Patient's perspective on direct anterior versus posterior approach total hip arthroplasty.

PURPOSE: Total hip arthroplasty approach comparison focused on patient's perspective. The direct anterior approach (DAA) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome. However, the question if the level of DAA promotion is justified seems to be rarely posed. METHODS: A single-surgeon consecutive series of patients who underwent bilateral THA, one in DAA and the other in posterior approach (PA). The same implant design and same component sizes were used for the both sides. All the operations were performed by a single surgeon under the same pre- and post-operative care protocol. RESULTS: Twenty-one patients underwent bilateral THA, mean age 60.09 years. Oxford Hip Score (OHS) was used for functional outcome assessment. There were no statistically significant differences between two approaches in terms of functional outcome (mean OHS for DAA series was 42.95 and that for the PA was 43.38, p 0.07 at an alpha level of 0.05). Fifteen patients gave the advantage to PA, and six patients favoured DAA. CONCLUSION: By study design, we tried to reduce the biases and acquire approach appraisal from patient's perspective. We anticipated the outcome in favour of DAA, but the results favoring PA came as a surprise. Future prospective randomized studies on evaluation of DAA and other approaches not only from surgeon's or industry's point of view, performed on a larger and more uniform groups, are warranted to further explore the subjective differences between DAA and PA.

Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age.

BACKGROUND: Many children with developmental dislocation of the hip especially in underdeveloped countries reach walking age and still remain undiagnosed, which can be detrimental to their growth and development. Because of the lack medical services often encountered in these regions, it would be attractive to find a cheap and effective treatment. Our work evaluated the results of treatment of these children by closed reduction with or without adductor tenotomy in a prospective study. METHODS: We included 20 patients in this study with 29 affected hips (15 right and 14 left). Nine patients (45%) had bilateral DDH and 11 (55%) had unilateral DDH. There were 18 girls (90%) and two boys (10%) who were followed up for a mean of 21 mo (18-24 mo). Ages ranged from 9 to 36 mo (mean age 18.3 mo). Patients were divided according to age into two groups: between 9-18 mo and from 19-36 mo. The first group included nine patients (14 hips) while the second had 11 patients (15 hips). RESULTS: In the first group, closed reduction failed in two patients (two hips) during the follow-up period (14.3%) and this necessitated shift to open reduction, while in the second group only one patient (bilateral DDH) had a similar failure (13.3%). We identified four hips with avascular necrosis. Three of them required no further treatment, the remaining hip was openly reduced. CONCLUSIONS: Closed reduction in older children offers a valid and reproducible treatment modality in the hands of an experienced pediatric orthopaedic surgeon as long as there is close follow-up and thorough knowledge of possible complications and their management including the ability to shift timely to open reduction.