Risk Factors And Prognosis Of Prefemoral Pain After Direct Anterior Approach Hip Arthroplasty

Aim: In our clinical work,we found that many patients had anterior thigh pain after Hip Arthroplasty in the Direct Anterior Approach,not incision pain,located in the middle part of the thigh,mostly in the anterolateral part,and the pain site was relatively limited,with pain points and obvious tenderness.We called this symptom as Prefemoral Pain.The purpose of this study was to investigate the incidence,related risk factors and prognosis of prefemoral pain after hip arthroplasty in the direct anterior approach in order to provide a reference for establishing clinical preventive strategies.Method: A total of 121 cases with complete data of hip arthroplasty undergoing direct anterior approach for femoral head necrosis,femoral neck fracture,hip osteoarthritis were collected for the first time in the Joint Surgery Department of our Hospital From September 2017 to October 2018.According to certain inclusion and exclusion criteria,A total of 91 patients undergoing primary direct anterior approach arthroplasty were included in this retrospective study.Postoperative symptoms of prefemoral pain were determined by the initial postoperative follow-up or telephone follow-up,by recording the pain,time,location and degree of pain in the thigh of the patient and observing the symptom relief of the patient.The degree of muscle injury was reflected by the change of serum creatine kinase before and after surgery.Six month after surgery,Harris score of hip joint was evaluated.Univariate analysis was used to analyze gender,age,diagnosis,left and right sides,duration of surgery,total hip or half hip arthroplasty and the difference of postoperative and preoperative serum creatine kinase with the relationship of prefemoral pain after direct anterior hip replacement.Then,multiple regression analysis was used to analyze the statistically significant or related factors to determine the risk factors for Prefemoral Pain.And whether there is any difference in hip Harris score in patients with pre-femoral pain and no pre-femoral pain at 1 month after operation.Result: Of the 121 patients collected,30 did not meet the inclusion criteria and met the criteria for a total of 91 people.In the 91 cases,50 cases had the symptoms of prefemoral pain,41 cases of non-prefemoral pain,and the incidence of prefemoral pain was 54.95%.58 males and 33 females;mean age 68.79 ± 12.17 years {range,40-91 years old}.A single variable analysis was performed on patients with symptoms of prefemoral pain,the difference of postoperative and preoperative serum creatine kinase and the duration of surgery are risk factors for pre-femoral pain,with statistical significance(P=0.027,and P=0.02).Multivariate analysis showed that the difference of postoperative and preoperative serum creatine kinase is the only independent risk factor for prefemoral pain(P = 0.047).Patients with no pre-femoral pain had an average Harris score of 94.37±4.41 in the sixth month after operation,and patients with prefemoral pain had an average Harris score of 94.93±3.75 in the sixth month after operation.The presence or absence of prefemoral pain had no significant effect on hip Harris score at six month after surgery(p=0.164).Conclusion:(1)Prefemoral pain is one of the common complications after DAA,and the incidence rate is 54.95%.(2)Muscle injury may be the main risk factor for the prefemoral pain after direct anterior hip arthroplasty.(3)During surgery,pay attention to soft tissue release and the use of the retractor to reduce the traction and damage to soft tissues such as muscles.(4)Whether there is post-femoral pain after surgery has no significant effect on postoperative hip function..