Comparative Study On The Clinical Efficacy Of Direct Anterior Approach And Posterolateral Approach In Primary Total Hip Arthroplasty

Objective Objective to investigate the surgical method and clinical efficacy of direct anterior approach(DAA)for total hip arthroplasty in lateral position,and compare with posterolateral approach(PLA).Objective to evaluate the clinical efficacy of tha through DAA approach in lateral position for hip replacement.Methods The perioperative and postoperative follow-up data of 285 patients with total hip arthroplasty by direct anterior approach(DAA)and posterolateral approach in the Second Affiliated Hospital of Anhui Medical University from January 2016 to July2019 were collected and analyzed.The height and weight of the patients,the total operation time,the hemoglobin count(Hgb),the hematocrit(HCT),the total blood loss,the blood transfusion,the drainage after total hip replacement,the time of straight leg elevation,and the time before and after operation(1 week,4 weeks,3 months,6 months)The follow-up included visual analogue scale(VAS),range of motion(ROM)and Harris hscore(HHS).The clinical data of direct anterior approach and posterolateral approach in total hip arthroplasty were analyzed and compared.Result All patients were followed up for 12-18 months.The average total blood loss of DAA group was(467.60 ± 286.97)ml,the average hidden blood loss was(218.45 ±279.95)ml,the hidden blood loss accounted for 47.72%;the average total blood loss of PLA group was(609.94 ± 268.15)ml,the average hidden blood loss was(357.31 ±267.15)ml,the hidden blood loss accounted for 58.58%.The proportion of total blood loss,hidden blood loss and hidden blood loss in DAA group was significantly less than that in PLA group(P < 0.01);the average total operation time and average straight leg raising time in DAA group were(105.70 ± 33.96)min and(7.64 ± 5.08)d,respectively;the average total operation time and average straight leg raising time in PLA group were(123.78 ± 47.58)min and(8.88 ± 5.17)d,respectively.The operation time and straight leg raising time of DAA group were shorter than those of PLA group(P < 0.05);VAS score and Harris score of DAA group at 1 week and 4 weeks after operation were significantly lower than those of PLA group(P < 0.01,P < 0.01;P = 0.003,P < 0.01);there was no significant difference in hip movement(flexion,extension,adduction,abduction,internal rotation,external rotation)between the two groups(P > 0.05).There was no significant difference in straight leg raising time between the first 50 patients(group A)and the last 50 patients(group B)in DAA group(P > 0.05).The operation time of group B was less than that of group A,the differences were statistically significant(P < 0.05).The total blood loss of group A was(595.99 ± 304.78)ml,the hidden blood loss was(326.29 ± 292.12)ml,the hidden blood loss accounted for54.74%;the average total blood loss of group B was(339.21 ± 119.63)ml,the hidden blood loss was(110.21 ± 221.59)ml,the hidden blood loss accounted for 32.49%.The total blood loss,hidden blood loss and their proportion of the latter 50 patients(group B)in DAA group were significantly lower than those of the former 50 patients(group A)(P < 0.05).Conclusion Compared with PLA,the first THA with DAA can effectively reduce the perioperative blood loss,shorten the operation time and reduce postoperative pain,which is conducive to early functional recovery,and with the improvement of surgical proficiency,it can further shorten the operation time and reduce the perioperative blood loss.