Early Results Of Total Hip Arthroplasty Via Direct Anterior Approach In Aged Patients

Objective To observe the early(12 weeks after surgery)results of direct anterior approach total hip arthroplasty in treatment for hip joint diseases in aged patients.Methods Included 76 aged patients(?80 years old)for primary total hip arthroplasty in Fujian Provincial Hospital as the research object.Patients were randomly divided into two groups approved by the ethics committee: direct anterior approach(DAA)total hip arthroplasty and posterolateral approach(PLA)total hip arthroplasty.In this study,the group of total hip arthroplasty via DAA was selected as the test group,and the group of total hip arthroplasty via conventional PLA was used as the control group,and 12 weeks after the surgery was selected as the end point of the study.The early efficacy of total hip arthroplasty was evaluated by the early indicators of DAA total hip arthroplasty and the PLA total hip arthroplasty.All patients were admitted between September 2015 and December 2017.Age,gender,Body Mass Index(BMI),underlying diseases,skin incision,operation time,intraoperative blood loss,assistant ambulation time,VAS on admission and first day after operation,Harris Hip Score(HHS)on admission and 6 weeks,12 weeks after operation,radiographic parameters of all components and complications during 12 weeks postoperatively were compared between two groups to assess early clinical outcomes for DAA total hip arthroplasty.36 patients(11 male and 25 female)with a mean age of 85.1 years old and a mean BMI of 24.5kg/m2 in DAA group.Underlying diseases include Type-2 Diabetes in 23 cases,15 cases of Hypertension,26 cases of Coronary Atherosclerotic Heart Disease(CAHD)and 32 cases of osteoporosis.And the hip joint diseases include 10 cases of avascular necrosis of the femoral head(-Period,Ficat and Arlet classification),14 patients with primary or secondary hip osteoarthritis and 12 cases of fracture of femoral neck.In addition,40 patients(17 male and 23 female)with a mean age of 84.5 years old and a mean BMI of 23.8kg/m2 in PLA group.Underlying diseases include 29 cases of Type-2 Diabetes,16 cases of Hypertension,31 cases of Coronary Atherosclerotic Heart Disease(CAHD)and 34 cases of osteoporosis.And the hip joint diseases include 10 cases of avascular necrosis of the femoral head(-Period,Ficat and Arlet classification),17 patients with primary or secondary hip osteoarthritis and 10 cases of fracture of femoral neck.There were no statistical difference in terms of age,gender,BMI,Underlying diseases,hip joint diseases,VAS and HHS on admission between these two groups.Results 1.Skin incision:The length of skin incision in DAA group was(9.8±0.7)cm with 1 case of superficial infection.While the length of skin incision in PLA group was(11.0±1.6)cm with 1 case of incision hematoma and 1 case of superficial infection.The difference of incision length between them was statistically significant(P<0.05).And there was no difference in complications of incision between them.2.Operation time:The operation time was(73.1±6.0)min in DAA group compare to(47.4±5.9)min in PLA group,and the difference was statistically significant.3.Intraoperative blood loss:Blood loss in DAA group was(191.4±49.3)ml compare to(172.3±47.5)ml in PLA group,and the difference between them was not significant.4.Postoperative Assistant ambulation activity time :Off-bed activity was regained in(2.2±0.8)d after surgery in DAA group earlier than(3.8±1.0)d in PLA group(P<0.05).5.VAS: The average postoperative pain score was 2.5 in DAA group better than 3.3 in PLA group(P<0.05).6.The postoperative hospitalization time of patients in DAA group was(5.9±1.5)d,and the PLA group was(7.6±1.3)d,with statistical difference.7.Harris Hip Score(HHS):Six weeks after surgery,Harris Hip Score was(74.5±6.8)in DAA group better than(69.7±10.6)in PLA group(P<0.05).12 weeks after surgery,Harris Hip Score was(81.7±4.9)in DAA group compare to(79.8±7.4)in PLA group,and there was no statistical differerce.8.During 12 weeks postoperatively,3 cases of complications occured in DAA group with sensory disturbances in anterolateral area of proximal thigh(LFCN).5 cases of complications occured in PLA group with 2 case of dislocation,2 cases of lower limb vein thrombosis and 1 case of sciatic nerve injury.Radiographic parameters(such as cup anteversion,cup inclination and stem alignment)of hip joint were obtained in 12 weeks after surgery,and defined cup anteversion(15±10)degree and cup inclination(40±10)degree as safe zone,and defined the angle(?3 degree)between femoral component and medullary canal as central position.Results showed that 35 cups(97%)of the DAA group had been implanted within the safe zone,and 33(85%)of cups in the PLA group were positioned within the safe zone.In addition,34 femoral components(94%)of the DAA group had been implanted within the central position,and 37(95%)of femoral components in the PLA group were positioned within the central position.There was no significant difference in cup safe-zone and femoral components positioning between the 2 groups.Conclusion Compare to conventional posterolateral approach,direct anterior approach,an alternative approach for total hip arthroplasty,with the advantage of minimally invasive,pain relief and fast function recovery,may lead to ambulation earlier and improve patients' living quality postoperatively,and it is worth spreading among aged people.