A Comparative Study Of Clinical Effects Of Direct Lateral Approach (DLA) And Posterior Approach (PA) After Primary Total Hip Arthroplasty

BackgroundTotal hip arthroplasty is one of the most successful and cost effective interventions in medicine that has revolutionized the treatment of various disorders related to hip joint.A number of surgical approaches to the hip exist,described in relation to the gluteus medius,each with unique advantages and disadvantages.The most commonly used approaches are direct lateral and posterior approach.Infection,Prosthesis loosening,dislocation,fracture,nerve injury,venous thromboembolism and abductor insufficiency are the common complications of total hip arthroplasty.Various clinical studies have already demonstrated the difference in complication rates,patient reported outcomes,and return to postoperative functions among the surgical approaches.This current study is done to analyze and compare the outcome of direct lateral approach(DLA)and posterior approach(PA)for primary Total Hip Arthroplasty(THA).ObjectiveThe purpose of this study is to analyze and compare the surgical technique and clinical effects between direct lateral approach(DLA)and posterior approach(PA)following primary total hip arthroplasty and find out the more suitable approach for the basis of clinical selection.MethodsWe conducted a retrospective study of 94 patients who underwent primary total hip arthroplasty between January 2015 and December 2017 by dividing into two groups group – I(DLA)and group – II(PA)and compared the parameters including the number of males and females,preoperative diagnosis,etc.,and evaluated whether there is any difference between the basic data such as gender,weight,and disease.We compared the length of incision,the amount of blood loss,the operation time,postoperative hemoglobin change,surgical site and deep infection.Differences in parameters of femoral fractures,deep vein thrombosis of the lower extremities,limb length,and dislocation rate were compared between the two surgical approaches.ResultExcellent results were observed in 76 out of 94 patients receiving total hip arthroplasty,during the first 3 months postoperative follow up period.1.There were no significant differences between the either groups with regard to patient demographics like age,sex,weight and the preoperative diagnosis(P >0.05).2.When comparing length of incison,significantly higher incision length was seen in direct lateral approach compared to posterior approach(P < 0.05).3.When comparing intraoperative blood loss and duration surgery,no significant difference was seen between the groups(P >0.05).4.When comparing postoperative outcomes like hemoglobin change and postoperative hospital stay,no significant difference were seen between these two groups(P >0.05).5.There were no significant differences in the postoperative outcomes like Superficial infection,deep infection,intraoperative femur fracture,Deep vein thrombosis,dislocation rate and limb length discrepancy between these two groups(P >0.05).ConclusionNo notable differences in outcome and complications were seen between these two approaches.Decision in favor of a single approach cannot be concluded based on the evidence of early surgical complications rates alone.Hence,surgeons should choose the approach in which they have more experience and ease.