| Objective:①To compare the short-term intra-operative and postoperative clinical outcomes of direct anterior approach total hip arthroplasty with direct lateral approach total hip arthroplasty and posterolateral approach total hip arthroplasty respectively.②Comparing the surgical data of DAA between the first 30 cases and the 31-50 cases,and plotting the learning curve of DAA.Methods:Collected a total of 110 cases from December 2015 to January 2017 in the first Department of Orthopedics of Fuzhou Second Hospital Affiliated to Xiamen University.30 direct lateral approach total hip arthroplasty cases(69.33 ± 6.67 years)and 30 posterolateral approach total hip arthroplasty cases(67.33 ± 6.32 years)and the NO.1～30 direct anterior approach total hip arthroplasty cases(70.50±8.15 years),variables included intra-operative blood loss,surgery time and incision length,as well as preoperative and postoperative Harris hip scores,postoperative VAS score and hospital stay.NO.31-50 direct anterior approach total hip arthroplasty cases(71.33 ±4.49 years)were obtained,variables included intra-operative blood loss,surgery time and incision length.Results:The operation time in DAA1～30 group was significantly longer than DLA group(P<0.05)and PLA group(P<0.01);Intraoperative blood loss of DAA1～30 group was significantly more than group DLA(P<0.01),and made no difference to PLA group(P>0.05);On length of incision,DAA1～30 group was not different to DLA group(P>0.05)and PLA group(P>0.05);The preoperative Harris score had no significant difference among three groups(P>0.05),however,postoperative Harris score of DAA1～30 group was significantly higher than that of DLA group(P<0.01)and PLA group(P<0.05),thus DAA1～30 group had greater postoperative hip joint function improvement;DAA1～30 group postoperative VAS pain score was significantly lower than that of DLA group(P<0.01)and PLA group(P<0.01).There was a statistically significant difference between DAA1～30 group(9.77 + 0.86cm)and group DAA31～50(8.04 + 0.14cm)when it came to the length of incision(P<0.01);The operation time of DAA1～30 group(102 + 25.52min)and that of DAA31～50 group(74.77 + 24.87min)were significant different(P<0.01);The intraoperative blood loss of DAA1～30 group(405 + 68.42mL)and DAA31～50 group(306.30 + 30.32mL)were significant different(P<0.01).CUSUM test showed that since 16th case of direct anterior approach total hip replacement,the surgery failure rate began to decline from the inflection point,CUSUM learning curve crossed the surgery failure rate lowest limit line(H0)in the 33th case and the surgery failure rate was acceptable after the 33th case,the CUSUM learning curve did not cross the unacceptable surgery failure rate limit line(H1)at any point.Conclusion:Relatively satisfied hip joint function and less pain postoperatively can be achieved after direct anterior approach total hip arthroplasty,while comparing to the direct lateral approach or the posterolateral approach total hip arthroplasty in the aspect of minimally invasive,it had significantly inferior surgical outcome on intra-operative blood loss and surgery time.In addition,the surgical technique of direct anterior approach total hip arthroplasty was also affected by the learning curve,it required at least 33 cases to harvest sufficiently low complication rate. |
