Short-term outcomes of the supine muscle-sparing anterolateral versus direct lateral approach to primary total hip arthroplasty.

BACKGROUND: Although total hip arthroplasty (THA) is among the most successful orthopaedic procedures, it is not without complications. As such, finding the optimal surgical approach has become an area of particular interest. In this study, we compare: (1) pain intensity; (2) opioid consumption; (3) lengths of stay (LOS); (4) complication rates; (5) discharge destination; and (6) ambulatory function between patients who underwent THA via the supine muscle-sparing anterolateral (MS-ALA) and conventional direct lateral (DLA) approaches. METHODS: A retrospective analysis was conducted on 220 consecutive patients who received primary THA using the supine MS-ALA (n = 101) or DLA (n = 119) between 1 January 2014 and 31 December 2016. Outcomes included postoperative pain intensity, opioid consumption, LOS, discharge destination, complications, additional procedures, and time to independent ambulation. RESULTS: We demonstrated significantly lower opioid consumption on postoperative days (POD) 1 and 2 (mean differences, -32.0 and -28.4 mg, respectively; p ⩽ 0.001) and decreased pain intensity during the second 24 hours of the hospital stay (mean difference, -22.0; p < 0.001) in patients receiving the MS-ALA. Relative to the DLA cohort, patients in the MS-ALA cohort were 2.04 times more likely to be discharged to home (p = 0.028) and 1.91 times less likely to experience postoperative abductor insufficiency (p = 0.039). CONCLUSION: The present study is the 1st to compare postoperative outcomes, particularly pain intensity and opioid consumption, between the supine muscle-sparing anterolateral and direct lateral THA approaches. Further research should investigate the effect of surgical approach on quality and cost of care, include larger sample sizes, and involve longer-term follow-up.

The Addition of Diclofenac to a Multimodal Pain Control Regimen Decreases Postoperative Pain and Opioid Consumption.

INTRODUCTION: Total knee arthroplasty (TKA) is a commonly-performed orthopaedic procedure in the United States. However, inadequate postoperative pain management following TKA has been associated with a number of negative consequences, including chronic postoperative pain requiring long-term opioid use. Multimodal pain control is a recently-popularized means of maximizing analgesia and postoperative outcomes. We aimed to evaluate the outcomes of a multimodal pain regimen incorporating diclofenac, including: 1) length of stay (LOS); 2) pain intensity; and 3) opioid consumption in primary TKA patients. MATERIALS AND METHODS: A prospective cohort study was performed. All patients scheduled for primary TKA by a single surgeon between March 1, 2017 and August 31, 2017 were screened for study involvement, yielding 46 consecutive patients (52 TKAs). This study group was treated with a postoperative regimen of intravenous (IV) diclofenac, in addition to a perioperative pain control regimen including adductor canal blockade (ACB) and periarticular multimodal drug injection (PMDI). Postoperative outcomes in this group were compared to those of a matched cohort of 78 patients (88 primary TKAs) who had previously been treated with the same perioperative pain control regimen. RESULTS: Patients prescribed a postoperative diclofenac regimen had lower mean LOS (2.10 vs. 2.33 days; p=0.053) and lower 24-hour postoperative pain intensity (76 vs. 104; p=0.056) as compared to the untreated group. The diclofenac-treated group had a significantly lower opioid consumption in the first 24 hours postoperatively than did their untreated counterparts (39.8 vs. 53.1 morphine milligram equivalents [MME]; p=0.041). In addition, 17 patients (18 TKAs, 35%) in the diclofenac group had zero opioid requirements during the first 12 hours postoperatively, and 12 of these patients (13 TKAs, 25%) continued to not require any opioids through the first 24 hours postoperatively. DISCUSSION: In the midst of the rapidly-increasing rates of TKA in the US, multimodal pain control has emerged as an extremely effective means of maximizing postoperative patient outcomes. To our knowledge, this is the first study to evaluate the postoperative outcomes of TKA patients treated with a regimen of IV diclofenac. We demonstrate shorter LOS, decreased 24-hour pain intensity, and significantly decreased 24-hour opioid consumption in patients treated with adjunctive IV diclofenac compared to patients managed with our institution's standard perioperative regimen.