Observation On Curative Effect Of Total Hip Arthroplasty Via Posterolateral And Direct Anterior Approaches

Objective:Comparison of the efficacy of total hip arthroplasty via posterolateral and direct anterior approach.Methods:A total of 68 patients who underwent unilateral THA at Qingdao Municipal Hospital in time that from Jun-2019 to Jun-2020 for the first time.And randomly divided into two groups.One of the groups was defined as posterolateral approach(PLA)group,and the surgical approach was performed by posterolateral approach.The other group was defined as direct anterior approach(DAA),and the surgical approach was performed by direct anterior approach.Through the application of a variety of clinical indicators and complications to compare between two groups,which the clinical indicators include:the length of incision,blood loss during operation,the time of operation and the time of going to the ground after operation,NRS pain score at24 and 48 hours after operation,preoperative Harris score(HHS)and Harris score at 1week,1 month and 6 months after operation.Results:(1)Baseline information:PLA group:(total number of patients:34;25cases of osteonecrosis of the femoral head,9 cases of osteoarthritis of hip joint;Age:66.97±7.42 years old;Affected limb:left/right=16/18;Sex:male/female=15/19;Body mass index:24.23±2.88 kg/m~2).DAA group:(total number of patients:34;24cases of osteonecrosis of the femoral head;10 cases of osteoarthritis of hip joint;Age:67.32±7.98 years old;Affected limb:left/right=18/16;Sex:male/female=17/17;Body mass index:24.86±2.79kg/m~2).There was no significant difference in etiology,age,affected side,sex and body mass index between the patients in PLA and DAA(P>0.05).(2)The patients in PLA group:the incision length was(11.90±1.11cm),the amount of intraoperative bleeding was(293.71±71.91ml),the operation time was(99.12±6.18min),the time of getting out of bed after operation was(34.94±9.37h).The patients in DAA group:the incision length was(9.48±1.02cm),the amount of intraoperative bleeding was(255.5±54.69ml),the operation time was(109.35±8.64min),the time of getting out of bed after operation was(28.8±2.92h).The incision length,intraoperative bleeding,time of getting out of bed in PLA group were worse than DAA group,but the operation time is on the contrary,there were significant differences between PLA and DAA groups(P<0.05).The patients in PLA group:the NRS pain score after operation was(4.56±0.89)at24 hours and(3.97±0.76)at 48 hours.The patients in DAA group:the NRS pain score after operation was(3.82±0.97)at 24 hours and(3.59±0.66)at 48 hours.The NRS pain score at 24 and 48 hours after operation in PLA group was higher than that in DAA group,there were significant differences between the two groups(P<0.05).The preoperative Harris score of PLA group was(54.06±5.24)and(52.94±5.93)of DAA group,there was no significant between two groups(P>0.05).The PLA group was(59.5±3.76)and the DAA group was(64.21±3.85)in one week after operation;the PLA group was(71.71±4.50)and the DAA group was(76.09±3.42)in one month after operation,there were significant differences between the two groups(P<0.001).But there was no significant between two groups in six months after operation which the PLA group was(89.88±2.23)and the DAA group was(90.38±2.03).The Harris score of two groups at 1 week,1 month and 6 months after operation were better than those preoperative and the differences were significant(P<0.001).Both groups were followed up half a year after operation,and only one case of incision infection occurred in the PLA group.None of the remaining patients had complications such as deep vein thrombosis and dislocation.Conclusions:Patients with femoral head necrosis or hip osteoarthritis undergoing first-time unilateral total hip arthroplasty,the function of hip joint was improved significantly after operation compared with that before operation,compared with the posterolateral surgical approach,the direct anterolateral surgical approach has the advantages of small incision length,early ambulation after operation,and light pain,and the function of the patient’s hip joint recovered quickly in the early stage.With the passage of time,the difference of clinical efficacy between the two approaches has gradually narrowed,but the long-term efficacy comparison needs further observation and research.