Early Effect Of Direct Anterior Approach And Modified Hardinge Approach On Total Hip Arthroplasty

Objective:The study aimed to compare the early effects of direct anterior approach and modified Hardinge approach on primary total hip arthroplasty in hip lesions and femoral neck fracture.Methods:The data of 77 patients undergoing primary total hip arthroplasty from September 2016 to June 2018 were analyzed retrospectively.There were 43 cases of hip diseases and 34 cases of femoral neck fracture.According to the operation group,40 patients underwent total hip arthroplasty through direct anterior approach(DAA),including 22 cases of hip joint lesions and 18 cases of femoral neck fracture;37 cases were underwent total hip arthroplasty through modified Hardinge approach,including 21 cases of hip joint lesions and 16 cases of femoral neck fracture.The operative time,incision length,intraoperative blood loss,postoperative drainage and total dominant blood loss were compared between the two groups.The differences of hemoglobin(Hb),hematocrit(HCT),erythrocyte sedimentation rate(ESR),creatine kinase(CK),C-reactive protein(CRP)and visual analogue score of pain(VAS)before operation and on the 1st,3rd and 5th day after operation were also compared.Finally,data regarding the Harris function score of hip joint,postoperative imaging indexes and postoperative complications before and after operation were compared.Results:1.For the patients with hip lesions and femoral neck fractures:? The THA through DAA approach were less than those of modified Hardinge approach in terms of incision length,intraoperative blood loss,postoperative drainage and total dominant blood loss(P<0.05),but in term of operation time,the THA through DAA approach were longer than those of modified Hardinge approach(P<0.05).?After operation,ESR,CRP and VS A in the direct-anterior-approach groups were significantly lower than those in the modified-Hardinge-approach groups(P<0.05).?In the 3 months after operation,the Harris score of hip joint in the direct-anterior-approach groups were better than those in the modified-Hardinge-approach groups,(P<0.05),but there was no significant difference in functional recovery between the two groups at 6 months after operation(P>0.05).?With regarding to Hb and HCT,no differences were found between the direct-anterior-approach groups and modified-Hardinge-approach groups on the 1st,3rd and 5th day after operation(P>0.05).?Postoperative imaging indexes were comparabled between two groups,there were no significant differences(P>0.05).2.For the patients with hip lesions,the postoperative CK level of the direct-anterior-approach group was higher than that of the modified-Hardinge-approach group(P<0.05).For patients with femoral neck fracture,the CK level of direct-anterior-approach group after operation was lower than that of modified-Hardinge-approach group(P<0.05).3.For the complications of total hip arthroplasty,there were two cases of lateral femoral cutaneous nerve injury in patients with hip lesions via DAA approach.By the last follow-up,the patients recovered completely.There was 1 case with hip disease of groin pain in the modified-Hardinge-approach group,and the symptom was relieved after 3 weeks.There were no early complications in patients with femoral neck fracture.All surgical incisions were expected to heal and there was no dislocation of the joint.Conclusion:For the patients with primary total hip arthroplasty,whether THA through DAA approach or modified Hardinge approach can achieve good functional recovery.In the early follow-up after operation,the direct-anterior-approach groups had advantages over the modified-Hardinge-approach groups in pain and functional recovery.But after 6 months,there was no significant difference in functional recovery between the two methods.For patients with hip lesions,THA through DAA approach has no significant advantage over modified Hardinge approach in the degree of muscle injury,but THA through DAA approach has obvious advantage in patients with femoral neck fracture in the degree of muscle injury.For joint surgeons in the learning curve of total hip arthroplasty via direct anterior approach,THA through DAA approach was preferred for patients with femoral neck fracture.It can bring better clinical benefits to patients.