A Comparative Study Of Hip Muscle Injury In Total Hip Arthroplasty With Minimally Invasive Anterior Approach And Anterolateral Approach

Objective:The minimally invasive direct anterior approach and conventional anterolateral approach were quantitatively analyzed and compared at the muscle injury level to evaluate the degree of hip muscle injury,the level of inflammation and the impact on gait.Methods:Eighty total hip replacements performed in our department between August 2019 and June 2020 will be enrolled and divided according to random number table into minimally invasive direct anterior approach(DAA group,n=40)and conventional anterolateral approach(ALA group,n=40).From clinical indicators such as operation time,incision length,intraoperative blood loss,and postoperative drainage;expression levels of inflammatory cytokines;Harris score,OHS score and VAS pain score were recorded at 1,3,and 12 months after surgery;Postoperative abductor muscle strength and angle;1,3,and 12 months postoperatively,magnetic resonance imaging showed the maximum width of the gluteus medius muscle abdomen and three-dimensional reconstruction of the volume of the gluteus medius muscle to compare the degree of muscle damage caused by the two approaches.The degree of muscle injury caused by the two approaches was compared in different aspects such as gait analysis between the two groups after operation.Results:There were no significant differences in age,gender,BMI and pathological pattern between the two groups(P > 0.05).The duration of operation in DAA group was significantly longer than that in ALA group,but the incision length was slightly smaller than that in ALA group,and the amount of intraoperative blood loss was less than that in ALA group.The difference between the two groups was statistically significant(P < 0.05).There were no significant differences in preoperative levels of CRP,ESR,CK,IL-6,IL-8,IFN and TNF-α in 2 groups(P > 0.05),and the levels of creatine kinase,IL-6 and IL-8 in DAA group were lower than those in ALA group(P <0.05).There was no significant difference in preoperative and postoperative Harris functional score between two groups(P > 0.05).OHS score of DAA group was better than ALA group 1month after surgery,and VAS pain score was better than ALA group,the difference between the two groups was statistically significant(P < 0.05),but there was no statistically significant difference 3 months after surgery(P > 0.05).One month after surgery,the abductor Angle and muscle strength of the affected limb in the anterior approach group were better than those in the anterolateral group,and the 6-minute walking distance was also better than that in the anterolateral group(P > 0.05).MRI showed that there was no significant difference in the muscular-abdominal width of the gluteus medius between the two groups before surgery(P >0.05),and the maximum muscular-abdominal width of the gluteus medius in the ALA group was significantly smaller than that in the DAA group 1 month after surgery,and the muscle atrophy rate was higher than DAA group(P < 0.05),but there was no statistical significance in the width difference between the two groups 3 months after surgery(P > 0.05).Gait analysis at 1 month after operation showed significant differences in stride length,cadence and pace between the two groups(P<0.05),but no significant differences in the maximum hip flexion angle,limb support phase and swing phase(P> 0.05).Conclusion:The direct anterior approach has lower postoperative gluteus medius atrophy rate,lighter muscle injury than the anterolateral approach,better gait analysis results,lower postoperative expression levels of muscle injury markers and inflammatory factors,and better protection of the function of gluteus medius and gluteus minimus in the early stage.However,there was no significant difference between the two approaches at three months of follow-up.