Comparative Study Of Anterolateral And Posterolateral Approaches For Minimally Invasive Surgery Total Hip Arthroplasty

Objective To compare the clinical effect of anterolateral and posterolateral approaches for minimally invasive surgery total hip arthroplasty (MIS-THA) .Methods From January, 2008 to September 2009, 25 patients (28 hips) from Medical University of Fujian Shengli Hospital were performed with MIS THA using the anterolateral approach for the treatment of patients with hip disease (anterolateral approach group). For comparison, 20 patients (22 hips) were performed with MIS THA using the posterolateral approach at the same period (posterolateral approach group). Anterolateral approach group: 25 Male patients (21 hips), 7 Female patients (7 hips), age (54.3±12.3) years old, 7 cases (7 hips) of femoral neck fracture, 9 cases (12 hips) of femoral head avascular necrosis, 7 cases (7 hips) of primary osteoarthritis, 2 cases (2 hips) of coxotuber culosis. Harris hip scoring preoperative was (34.9±17.8). Posterolateral approach group: 9 Male patients (11 hips), 11 Female patients (11 hips). Age (49.0±17.9) years old, 4 cases (4 hips) of femoral neck fracture, 9 cases (11 hips) of femoral head avascular necrosis, 6 cases (7 hips) of primary osteoarthritis, 1 cases (1 hips) of congenital dislocation of hip. Harris hip scoring preoperative was (40.5±20.5). The length of incision, operative time, blood loss and transfusion were observed.Results①Two groups of incision length are both about 10 cm, and two groups of perioperative blood loss, blood volume and surgical time compared, the differences has no statistical significance (P>0.05).②Patients were stage I incision healed. Two groups of patients walked by crutches after operative, and walked by crutch in the postoperative 2 months, and disposable Po walking after 3 months of operation. Anterolateral approach group have one patient occurring backward dislocation of hip, and the other group has no complications.③Two groups of patients were followed up for 3 to 23 months, an average of 11 months. The Harris scorings of 3 months postoperation of anterolateral approach group were (84.5±4.7), which were excellent in 4 hips, good in 18 hips, good rate were 78.6%, and the Harris scorings of the other group were (84.7±4.9), which were excellent in 5 hips, good in 13 hips, good rate were 81.8%. Comparison between the two groups was no significant difference (P>0.05), with the same group of preoperative have statificant diference between (P<0.05) .④After 6 months follow-up the anterolateral group of 23 hips, the Harris scorings were (89.8±3.4), which were excellent in 13 hips, good in 10 hips, good rate were 100.0%, Posterolateral group up to 12 hips, the Harris scorings were (91.6±5.1), which were excellent in 8 hips, good in 4 hips, good rate were 100.0%. Comparison between the two groups was no significant difference (P>0.05).⑤The myodynamia of the hip abductor and functional gait of anterolateral approach group were worse than the other group.Conclusion The differences of clinical effect of the THA thtough the anterolateral and posterolateral mini-incision approaches are not statistical significant, but the myodynamia of the hip abductor and functional gait of anterolateral approach group were worse than the other group.