Preliminary Results Of Bikini Incision Total Hip Arthroplasty With Preoperative Planning Of 3D CT And Percutaneously Assisted

Objective:Compared with the direct anterior approach of traditional longitudinal incision and the posterolateral approach,this paper summarized Bikini approach total hip arthroplasty,using digital technology(3D CT)on preoperative planning and the PATH method on the acetabular side,and reported its early efficacy.Materials and Methods:According to inclusion and exclusion criteria,a total of 227 patients who underwent primary total hip arthroplasty at our joint center from March 2020 to August 2021 were retrospectively analyzed.They were divided into three groups according to different approaches: 71 patients in the Bikini approach group,74 patients in the DAA(Direct Anterior Approach)group,82 patients in the PLA(Posterolateral Approach)group.The Bikini approach group with preoperative3 D CT planning was the experimental group,and the DAA group and PLA group without preoperative planning were two independent control groups.Prosthesis information of preoperative planning and actually used during surgery were counted,am to analyze the accuracy of preoperative planning.The incision length,length of stay,operation time,difference of hemoglobin and albumin before and after operation,leg length discrepancy postoperative,abduction Angle and anteversion Angle of acetabular prosthesis,the angle between the stalk and medullary cavity axis of the femoral prosthesis,Harris score(1,3,6 months after operation),scar score of surgical incision and other information were compared.Results:1 、 Preoperative planning: the accuracy of acetabular prosthesis planning was85.9% and that of femur prosthesis planning was 95.8%.2 、 In terms of incision length(cm)and scar score,Bikini group(7.4±0.6 、7.03±1.42)was superior to DAA group(10.1±0.6、8.50±1.65)and PLA group(14.3±0.6、9.67±1.90),and the difference was statistically significant(P<0.001);In terms of operation time(min),the Bikini group(80.6±13.6)was significant longer than the DAA group(72.2±13.0)and the PLA group(66.2±10.9),P<0.001.3 、 There was no significant difference in the length of hospital stay in Bikini group(10.0±1.9)、 DAA group(10.2±2.8)、 PLA group(10.6±3.3),P>0.05.4、Surgical injury related indicators: The difference of perioperative hemoglobin(HGB)in Bikini group(26.69±10.91)was higher than that in DAA group(22.89±6.83),P<0.05,but there was no significant difference compared with PLA group(25.63±7.12)(P>0.05);The difference of perioperative albumin(ALB)in the Bikini group(9.11±3.50)was higher than that in the DAA group(6.85±3.53),P < 0.001,but there was no significant difference compared with PLA group(8.93±4.23)(P>0.05).5 、 Prosthesis related imaging indicators: There was no statistical difference in abduction angle of acetabular prosthesis in Bikini group compared with DAA group and PLA group(P > 0.05);The anterior inclination angle of acetabular prosthesis in Bikini group was smaller than that in DAA group(P < 0.001),but there was no statistical difference compared with that in PLA group(P > 0.05);In terms of the angle between the stalk and medullary cavity axis of the femoral prosthesis,There was no statistically significant difference between the Bikini group and the DAA group(P > 0.05),and there was statistically significant difference between the Bikini group(average Angle was varus 0.86°)and the PLA group(average Angle was varus0.20°)(P < 0.001).6、Hip joint function Harris score: One month after the operation,Bikini group had an advantage over DAA group and PLA group,P<0.001,which was statistically significant;Three months after the operation,Bikini group had no advantage compared with DAA group(P > 0.05),but still had advantage compared with PLA group(P < 0.05),which was statistically significant;Bur there was no significant difference in Harris score between the three groups at 6 months follow-up.Conclusion:1、AI HIP software(Changmugu)was used for preoperative planning,and the accuracy of prosthesis prediction was high,which is worth promoting.2、With the aid of the PATH technology,the total hip replacement through the Bikini approach has small incision scar and beautiful appearance,and the prosthesis is in a good position;The prosthesis was well positioned and beneficial to the rapid recovery of postoperative hip function,and good early clinical results were obtained.