A Prospective Study of Minimally Invasive Anterolateral Approach in the Supine Position Versus Direct Anterior Approach Total Hip Arthroplasty. Early results

Abstract

Background Both of Minimally Anterolateral Approach (MIS-ALA) and Direct Anterior Approach (DAA) have been reported to be advantageous in Total Hip Arthroplasty (THA), reducing postoperative pain and permit quicker rehabilitation by preserving muscle insertions. There is little literature concern the difference of them. Therefore, we conducted a prospective study to assess the difference of early clinical outcomes, radiological, and patient-reported outcomes between the two minimally invasive approaches of MIS-ALA and DAA. Methods The subjects were 98 patients, with 50 in the MIS-ALA group and 48 in the DAA group. Patients with complete data were evaluated preoperatively and postoperatively at 2, 6 and 12 weeks. Clinical measurements including the ability to climb stairs and walk, a 6 minutes walk test (6MWT) distances, the Forgotten Joint Scale (FJS-12), Japanese Orthopaedic Association (JOA) Hip scores, radiological evaluation, and complications data were collected. Results There were no significant differences in clinical outcomes and implant alignments between MIS-ALA and DAA groups. In regards to patient-reported outcomes, the FJS-12 was significantly higher in the MIS-ALA group than in the group DAA at 2 and 6 weeks postoperatively. However, there was no significant difference in the FJS-12 between the two groups at 12 weeks after surgery. The differences also included shorter operative times, less blood loss, lower Hb drop, and fewer blood transfusions in the MIS-ALA group. The incidence of lateral femoral cutaneous nerve (LFCN) neuropraxia after surgery was 7 (14.6%) in the DAA group, zero occurred in the MIS-ALA group. One fracture was identified with each group and managed conservatively. Conclusion Both MIS-ALA and DAA approaches yielded excellent and similar early clinical outcomes. However, better patient-reported outcomes could be achieved by MIS-ALA THA. The MIS-ALA was a safer approach for shorter operative times, less blood loss, lower Hb drop, fewer blood transfusions and LFCN neuropraxia compared with DAA. A longer follow-up is needed to examine differences between these procedures.

Comparative evaluation of the clinical efffcacy and safety of surgical approaches in total hip arthroplasty

“…В нескольких работах было показано, что при выполнении ЭТС с использованием ППД пациенты в дальнейшем легче осуществляют подъем по лестнице, по сравнению с группой больных, которым вмешательство выполнялось с использованием ЗД [57]. Также продемонстрировано, что применение ППД ассоциировано с улучшением параметров походки пациентов после операции [21,58].…”