| Purpose: In clinical work,we have found that some patients will have an early complication of pain in the anterior lateral thigh after the direct anterior approach(DAA)Total Hip Arthroplasty(THA).The location and manifestation of the pain of this complication are different from other complications that can cause pain.This early pain will reduce the patient’s satisfaction with the operation and affect the patient’s compliance with the pre-functional rehabilitation exercise.This complication is rarely reported in the literature at home and abroad,and there is no specific name,so we will call it ant-femoral pain for the time being.This study is to analyze and explore the related risk factors and prognosis of ant-femoral pain after direct anterior total hip arthroplasty,and provide a basis for related preventive measures.Methods: A retrospective analysis of patients who were hospitalized in the Department of Joint Surgery of the Second Affiliated Hospital of Dalian Medical University from November 2018 to September 2020 due to hip osteoarthritis and femoral head necrosis who underwent direct anterior total hip arthroplasty by the same surgeon data,a total of61 cases were collected,according to the inclusion criteria Patients were screened with exclusion criteria,and a total of 47 eligible patients were screened.The 47 patients were recorded whether they had ant-femoral pain complication and the time,pain range and degree after the operation,and divided the 47 patients into the thigh pain group and the no thigh pain group according to whether they were complicated with thigh pain.Collect all patients’ age,gender,disease diagnosis,left and right side of the affected limb,operation time,lateral femoral cutaneous nerve(Lateral Femoral Cutaneous Nerve,LFCN)injury,muscle injury and other data.The degree of muscle damage was measured by ultrasound in the corresponding area of muscles(lateral femoris,intermediary femoris,rectus femoris,tensor fascia lata)before and after the thickness difference and serum creatine kinase(CK)before and after the operation.The difference is reflected.Through telephone follow-up and outpatient follow-up follow-up,the Harris scores of the hip joint in the first and second months after the operation were collected,and the patients were asked whether the symptoms of ant-femoral pain disappeared or not.If they disappeared,the specific time when the symptoms disappeared was asked.The age,gender,disease diagnosis,left and right side of the affected limb,operation time,LFCN injury,preoperative and postoperative CK difference,and the preoperative and postoperative thickness difference of the muscles in the corresponding area and the direct anterior approach total hip A univariate analysis was performed on the relationship between antfemoral pain after replacement surgery,and then a multivariate binary logistic regression analysis was performed on the factors with significant differences in the univariate analysis,and the relevant risk factors for postoperative thigh pain were obtained.Then analyze whether the occurrence of postoperative ant-femoral pain is different from the Harris score in the first and second months after surgery.Results: Among the 47 patients included in the study,the average age was 60.94±10.955 years,21 males and 26 females.There were 26 patients with anterior thigh pain complications and 21 patients without anterior thigh pain complications.The incidence of pre-thigh pain was 55.3%.In the group with ant-femoral pain,7 cases had pain symptoms on the day of surgery,19 cases had pain symptoms on the first day after surgery,and the patient’s VAS score was 4.15±1.255;5 cases had LFCN injury,without There were 21 cases of LFCN injury;16 cases of symptoms were relieved or disappeared within1 month after operation,7 cases were relieved or disappeared within 2 months after operation,and 2 cases were still present at 3 months after operation In 1 case,the symptoms still existed six months after the operation;5 cases were treated with local sealing.In the univariate analysis of the risk factors for ant-femoral pain after DAA-THA,the left and right sides of the affected limb,the difference in CK before and after the operation,the difference in the thickness of the lateral femoral muscle before and after the operation,and the middle of the thigh before and after the operation The difference in muscle thickness and the difference in tensor fascia lata muscle thickness before and after surgery are risk factors for postoperative ant-femoral pain symptoms,which have significant statistical significance(P<0.05).Binary logistics regression analysis of statistically significant related factors in univariate analysis showed that the preoperative and postoperative CK difference and the preoperative and postoperative lateral femoral muscle thickness difference were risk factors for postoperative ant-femoral pain symptoms.The analysis of the impact of whether postoperative anterior thigh pain has on the early postoperative function of the hip joint showed that whether postoperative anterior thigh pain has no effect on the Harris score of the hip joint in the first and second months after surgery(P value is 0.353,respectively)And 0.813).Conclusion:(1)Ant-femoral pain is one of the common early complications after direct anterior total hip arthroplasty,with an incidence rate of 55.3%;(2)The risk factor for Antfemoral pain is muscle injury,of which the tensor fascia lata and lateral femoris muscles are the main ones;(3)Ant-femoral pain will reduce the patient’s satisfaction with the operation and affect their compliance with the pre-functional rehabilitation exercise,but whether the postoperative ant-femoral pain will affect the early function of the hip joint Rehabilitation has no significant impact;(4)During the operation,reasonable use of auxiliary equipment such as bone sled and bending hook,gently change the patient’s posture,try to avoid damage to the muscles of the anterolateral thigh area,which may prevent the appearance of ant-femoral pain. |
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