Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements

Abstract

Background and purpose — Several surgical approaches are used in primary total hip arthroplasty (THA). In this randomized controlled trial we compared gait, risk of fall, self-reported and clinical measurements between subjects after direct superior approach (DSA) versus posterolateral approach (PL) for THA. Patients and methods — Participants with DSA (n = 22; age 74 [SD 8.9]) and PL (n = 23; age 72 [7.7]) underwent gait analysis, risk of fall assessment and Timed Up and Go Test (TUG) before (PRE), 1 month (T1) and 3 months after (T3) surgery. Data on bleeding and surgical time was collected. Results — DSA resulted in longer surgical times (90 [14] vs. 77 [20] min) but lower blood loss (149 [66] vs. 225 [125] mL) than PL. DSA had lower risk of fall at T3 compared with T1 and higher TUG scores at T3 compared with T1 and PRE. PL improved balance at T3 compared with T1 and PRE. Spatiotemporal gait parameters improved over time for both DSA and PL with no inter-group differences, whereas DSA, regarding hip rotation range of motion, showed lower values at T3 and T1 compared with PRE and, furthermore, this group had lower values at T1 and T3 compared with PL. All foregoing comparisons are statistically signficant (p < 0.05) Interpretation — DSA showed longer surgical time and lower blood loss compared with PL and early improvements in TUG, spatiotemporal, and kinematic gait parameters, highlighting rapid muscle strength recovery.

Minimally Invasive Approaches for Total Hip Arthroplasty: Systematic Review

“…Существует модификация доступа SuperCap -direct superior (Stryker Inc., Kalamazoo, MI, USA) [21]. Обе техники используют доступ через верхний отдел капсулы сустава, а также специальные инструменты, предотвращающие повреждение коротких наружных ротаторов [20,22].…”

“…Суть данных хирургических доступов заключается в использовании интервала между m. gluteus minimus и m. piriformis с сохранением большей части наружных ротаторов и абдукторов бедренной кости [22]. Однако при использовании direct superior чаще всего происходит мобилизация сухожилий m. piriformis и m. gemelleus superior, остальные ротаторы защищены благодаря уменьшенному объему движения бедренной кости во время операции (40° приведения, 40° сгибания, 40° внутренней ротации) [23].…”

Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review

“…One study was excluded because it was a reliability study [ 30 ], and another one was excluded because it did not report post-surgical data on balance assessment [ 33 ]. At the end of the selection protocol, 41 articles were included and evaluated for systematic review; of these, 33 were assessment studies [ 11 , 13 , 34 – 64 ], while the remaining 8 were rehabilitation training studies [ 65 – 72 ]. A summary of the data extracted from each article is reported in Table 1 and Table 2 .…”

“…Static balance/postural stability was assessed in 20 studies [ 11 , 35 , 37 – 53 , 63 ]; dynamic balance was assessed in 10 studies [ 34 , 36 , 41 , 52 , 54 – 59 ]; proprioception in terms of sense of joint position was assessed in 2 studies [ 60 , 61 ]; clinical scales and other test batteries for balance assessment were used in 10 studies [ 11 , 13 , 40 , 41 , 52 , 59 , 60 , 62 – 64 ].…”

“…Timed-up-and-go was used in four studies. No differences have been reported between patients with unilateral and bilateral THA [ 11 ], patients undergoing either a direct superior approach or a posterolateral approach for surgery [ 64 ], as well as in patients undergoing large-diameter THA or HR. [ 41 ] However, THA patients were significantly slower than healthy age-matched controls [ 41 , 62 ].…”