Analysis Of Gait After Total Hip Arthroplasty Through Different Approaches

Objective: By making a comparison of gait parameters at different time stages after direct anterior approach and lateral approach total hip arthroplasty,we analyzed which surgical approach was more favorable for postoperative gait function recovery in terms of postoperative gait parameters.Methods:86 participants were prospectively enrolled to undergo a unilateral THA through either a direct anterior approach(DAA)or lateral approach(LA)randomly from October 2019 to January 2021.There were 44 cases in DAA group and 42 cases in LA group respectively.The same rehabilitation training method was used in both groups at the same time after surgery.The Korean Cyber Medic GAT system was used to measure and collect the gait parameters of gait length,gait speed,gait frequency,proportion of phase of unilateral support of the suffered limb to the gait duration and symmetry of unilateral support of the two teams at preoperative,1 month,3 months and 6 months postoperatively,and statistical analysis was performed to clarify the differences between them.Results:86 cases were followed up for more than 6 months.The preoperative gender,age,affected limb,body mass index and complications of the two groups were not statistically significant(P > 0.05),which confirmed that the two groups were comparable.Two-way Repeated Measure Anova was performed on the step length,gait speed,gait frequency,the percentage of affected single limb support phase in gait cycle and the symmetry of single limb support in the two groups at different times.Through the intra subject effect test,the results showed that with the extension of time,the step length,gait speed,gait frequency,single-support phase of the affected limb as a percentage of the gait cycle and single-extremity support symmetry of all patients gradually improved with time(P < 0.05);The inter subject effect test confirmed that there were significant differences in gait parameters between the two groups(P <0.05).DAA group was significantly better than LA group;The interaction between the two groups was confirmed by a statistical discussion of the statistical analysis of the effect of subgroup and time(F =222.795,P <0.001,F =301.756,P <0.001,F=71.475,P <0.001,F=213.914,P <0.001,F =251.077,P <0.001).It was confirmed that the gait parameters of the two groups had different trends with time,so a simple effect analysis was needed.The differences of the same surgical approach at different time points and different surgical approaches at the same time point were investigated.The statistical results of the intra-group comparison of patients in the DAA group showed that the gait parameters at all postoperative time points were significantly improved compared with those before surgery,and all gait indicators were remarkably better at 3 months postoperatively than at 1 month postoperatively(P<0.05),and no statistically significant differences were found between the gait parameters at 6months and 3 months after surgery(P>0.05),indicating that 3 months after surgery was the best period for the improvement of gait parameters in the DAA group.The statistical results of intra-group comparison of patients in the LA group showed that all gait parameters improved significantly at all postoperative time points compared with those before surgery,and all gait parameters were significantly better at 3 months after surgery than at 1 month after surgery,and all gait parameters were significantly better at 6 months after surgery than at 3 months after surgery(P<0.05),confirming that gait parameters in the LA group improved gradually at 6 months after surgery;the results of inter-group comparison at different time points showed that the gait parameters of patients in the preoperative group were significantly better than those at1 month after surgery.Comparison between groups at different time points showed that there was no obvious distinction in each gait index between the two sets of patients pre-operatively(P>0.05),and each gait index was dramatically better in the DAA group than in the LA group at 1 month and 3 months postoperatively(P<0.05),and there was no statutory variation in each gait index between the two subjects at 6months postoperatively(P>0.05),demonstrating that there was no large difference in gait index between the two sections at 6 months postoperatively.Conclusion: Both surgical approaches significantly improved the gait of patients,and the major improvement in gait parameters in the DAA group was focused on the first3 months postoperatively,while the gait parameters in the LA group improved within6 months,indicating that the DAA group had a marked early advantage in postoperative gait recovery,and further follow-up studies are needed to study the long-term gait parameters of patients in both groups.