ABSTRACT
BACKGROUND: At present, minimally invasive total hip arthroplasty is gradually developed, and becomes one of the representative types of total hip arthroplasty. The direct anterior approach is characterized by small tissue injury, low postoperative complications and rapid postoperative recovery. Compared with other approaches, there is still a lot of controversy on whether the approach can obtain better early and long-term effects. OBJECTIVE: To compare the clinical effect of direct anterior approach and posterolateral approach in minimally invasive total hip arthroplasty. METHODS: Totally 88 patients with minimally invasive total hip arthroplasty from September 2015 to September 2016 in the First Department of Orthopedics, Changzhou City Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine were selected as the subjects. The patients were divided into direct anterior approach group and posterolateral approach group, with 44 patients in each group. The incision length, operation time, postoperative drainage volume, blood transfusion volume, hemoglobin difference before and after operation, time of bed walking, postoperative acetabular abduction angle and acetabular anteversion angle were recorded and compared. Blood sedimentation rate, C-reactive protein levels, complications (infection, vascular injury and hip dislocation), hip function Harris score preoperatively, postoperatively 1, 3, and 6 months were analyzed. RESULTS AND CONCLUSION: (1) There was no significant difference in the postoperative acetabular abduction angle and acetabular anteversion angle between both groups (P > 0.05). (2) The average operation time of the patients in the direct anterior approach group was significantly longer than that in the posterolateral approach group (P < 0.05). The length of incision, intraoperative blood loss, postoperative drainage volume, hemoglobin difference, postoperative erythrocyte sedimentation rate, postoperative C-reactive protein and time of bed walking were significantly lower in direct anterior approach group than in posterolateral approach group (P < 0.05). (3) Harris score of direct anterior approach group was significantly higher than that of posterolateral approach group (P < 0.05). There was no significant difference in Harris score between the two groups before and 6 months after operation (P > 0.05). (4) There was no significant difference in postoperative complications between the two groups (P > 0.05). (5) There is no significant difference in the efficacy during 6-month follow-up and postoperative complications between posterolateral approach and direct anterior approach, but the direct anterior approach is less traumatic, with faster postoperative recovery, higher joint stability, more consistent with minimally invasive surgery and the concept of rapid rehabilitation.
ABSTRACT
<p><b>OBJECTIVE</b>To introduce the technique of total hip surface replacement, evaluate the early results and review the factors which affect the results.</p><p><b>METHODS</b>From October 2000 to January 2005, 31 patients (37 hips) with osteonecrosis, osteoarthritis, hip dysplasia, ankylosing spondylitis were treated with the total hip surface replacement. Among them, 15 were male, and 16 were female, with an average age of 42 years (range from 23 - 65 years). All the 31 patients had the indications for hip surface replacement. Standard operation technique which was brought forth by Amstutz and Nelson was employed, and all patients were followed up after operation.</p><p><b>RESULTS</b>Patients were followed up for an average period of 42 months (3 - 51 months). There were no femoral neck fracture, no dislocation, no infection in all patients. Radiolucent line existed around acetabular prosthesis in 1 hip and another hip had been revised because the prosthesis of femoral head was in incorrect situation. The average Harris hip score improved significantly from 30 to 90, and the score was 93 in the latest follow-up. Based on Harris system, 35 hips were excellent, 1 hip good, and 1 hip fail.</p><p><b>CONCLUSIONS</b>The total hip surface replacement is an effective solution for the problem of the patients with osteonecrosis of the femoral head, osteoarthritis, hip dysplasia and ankylosing spondylitis. The short-term results are satisfied.</p>