Clinical Comparative Study Of Direct Anterior Approach And Posterior Lateral Approach For Total Hip Arthroplasty

Objective: To compare the clinical efficacy of direct Anterior Approach(DAA)and Posterior lateral Approach(PLA)for total hip arthroplasty(THA),so as to provide a reference for the selection of surgical approach.Methods: The clinical data of 80 patients who underwent primary total hip arthroplasty from September 2016 to December 2017(The Second People’s Hospital of Pingnan County,Guangxi)were retrospectively analyzed.They were divided into two groups according to the surgical approach: DAA group of 40 patients,aged(58.6±5.2)years,PLA group of 40 patients,aged(62.4±4.9)years.The incision length,operation time,intraoperative blood loss,hospital stay,CK,CRP,ESR,IL-6,visual analogue scale(VAS),Harris score,imaging indicators(acetabular anteversion and abduction angle)and complications were compared between the two groups.Results: There were 1 case of nerve injury in DAA group and 1 case of dislocation in PLA group.All patients were followed up for 12 ～ 18 months,with an average of 15.2 months.The length of incision in the DAA group was shorter than that in the PLA group [(12.8±0.7)cm and(13.6±1.2)cm],the operation time was shorter than that in the PLA group[(69.7±10.2)min and(85.5±11.4)min],the intraoperative blood loss was lesser than that in the PLA group [(191.9±47.6)ml and(231.1±60.5)ml],and the postoperative hospital stay was shorter than that in the PLA group[(8.0±0.1)d and(8.5±0.3)d].CK in DAA group 1 and 7 days after surgery was lower than that in PLA group with statistically significant difference(P < 0.05),and serum CK level in the two groups 14 days after surgery had no statistically significant difference(P > 0.05).There was no significant difference in CRP,ESR and IL-6 between the two groups(P >0.05).The Harris hip function score of DAA group was better than that of the PLA group with statistically significant difference at the 6 weeks and3 months after surgery(P < 0.05),and there was no statistically significant difference between the two groups at 6 and 12 months after surgery.The acetabular anteversion angle in the DAA group was smaller than that in the PLA group [(14.2°±1.3°)and(15.1°±1.7°)],and the difference was statistically significant(P < 0.05),while the acetabular abduction angle in the DAA group was smaller than that in the PLA group [(40.1°±2.2°)and(41.2°±1.3°)],and the difference between the two groups was not statistically significant(P>0.05).Conclusion: Both DAA and PLA can achieve good clinical efficacy,but DAA THA has less muscle damage,less pain after surgery,shorter hospital stay,better early stability of hip and faster recovery of hip function.It has better early clinical efficiency.