Evaluation of the association between the conjoined tendon-preserving posterior approach in total hip arthroplasty and early postoperative functional recovery: a retrospective cross-sectional study.

Abstract

Background: This study aimed to assess the impact of the conjoined tendon-preserving posterior (CPP) approach in total hip arthroplasty (THA) in reducing the number of days to independent walking and early postoperative clinical outcomes compared with conventional posterolateral (PL) and piriformis muscle-sparing PL (P-PL) approaches. Methods: In total, 91 patients who underwent robotic arm-assisted THA using the PL, P-PL, or CPP approaches were included in this study. Clinical outcomes, including the modified Harris Hip Score (mHHS) and Japanese Orthopaedic Association (JOA) hip score, were evaluated preoperatively and at 3 and 6 months postoperatively. Furthermore, the number of days to independent walking with two canes after surgery (T1) and the number of days to independent walking with a single cane after surgery (T2) were compared among the three approaches. Results: Following the PL approach, T1 and T2 were 11.1 and 24.6 days, respectively. Following the P-PL approach, T1 and T2 were 9.1 and 24.5 days, respectively. Following the CPP approach, T1 and T2 were 5.3 and 15.6 days, respectively. In each period of walking independence, CPP was significantly shorter than the others (T1, P <0.001 and T2, P <0.001). Clinical outcomes, including walking ability and activities of daily living, consistently favored the CPP approach for up to 6 months postoperatively. Intraoperative complications were observed in the PL and P-PL approaches. The CPP approach showed better results for postoperative pain at 3 months postoperatively. Conclusions: The CPP approach in THA significantly reduced the number of days to independent walking and exhibited superior early postoperative clinical outcomes compared to PL and P-PL approaches.