND:Improper angle of prosthesis placement often induces acetabular cup impact, and limits the scope of activity of artificial hip joint, and cannot meet the requirement of daily life. At present, the angle of acetabular cup instal ation remains controversial during total hip arthroplasty. Moreover, there is lack of targeted guide for the acetabular cup instal ation during hip arthroplasty with different head-neck ratios. OBJECTIVE:To explore the safe range of the artificial acetabular cup instal ation angle for different head-neck ratios. METHODS:In accordance with the calculation formula of range of internal rotation and external rotation, abduction and adduction, flexion and extension after total hip replacement, interpretation of dynamical variety law of acetabular abduction and anteversion, and deriving inequalities depending on Widmer’s standard of artificial hip joint normal activities range:(1) external rotation range was at least 40°, and internal rotation range was at least 80°. (2) Abduction range was at least 50°, and adduction range was at least 50°. (3) Anteflexion range was at least 130°, and extension range was at least 40°. The safety scope of artificial hip joint instal ation angle at different head-neck ratios was determined by solving the above three groups of inequality. RESULTS AND CONCLUSION:The safe range of the artificial acetabular cup instal ation angle for different head-neck ratios was different. To meet the normal hip joint activities, the head-neck ratios of artificial hip should be greater than 22/12. Artificial hip joint activities gradual y increase with the enlargement of head neck ratios. With enlarging the head-neck ratios, the acetabular cup instal ation safety angle scope of abduction and anteversin gradual y increases and the extreme of abduction increases gradual y, then with anteversion increasing gradual y, the abduction upper extreme of the security scope gradual y decrease and lower extreme of the security scope gradual y increase, tending to 45° symmetrical y. When anteversion is the biggest, the abduction should be 45°.