Comparison of early rehabilitation effects of total hip arthroplasty with direct anterior approach versus posterior approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ziqi , WANG Chunsheng , YANG Pei , DANG Xiaoqian ,  WANG Kunzheng

Department of Orthopedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P.R.China;

Corresponding author：

WANG Kunzheng, Email: xjtuwkz@163.com

Keywords：

Total hip arthroplasty; direct anterior approach; posterior approach; early rehabilitation

DOI：

10.7507/1002-1892.201712059

Video：

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Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with direct anterior approach (DAA) versus posterior approach (PA). Methods A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups (P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared. Results All incisions healed primarily and no infection, dislocation, or fracture occurred. All patients were followed up 30.2 months on average (range, 6-44 months). The numbness symptom caused by the lateral femoral cutaneous nerve injury occurred in 2 patients of DAA group and released after symptomatic treatment. The length of incision, total amount of bleeding, the time of first postoperative walking with crutch, and the time of first postoperative walking without crutch of DAA group were significantly superior to those of PA group (P<0.05). The Harris scores of DAA group were significantly higher than those of PA group at 2 weeks and 1 month after operation (P<0.05), while no significant difference was found between 2 groups before operation and at 3 months and 6 months after operation (P>0.05). The VAS scores of DAA group were significantly lower than those of PA group at 1 day, 4 days, 1 week, and 2 weeks after operation (P<0.05), while no significant difference was found between 2 groups before operation (P>0.05). Conclusion DAA is meaningful to enhanced recovery after THA. But it should be chosen carefully because of the disadvantages, such as long learning curve, limited indications, and requirements of specific instruments.

Citation： ZHANG Ziqi, WANG Chunsheng, YANG Pei, DANG Xiaoqian, WANG Kunzheng. Comparison of early rehabilitation effects of total hip arthroplasty with direct anterior approach versus posterior approach. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(3): 329-333. doi: 10.7507/1002-1892.201712059 Copy

1.	Hogerzeil DP, Muradin I, Zwitser EW, et al. Acute compartment syndrome of the thigh following hip replacement by anterior approach in a patient using oral anticoagulants. World J Orthop, 2017, 8(12): 964-967.
2.	Graves SC, Dropkin BM, Keeney BJ, et al. Does surgical approach affect patient-reported function after primary THA? Clin Orthop Relat Res, 2016, 474(4): 971-981.
3.	Mjaaland KE, Svenningsen S, Fenstad AM, et al. Implant survival after minimally invasive anterior or anterolateral vs. conventional posterior or direct lateral approach: an analysis of 21, 860 total hip arthroplasties from the norwegian arthroplasty register (2008 to 2013). J Bone Joint Surg (Am), 2017, 99(10): 840-847.
4.	倘艳锋, 李红军, 刘又文, 等. 不同手术入路行分期双侧人工全髋关节置换术的早期疗效比较研究. 中国修复重建外科杂志, 2017, 31(11): 1300-1304.
5.	Lee SH, Kang SW, Jo S. Perioperative comparison of hip arthroplasty using the direct anterior approach with the posterolateral approach. Hip Pelvis, 2017, 29(4): 240-246.
6.	Kim SC, Lim YW, Jo WL, et al. Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral total hip Arthroplasty in patients with osteonecrosis of the femoral head. BMC Musculoskelet disord. 2017, 18(1): 266.
7.	Engelman RM, Rousou JA, Flack JE 3rd, et al. Fast-track recovery of the coronary bypass patient. Ann Thorac Surg, 1994, 58(6): 1742-1746.
8.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
9.	Ljunggvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg, 2017, 152(3): 292-298.
10.	Ibrahim MS, Alazzawi S, Nizam I, et al. An evidence-based review of enhanced recovery interventions in knee replacement surgery. Ann R Coll Surg Engl, 2013, 95(6): 386-389.
11.	Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth, 2015, 62(2): 203-218.
12.	Alecci V, Valente M, Crucil M, et al. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol, 2011, 12(3): 123-129.
13.	Stryker LS, Gilliland JM, Odum SM, et al. Femoral vessel blood flow is preserved throughout direct anterior total hip arthroplasty. J Arthroplasty, 2015, 30(6): 998-1001.
14.	Rodriquez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res, 2014, 472(2): 455-463.
15.	Macheras GA, Christofilopoulos P, Lepetsos P, et al. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. Hip Int, 2016, 26(4): 338-343.
16.	Rivera F, Leonardi F, Evangelista A, et al. Risk of stem undersizing with direct anterior approach for total hip arthroplasty. Hip Int, 2016, 26(3): 249-253.
17.	Watts CD, Houdek MT, Wagner ER, et al. High risk of wound complications following direct anterior total hip arthroplasty in obese patients. J Arthroplasty, 2015, 30(12): 2296-2298.
18.	Berend KR, Mirza AJ, Morris MJ, et al. Risk of periprosthetic fractures with direct anterior primary total hip arthroplasty. J Arthroplasty, 2016, 31(10): 2295-2298.

