Comparison Of Functional And Gait Changes After Total Hip Arthroplasty Between Direct Anterior Approach And Posterolateral Approach

OBJECTIVE:This study compared the functional and gait changes of total hip arthroplasty with the direct anterior approach and the posterolateral approach in the lateral decubitus position by means of a prospective randomized controlled study.In order to better explore the advantages and value of the direct anterior approach.METHODS: A total of 91 patients with unilateral hip osteoarthritis who were treated in Qingdao Municipal Hospital from September 2019 to September 2021 were selected,25 patients who were lost to follow-up were excluded,and 66 patients who received complete follow-up were randomly divided into two groups.2 groups were DAA group(n=33,age: 66.2 ± 5.9 years old,gender: male/female=16/17,affected limb:left/right=18/15,BMI: 23.9±2.2kg/m2,bone Arthritis grade: Ⅲ/Ⅳ=19/14),total hip replacement by direct anterior approach;PLA group(n=33,age: 67.8± 6.8 years old,gender: male/female=15/18,patients with Limbs: left/right=16/17,BMI: 24.1±3.1kg/m2,osteoarthritis grade: Ⅲ/Ⅳ=20/13),total hip replacement was performed by posterolateral approach.The gait analysis technique was used to evaluate the changes of gait speed,cadence,and ipsilateral support phase of the two groups of patients before and 1,3,and 6months after the operation;the visual analogue scale and Harris hip function score were used to compare the pain level and Functional status.RESULTS :1)There was no significant difference in baseline data such as age,gender,hip osteoarthritis lesion grade and affected limb between the DAA group and the PLA group before surgery(P>0.05).And there was no significant difference in the pace,cadence,ipsilateral support phase percentage,Harris hip function score and VAS pain score between the two groups before surgery.2)The within-subject effect test was statistically significant(P<0.000),and the results showed that the pace,cadence,percentage of ipsilateral support and Harris hip function of patients in the DAA group and the PLA group at 1 month,3 months,and 6 months after the operation were compared with those before the operation(P < 0.05);VAS scores were all lower than before(P < 0.05);3)Comparison within groups:DAA group: Compared with preoperative,1,3,and 6 months after operation,pace,cadence,percentage of ipsilateral support phase and Harris score were significantly increased(P<0.000),and VAS score was significantly decreased(P<0.000);Compared with 1 month after operation,pace,cadence,percentage of ipsilateral support phase and Harris score were significantly increased(P<0.000),and VAS score was significantly decreased(P<0.000)at 3 months after operation.Compared with 1 month after operation,pace,cadence,percentage of ipsilateral bracing phase and Harris score were significantly increased(P<0.000),and VAS score was significantly decreased(P<0.000).There was no significant difference in statistical indicators(P>0.05).PLA group: Compared with preoperative,1,3,and 6 months after operation,pace,cadence,percentage of ipsilateral support phase and Harris score were significantly increased(P<0.000),and VAS score was significantly decreased(P<0.000);Compared with 1 month after operation,pace,cadence,percentage of ipsilateral support phase and Harris score were significantly increased(P<0.000),and VAS score was significantly decreased(P<0.000)at 3 months after operation.Compared with 1 month after operation,pace,cadence,percentage of ipsilateral bracing phase and Harris score were significantly increased(P<0.000),and VAS score was significantly decreased(P<0.000).The pace,cadence,percentage of ipsilateral bracing phase and Harris score were still improved(P<0.000),and the VAS score was still decreased(P<0.000),and the differences were statistically significant.4)Comparison between groups:1 month and 3 months after operation: the pace,cadence,percentage of ipsilateral bracing and Harris score in the DAA group were higher than those in the PLA group(P<0.000);the VAS pain score in the DAA group was lower than that in the PLA group(P<0.000).6 months after operation: There were no significant differences in pace,cadence,percentage of ipsilateral bracing phase,Harris score and VAS pain score between the two groups(P>0.05).Conclusion:1)Both surgical approaches can relieve pain and improve hip function in patients with total hip arthroplasty.2)Total hip arthroplasty with two surgical approaches can significantly improve the patient’s gait.3)Compared with the posterolateral approach,the direct anterior approach is more advantageous in early postoperative rehabilitation.