The Follow-up Results Of Early Clinical Efficacy To The Total Hip Replacement By Direct Anterior Approach In The Lateral Decubitus Position

Background Total hip arthroplasty(THA)is an effective treatment for the end stage of hip disease.Traditional surgical approaches include the posterolateral approach,lateral approach,anterolateral approach,greater trochanteric osteotomy and super-path approach.With the development of more than 100 years,the technology of hip arthroplasty has become increasingly mature and minimally invasive surgical operations have been conducted.Direct anterior approach(DAA)conforms to the international rapid rehabilitation concept,and with the nerve and muscle anatomy clearance,DAA doesn't cut any nerve and muscle tissue.It is an ideal kind of minimally invasive surgery because of the less soft tissue damage,operational ease,small trauma,less blood loss,light postoperative pain,short hospital time and rapid recovery.In recent years,the supine DAA-THA has been developed rapidly,but those expensive surgical traction beds and special medical instruments limits its clinical application,so many scholars are looking for better surgical methods for DAA-THA.Objective This thesis is to evaluate the early clinical efficacy and to explore the clinical application value of minimally invasive for total hip arthroplasty(THA)by direct anterior approach(DAA)in the lateral decubitus position.Methods From July 2014 to March 2016,309 patients(367hips)underwent primary THAs,and they were performed by using a common surgical bed and a common surgical instrument for hip joint by the same surgeon via minimally invasive DAA in thelateral decubitus position in the Department of Orthopaedics,the Affiliated Anhui Provincial Hospital of Anhui Medical University.It was recorded and evaluated from the operation time,intraoperative and postoperative blood loss,related complications,visual analogue scale(VAS)score,Harris score and anteroposterior radiographic outcomes.Result A total of 281 patients(334 hips)(90.9%)were followed up.Follow-up duration was 12-21(average,15.3)months.Operative time was 58±8.2 min,and blood loss was 320±82.0 mL.4 cases(5 hips)occurred the femoral fracture,1 case(1 hip)occurred the hematoma,and 3 cases(3 hips)of superficial incision were infected.The lateral femoral cutaneous nerve injury was noted in 6 patients(6 hips),and the intermuscular venous thrombosis was noted in 1 patient.Deep venous thrombosis occurred in 1 patient(1 hip).The early dislocation occurred in 2 patients(2 hips),the tensor fascia tensor injury in 2 patients(2 hips).The orientatioin of the component was16.6°±4.8°anteversion and 43.5°±3.2°abduction.Compared with those preoperative ones,VAS score and Harris score were improved significantly.Conclusion It is an effective surgical approach to primary THA in the lateral decubitus position by DAA without special operation bed and traction equipment.It uses the traditional surgical instruments,and reduces the requirement for operation bed and surgical instruments.Through the nerve and muscle anatomy clearance,direct anterior approach(DAA)doesn't cut any nerve and muscle tissue.It is an ideal kind of minimally invasive surgery because of the less soft tissue damage,operational ease,small trauma,less blood loss,light postoperative pain,short hospital time and rapid recovery.However,it demands higher operation technology and the learning curve is longer.It is necessary to master the indications and contraindications of the operation and reduce the incidence of complications.Shortly after the DAA,there were relativelyhigh incidence of LFCN injury and fracture around the femoral prosthesis.With the accumulation of experience,and the improvement of the surgical methods and the medical instruments,the side effects of DAA-THA could be prevented by reducing complications.Because of the short follow-up time of this group,the long-term effect needs to be further studied.Based on the minimally invasive features of the surgical approach and a satisfactory short-term clinical effect,and the reduction of the postoperative pain,it is an advanced surgical approach at present and worthy of clinical promotion,as a result,the hospital stay time of the patients can be shortened,daily activities can be resumed early,and hospital costs can be reduced.