Comparative Study Of Direct Anterior Approach And Posterolateral Approache For Minimally Invasive Surgery Total Hip Arthroplasty

Objective To compare the clicinal effect of direct anterior approach andposterolateral approach for minimally invasive surgery total hip arthroplasty.Methods From January2011to September2011，the patients who need to de thesurgery of total hip arthriplasty and was in the Division2of orthopedics of FujianProvincial Hospital. Body mass index of all ones are less than30kg/m2.23patients(25hips) were performed with MIS-THA using the direct anterior approach (DAAgroup). For comparison,24patients (25hips) were performed with MIS-THA usingthe posterolateral approach（PLA group）at the same period.The DAA group：17Male patients (19hips),6Female patients (6hips)，average age59.3years old (41～73).10cases (11hips) of hip osteoarthritis;13cases (14hips) of the avascularnecrosis (Ⅲ-Ⅳperiod).BMI25.19kg/m2(19.1~29.1),preoperative Harris score39.4(17.9~57.9)，preoperative Hb128.2g/l (108~155). The PLA group：18Malepatients (19hips)，6Female patients (6hips),average age61.1years old（49～74）.12cases (12hips) of hip osteoarthritis；12cases (13hips) of the avascular necrosis(Ⅲ-Ⅳ period). BMI24.85kg/m2(18.7~29.9)，preoperative Harris score38.6(23.1~56.5)，preoperative Hb126.7g/l (97~155). The length of incision，operative time，blood loss and transfusion were observed.Results1. All the Patients were stage I incision healed.Both groups have nocomplications.2. The length of incision：DAA group9.3cm（7.9～11.2）and PLAgroup9.7cm(8.7～11.1). The differences has no statistical significance (P>0.05).The operative time：DAA group94.2min（77～109） and PLA group82.6min（67～107）. The differences has statistical significance（P＜0.05）. The blood loss： DAAgroup209.6ml（130～500）and PLA group385.9ml（280～530），The differences has statistical significance（P＜0.05）.The transfusion:DAA group1.3u（0～4）andPLA group2.9u（2～6）. The differences has obvious statistical significance（P＜0.05）.The Hb of postoperate: DAA group106.1g/l（88～135）and PLA group96.1g/l（68～128）.The differences has obvious statistical significance（P＜0.05）.TheHb drop:DAA group22.0g/l（2～54）and PLA group30.4g/l(12～63). Thedifferences has obvious statistical significance（P＜0.05）.3. The patients of bothgroup were followed up6months(6～12).The Harris scores of postoperate3months：DAA group89.6（79.1～97.2）and PLA group87.0（77.9～93.4）. Thedifferences has no statistical significance (P>0.05). good rate：DAA group92%andPLA group87.5%.he Harris scores of postoperate6months：DAA group92.0（87.4～99.1）and PLA group91.6（86.9～97.2）.The differences has no statisticalsignificance (P>0.05).The cases of both group get100%good tate.4.Themyodynamia of the hip extorsion and functional gait of posterolateral approachgroup were worse than the other group.Conclusion The total hip arthroplasty procedure through direct anterior approachhas a good advantage in function recovery and stability of joint comparing with theposterolateral approach at the round operation period...