1. Hogerzeil DP, Muradin I, Zwitser EW, et al. Acute compartment syndrome of the thigh following hip replacement by anterior approach in a patient using oral anticoagulants. World J Orthop, 2017, 8(12): 964-967.
2. Graves SC, Dropkin BM, Keeney BJ, et al. Does surgical approach affect patient-reported function after primary THA? Clin Orthop Relat Res, 2016, 474(4): 971-981.
3. Mjaaland KE, Svenningsen S, Fenstad AM, et al. Implant survival after minimally invasive anterior or anterolateral vs. conventional posterior or direct lateral approach: an analysis of 21, 860 total hip arthroplasties from the norwegian arthroplasty register (2008 to 2013). J Bone Joint Surg (Am), 2017, 99(10): 840-847.
4. 倘艳锋, 李红军, 刘又文, 等. 不同手术入路行分期双侧人工全髋关节置换术的早期疗效比较研究. 中国修复重建外科杂志, 2017, 31(11): 1300-1304.
5. Lee SH, Kang SW, Jo S. Perioperative comparison of hip arthroplasty using the direct anterior approach with the posterolateral approach. Hip Pelvis, 2017, 29(4): 240-246.
6. Kim SC, Lim YW, Jo WL, et al. Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral total hip Arthroplasty in patients with osteonecrosis of the femoral head. BMC Musculoskelet disord. 2017, 18(1): 266.
7. Engelman RM, Rousou JA, Flack JE 3rd, et al. Fast-track recovery of the coronary bypass patient. Ann Thorac Surg, 1994, 58(6): 1742-1746.
8. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr, 2005, 24(3): 466-477.
9. Ljunggvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg, 2017, 152(3): 292-298.
10. Ibrahim MS, Alazzawi S, Nizam I, et al. An evidence-based review of enhanced recovery interventions in knee replacement surgery. Ann R Coll Surg Engl, 2013, 95(6): 386-389.
11. Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth, 2015, 62(2): 203-218.
12. Alecci V, Valente M, Crucil M, et al. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol, 2011, 12(3): 123-129.
13. Stryker LS, Gilliland JM, Odum SM, et al. Femoral vessel blood flow is preserved throughout direct anterior total hip arthroplasty. J Arthroplasty, 2015, 30(6): 998-1001.
14. Rodriquez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res, 2014, 472(2): 455-463.
15. Macheras GA, Christofilopoulos P, Lepetsos P, et al. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. Hip Int, 2016, 26(4): 338-343.
16. Rivera F, Leonardi F, Evangelista A, et al. Risk of stem undersizing with direct anterior approach for total hip arthroplasty. Hip Int, 2016, 26(3): 249-253.
17. Watts CD, Houdek MT, Wagner ER, et al. High risk of wound complications following direct anterior total hip arthroplasty in obese patients. J Arthroplasty, 2015, 30(12): 2296-2298.
18. Berend KR, Mirza AJ, Morris MJ, et al. Risk of periprosthetic fractures with direct anterior primary total hip arthroplasty. J Arthroplasty, 2016, 31(10): 2295-2298.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of early rehabilitation effects of total hip arthroplasty with direct anterior approach versus posterior approach

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