Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: Perioperative findings

被引：145

作者：

Alecci V. ^{[1
]}

Valente M. ^{[1
]}

Crucil M. ^{[1
]}

Minerva M. ^{[1
]}

Pellegrino C.-M. ^{[2
]}

Sabbadini D.D. ^{[2
]}

机构：

[1] Department of Orthopaedics and Traumatology, San Polo Hospital, 34074 Monfalcone, GO, via Galvani

[2] Anesthesia and Intensive Care Unit, San Polo Hospital, 34074 Monfalcone, GO, via Galvani

来源：

Journal of Orthopaedics and Traumatology | 2011年 / 12卷 / 3期

关键词：

Direct anterior approach; Hip arthroplasty; Minimally invasive surgery; Surgical technique;

D O I：

10.1007/s10195-011-0144-0

中图分类号：

学科分类号：

摘要：

Background Given the increasing demand for tissuesparing surgery, the surgical approach is the subject of lively debate in total hip replacement. The aim of this paper is to compare the efficacy of the minimally invasive direct anterior approach and the standard lateral approach to total hip replacement surgery by observing intra- and perioperative outcomes. Materials and methods The authors conducted a retrospective study on a group of 419 consecutive patients undergoing total hip replacement for coxarthrosis. The patients were divided into a first group (A) of 198 patients who had surgery with the standard lateral approach, and a second control group (B) of 221 patients who had the same procedure via the minimally invasive direct anterior approach. Assessment of the two groups considered the following perioperative parameters: length of the surgical procedure, intraoperative complications, intra- and postoperative blood loss, postoperative pain, postoperative nausea and vomiting, length of stay, and type of discharge. Results The two groups were homogeneous when compared in relation to mean age, sex and body weight. The minimally invasive direct anterior approach was performed within an acceptable time (89 ± 19 min vs. 81 ± 15 min) and with modest blood loss (3.1 ± 0.9 g/dL vs. 3,5 ± 1 g/dL). Patients experienced less pain (1.4 ± 1.5 NRS score vs. 2.5 ± 2 NRS score), and PONV affected only 5% versus 10% of cases. Times to discharge were shorter (7 ± 2 days vs. 10 ± 3.5 days), and 58.4% versus 11.6% of patients were discharged to home. Conclusions In our study, patients treated with a minimally invasive direct anterior approach had a better perioperative outcome than patients treated with the lateral approach. The longer time of surgery for the minimally invasive direct anterior approach may be attributed to the learning curve. Further studies are necessary to investigate the advantages of a minimally invasive direct anterior approach in terms of clinical results in the short and long run. © The Author(s) 2011.

引用

页码：123 / 129

页数：6

共 18 条

[1]

Mayr E., Nogler M., Benedetti M.G., Et al., A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: A gait analysis study, Clin Biomech (Bristol, Avon), 24, pp. 812-818, (2009)

[2]

Outcomes following the single-incision anterior approach to total hip arthroplasty: A multicenter observational study, Orthop Clin North Am, 40, pp. 329-342, (2009)

[3]

Kennon R.E., Keggi J.M., Wetmore R.S., Zatorski L.E., Huo M.H., Keggi K.J., Total hip arthroplasty through a minimally invasive anterior surgical approach, Journal of Bone and Joint Surgery - Series A, 85, SUPPL. 4, pp. 39-48, (2003)

[4]

Matta J.M., Shahrdar C., Ferguson T., Single-incision anterior approach for total hip arthroplasty on an orthopaedic table, Clinical Orthopaedics and Related Research, 441, pp. 115-124, (2005)

[5]

Rachbauer F., Krismer M., Minimalinvasive huftendoprothetik uber den anterioren zugang, Oper Orthop Traumatol, 20, pp. 239-251, (2008)

[6]

Kehlet H., Holte K., Effect of postoperative analgesia on surgical outcome, British Journal of Anaesthesia, 87, 1, pp. 62-72, (2001)

[7]

De Verteuil R., Imamura M., Zhu S., Et al., A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip, Health Technol Assess, 12, (2008)

[8]

Lovell T.P., Single-incision direct anterior approach for total hip arthroplasty using a standard operating table, J Arthroplasty, 23, pp. 64-68, (2008)

[9]

Bal B.S., Haltom D., Aleto T., Barrett M., Early complications of primary total hip replacement performed with a two-incision minimally invasive technique, Journal of Bone and Joint Surgery - Series A, 87, 11, pp. 2432-2438, (2005)

[10]

Meneghini R.M., Pagnano M.W., Trousdale R.T., Hozack W.J., Muscle damage during MIS total hip arthroplasty: Smith-peterson versus posterior approach, Clinical Orthopaedics and Related Research, 453, pp. 293-298, (2006)

← 1 2 →