A Comparison Of The Modified Hardinge Approach Versus The Traditional Hardinge Approach In The THA

Backgroundsince DOCTER BERGER operated the first mini-invasive total hip arthroplasty,themini-invasive approachs began to be widely used in the THA.As a kind of lateralapproachs, the modified Hardinge approach inproved by Berger、Sculco、and Chung hasits advantage of minimal invasion、nice looking and better short-term postoperativeclinical outcome.In the clinical follow-up,the Harris hip score is used widelydomestically.But the harris hip score has its weakness including less longitudinalsensitivity,sample loss due to bad follow-up,clinician bias for the complex calculation ofjoint function,the lack of taking age/co-morbidities into account and some measurequantifier difficult understood such as street for our domestical patients.The ideal THAoutcome measure should contains:the coverage of generic component,clear andconcis,the consideration of age/co-morbidities,walking-aid use and easyfollow-up,et.Thus the international orthopedics recommend a combination measurementwhich is including a hip-component outcome and a disease-specific score.Using theoxford hip score and WOMAC score(The Western Ontario and McMaster UniversitiesArthritis Index，WOMAC) are Accurate and convenient for THA outcome.ObjectiveThe purpose of this study is to measure the clinical THA outcome between thetraditional Hardinge approach and the minimal invasion via the modified approach inthe short and middle term, to provide a basis for clinical application. Methodsthe random prospective trial of80patients awaiting for total hipreplacement,divided into two groups which is applied for traditional Hardinge approachwhile the other is used mini-invasive modified Hardinge approach. All patients areexcluded the contraindication,and after routine pre-op examination operated all by anexperienced doctor and a same operation team.Before operation,review the x-ray andanalysis the prosthesis size of implant.preventive use of antibiotics and the bloodcontrol in the anesthesia(BP control,110/60mmHg).the implant prosthesis isbio-prosthesis of LINK company.record the length of incision,intraoperative andpostoperative blood loss,postoperative pain scores(using visual analog scale,VAS).allpatients are strictly followed up by one staff in1st month,3rd month,6th month,12thmonth and24th month postoperatively.take all data into statistical comparison and drawconclusion.ResultsThe group of mini-invasive modified Hardinge approach prevail in the incisionlength,blood loss,pain,short-term outcome statistically while no difference in the longterm.ConclusionsThe minimal incision via MHA has the advantage in minimal invasion、postoperativepain and short-term outcome than traditional Hardinge approach. While in thelong-term outcome there is no significantly difference between the two approaches.MHA is an effective and practical approach in THA and should obey the surgicalindications strictly.This minimal invasion approach only applies to patients with slimbody and a good bone conditions, no need for bone cement, etc. for such as hiprevision surgery,and those which need a sufficient surgical exposion, the approach isforbidden.