Mid-term effectiveness of total hip arthroplasty by direct anterior approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Libo ,  MA Jinzhong , SANG Weilin , LU Haiming , WANG Cong , JIANG Yafei

Department of Orthopaedics, Shanghai First People’s Hospital Affiliated Shanghai Jiaotong University, Shanghai, 201620, P.R.China;

Corresponding author：

MA Jinzhong, Email: majinzhong007@sina.com

Keywords：

Direct anterior approach; total hip arthroplsty; mid-term effectiveness

DOI：

10.7507/1002-1892.201705011

Video：

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ObjectiveTo retrospectively compare the mid-term effectiveness between by direct anterior approach (DAA) and by posterolateral approach in total hip arthroplasty (THA).MethodsBetween January 2009 and December 2010, 110 patients (110 hips) treated with THA and followed up more than 5 years were chosen in the study. THA was performed on 55 patients by DAA (DAA group), and on 55 patients by posterolateral approach (PL group). There was no significant difference in gender, age, body mass index, types of hip joint disease, and preoperative Harris score between 2 groups (P>0.05). The operation time, amount of bleeding, length of hospital stay, postoperative complications, and the Harris scores were recorded and compared.ResultsThere was no significant difference in operation time and length of hospital stay between 2 groups (t=0.145, P=0.876; t=1.305, P=0.093). The amount of bleeding was significantly less in DAA group than in PL group (t=2.314, P=0.032). All patients were followed up 5-7 years (mean, 5.97 years). Complications happened in 5 cases (9.1%) of DAA group and in 3 cases (5.5%) of PL group, and there was no significant difference in the incidence of complications between 2 groups (χ²=0.539, P=0.463). There was significant difference in Harris scores at 6 months after operation between 2 groups (t=2.296, P=0.014), but no significant difference was found in Harris score at 1 year and 5 years between 2 groups (t=1.375, P=0.130; t=0.905, P=0.087). Further analysis, at 6 months after operation, the joint function score in DAA group was significantly higher than that in PL group (t=1.087, P=0.034), while there was no significant difference in the pain score and range of motion score between 2 groups (t=1.872, P=0.760; t=1.059, P=0.091).ConclusionTHA by DAA has the advantages of less bleeding and faster recovery. The short-term effectiveness is superior to the THA by traditional posterolateral approach, but there is no obvious advantage in the mid-term effectiveness.

Citation： ZHU Libo, MA Jinzhong, SANG Weilin, LU Haiming, WANG Cong, JIANG Yafei. Mid-term effectiveness of total hip arthroplasty by direct anterior approach. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1031-1035. doi: 10.7507/1002-1892.201705011 Copy

1.	Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct Anterior Approach for Total Hip Arthroplasty: Indications, Technique, and Results. J Am Acad Orthop Surg, 2014, 22(9): 595-603.
2.	Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am, 2009, 40(3): 311-320.
3.	Taunton MJ, Mason JB, Odum SM, et al. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty, 2014, 29(9 Suppl): 169-172.
4.	Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. J Arthroplasty, 2015, 30(9 Suppl): 94-97.
5.	Mohan R, Yi PH, Hansen EN. Evaluating online information regarding the direct anterior approach for total hip arthroplasty. J Arthroplasty, 2015, 30(5): 803-807.
6.	桑伟林, 朱力波, 马金忠, 等. 微创直接前入路全髋关节置换术. 国际骨科学杂志, 2010, 31(5): 266-267.
7.	桑伟林, 朱力波, 陆海明, 等. 直接前入路与后外侧入路全髋关节置换术的对比研究. 中华关节外科杂志 (电子版), 2015, 9(5): 584-588.
8.	Sang W, Zhu L, Ma J, et al. The Influence of Body Mass Index and Hip Anatomy on Direct Anterior Approach of Total Hip Replacement. Med Princ Pract, 2016, 25(6): 555-560.
9.	Mirza AJ, Lombardi AV Jr, Morris MJ, et al. A mini-anterior approach to the hip for total joint replacement: optimising results: improving hip joint replacement outcomes. Bone Joint J, 2014, 96-B(11 Supp A): 32-35.
10.	Tsukada S, Wakui M. Lower Dislocation Rate Following Total Hip Arthroplasty via Direct Anterior Approach than via Posterior Approach: Five-Year-Average Follow-Up Results. Open Orthop J, 2015, 15(9): 157-162.
11.	Sheth D, Cafri G, Inacio MC, et al. Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk. Clin Orthop Relat Res, 2015, 473(11): 3401-3408.
12.	Lanting BA, Odum SM, Cope RP, et al. Incidence of perioperative events in single setting bilateral direct anterior approach total hip arthroplasty. J Arthroplasty, 2015, 30(3): 465-467.
13.	Meneghini RM, Pagnano MW, Trousdale RT, et al. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res, 2006, 453: 293-298.
14.	Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg (Am), 2011, 93(15): 1392-1398.
15.	Grob K, Monahan R, Gilbey H, et al. Distal extension of the direct anterior approach to the hip poses risk to neurovascular structures: an anatomical study. J Bone Joint Surg (Am), 2015, 97(2): 126-132.
16.	Barnett SL, Peters DJ, Hamilton WG, et al. Is the Anterior Approach Safe? Early Complication Rate Associated with 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach. J Arthroplasty, 2016, 31(10): 2291-2294.
17.	De Geest T, Fennema P, Lenaerts G, et al. Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg, 2015, 135(8): 1183-1192.
18.	Rudin D, Manestar M, Ullrich O, et al. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. J Bone Joint Surg (Am), 2016, 98(7): 561-567.
19.	Homma Y, Baba T, Sano K, et al. Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. Int Orthop, 2016, 40(8): 1587-1593.
20.	Grob K, Manestar M, Ackland T, et al. Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint: An Anatomical Study. J Bone Joint Surg (Am), 2015, 97(17): 1426-1431.
21.	den Hartog YM, Mathijssen NM, Vehmeijer SB. The less invasive anterior approach for total hip arthroplasty: a comparison to other approaches and an evaluation of the learning curve-a systematic review. Hip Int, 2016, 26(2): 105-120.

1. Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct Anterior Approach for Total Hip Arthroplasty: Indications, Technique, and Results. J Am Acad Orthop Surg, 2014, 22(9): 595-603.
2. Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am, 2009, 40(3): 311-320.
3. Taunton MJ, Mason JB, Odum SM, et al. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty, 2014, 29(9 Suppl): 169-172.
4. Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. J Arthroplasty, 2015, 30(9 Suppl): 94-97.
5. Mohan R, Yi PH, Hansen EN. Evaluating online information regarding the direct anterior approach for total hip arthroplasty. J Arthroplasty, 2015, 30(5): 803-807.
6. 桑伟林, 朱力波, 马金忠, 等. 微创直接前入路全髋关节置换术. 国际骨科学杂志, 2010, 31(5): 266-267.
7. 桑伟林, 朱力波, 陆海明, 等. 直接前入路与后外侧入路全髋关节置换术的对比研究. 中华关节外科杂志 (电子版), 2015, 9(5): 584-588.
8. Sang W, Zhu L, Ma J, et al. The Influence of Body Mass Index and Hip Anatomy on Direct Anterior Approach of Total Hip Replacement. Med Princ Pract, 2016, 25(6): 555-560.
9. Mirza AJ, Lombardi AV Jr, Morris MJ, et al. A mini-anterior approach to the hip for total joint replacement: optimising results: improving hip joint replacement outcomes. Bone Joint J, 2014, 96-B(11 Supp A): 32-35.
10. Tsukada S, Wakui M. Lower Dislocation Rate Following Total Hip Arthroplasty via Direct Anterior Approach than via Posterior Approach: Five-Year-Average Follow-Up Results. Open Orthop J, 2015, 15(9): 157-162.
11. Sheth D, Cafri G, Inacio MC, et al. Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk. Clin Orthop Relat Res, 2015, 473(11): 3401-3408.
12. Lanting BA, Odum SM, Cope RP, et al. Incidence of perioperative events in single setting bilateral direct anterior approach total hip arthroplasty. J Arthroplasty, 2015, 30(3): 465-467.
13. Meneghini RM, Pagnano MW, Trousdale RT, et al. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res, 2006, 453: 293-298.
14. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg (Am), 2011, 93(15): 1392-1398.
15. Grob K, Monahan R, Gilbey H, et al. Distal extension of the direct anterior approach to the hip poses risk to neurovascular structures: an anatomical study. J Bone Joint Surg (Am), 2015, 97(2): 126-132.
16. Barnett SL, Peters DJ, Hamilton WG, et al. Is the Anterior Approach Safe? Early Complication Rate Associated with 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach. J Arthroplasty, 2016, 31(10): 2291-2294.
17. De Geest T, Fennema P, Lenaerts G, et al. Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg, 2015, 135(8): 1183-1192.
18. Rudin D, Manestar M, Ullrich O, et al. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. J Bone Joint Surg (Am), 2016, 98(7): 561-567.
19. Homma Y, Baba T, Sano K, et al. Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. Int Orthop, 2016, 40(8): 1587-1593.
20. Grob K, Manestar M, Ackland T, et al. Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint: An Anatomical Study. J Bone Joint Surg (Am), 2015, 97(17): 1426-1431.
21. den Hartog YM, Mathijssen NM, Vehmeijer SB. The less invasive anterior approach for total hip arthroplasty: a comparison to other approaches and an evaluation of the learning curve-a systematic review. Hip Int, 2016, 26(2): 105-120.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of total hip arthroplasty by direct anterior approach

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