Comparison of short-term effectiveness of staged bilateral total hip arthroplasty via different approaches_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Yanfeng , LI Hongjun ,  LIU Youwen , YANG Yuxia , LI Wuyin , CAI Hongmin

Department of Hip Injury, Luoyang Orthopedic Traumatological Hospital of Henan Province (Henan Province Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;

Corresponding author：

LIU Youwen, Email: liuyouwen534@sina.com

Keywords：

Total hip arthroplasty; direct anterior approach; direct lateral approach; short-term effectiveness

DOI：

10.7507/1002-1892.201705078

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Objective To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Methods Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups. Results All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group (P<0.05). The operation time was significantly longer in DAA group than in DLA group (P<0.05). There was no significant difference in acetabular anteversion angle between 2 groups (t=1.122, P=0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference (χ²=0.869, P=0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group (P<0.05); there was no significant difference at 18 months after operation between 2 groups (P>0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation (P<0.05); there was no significant difference at 4 and 8 weeks between 2 groups (P>0.05). The prosthesis did not loosen and sink during the follow-up. Conclusion Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.

Citation： TANG Yanfeng, LI Hongjun, LIU Youwen, YANG Yuxia, LI Wuyin, CAI Hongmin. Comparison of short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1300-1304. doi: 10.7507/1002-1892.201705078 Copy

1.	Ibn Yacoub Y, Amine B, Laatiris A, et al. Gender and disease features in Moroccan patients with ankylosing spondylitis. Clin Rheumatol, 2012, 31(2): 293-297.
2.	Amstutz HC, Su EP, Le Duff MA MJ, et al. Are there benefits to one- versus two-stage procedures in bilateral hip resurfacing? Clin Orthop Relat Res, 2011, 469(6): 1627-1634.
3.	李毓灵, 傅峥, 张健. 同期与分期行双侧全髋关节置换术的短期临床结果比较. 中华创伤杂志, 2013, 29(7): 637-640.
4.	项鹏, 余斌, 熊军, 等. 双侧髋关节同期与分期置换临床疗效与安全性的 Meta 分析. 中国矫形外科杂志, 2012, 20(4): 289-294.
5.	Johnston LR, Clift BA, Abboud RJ. Bilateral simulataneous hip replacement versus bilateral sequential hip replacement. A 7-year data review. Orthop Nurs, 2011, 30(2): 119-123.
6.	Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orhop Surg, 2014, 22(9): 595-603.
7.	杨玉霞, 杨桦, 范茹, 等. 直接前入路微创全髋关节置换术的围手术期护理. 中医正骨, 2016, 28(3): 77-80.
8.	李文龙, 范亚楠, 张蕾蕾, 等. 微创全髋关节置换术直接前侧入路与外侧小切口入路的对比研究. 中医正骨, 2016, 28(3): 24-29.
9.	桑伟林, 朱力波, 陆海明, 等. 直接前入路与后外侧入路全髋关节置换术的对比研究. 中华关节外科杂志 (电子版), 2015, 9(5): 584-588.
10.	CHEN Y, Kang PD, Pei FX. Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty. A Systematic Review and Meta-Analysis (PRISMA). Medicine (Baltimore), 2015, 94(50): e2125.
11.	York PJ, Smarck CT, Judet T, et al. Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop, 2016, 40(10): 2041-2048.
12.	Meemans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J, 2017, 99-B(6): 732-740.
13.	Grob K, Manestar M, Ackland T, et al. Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint: An Anatomical Study. J Bone Joint Srug (Am), 2015, 97(17): 1426-1431.
14.	Rudin D, Manestar M, Ullrich O, et al. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. J Bone Joint Srug (Am), 2016, 98(7): 561-567.
15.	Watts CD, Houdek MT, Wanger ER, et al. High Risk of Wound Complications Following Direct Anterior Total Hip Arthroplasty in Obese Patients. J Arthroplasty, 2015, 30(12): 2296-2298.
16.	Purcell RL, Parks NL, Gargiulo JM, et al. Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty. J Arthroplasty, 2016, 31(9 Suppl): 162-165.
17.	Russo MW, Macdonell JR, Paulus MC, et al. Increased Complications in Obese Patients Undergoing Direct Anterior Total Hip Arthroplasty. J Arthroplasty, 2015, 30(8): 1384-1390.

1. Ibn Yacoub Y, Amine B, Laatiris A, et al. Gender and disease features in Moroccan patients with ankylosing spondylitis. Clin Rheumatol, 2012, 31(2): 293-297.
2. Amstutz HC, Su EP, Le Duff MA MJ, et al. Are there benefits to one- versus two-stage procedures in bilateral hip resurfacing? Clin Orthop Relat Res, 2011, 469(6): 1627-1634.
3. 李毓灵, 傅峥, 张健. 同期与分期行双侧全髋关节置换术的短期临床结果比较. 中华创伤杂志, 2013, 29(7): 637-640.
4. 项鹏, 余斌, 熊军, 等. 双侧髋关节同期与分期置换临床疗效与安全性的 Meta 分析. 中国矫形外科杂志, 2012, 20(4): 289-294.
5. Johnston LR, Clift BA, Abboud RJ. Bilateral simulataneous hip replacement versus bilateral sequential hip replacement. A 7-year data review. Orthop Nurs, 2011, 30(2): 119-123.
6. Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orhop Surg, 2014, 22(9): 595-603.
7. 杨玉霞, 杨桦, 范茹, 等. 直接前入路微创全髋关节置换术的围手术期护理. 中医正骨, 2016, 28(3): 77-80.
8. 李文龙, 范亚楠, 张蕾蕾, 等. 微创全髋关节置换术直接前侧入路与外侧小切口入路的对比研究. 中医正骨, 2016, 28(3): 24-29.
9. 桑伟林, 朱力波, 陆海明, 等. 直接前入路与后外侧入路全髋关节置换术的对比研究. 中华关节外科杂志 (电子版), 2015, 9(5): 584-588.
10. CHEN Y, Kang PD, Pei FX. Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty. A Systematic Review and Meta-Analysis (PRISMA). Medicine (Baltimore), 2015, 94(50): e2125.
11. York PJ, Smarck CT, Judet T, et al. Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop, 2016, 40(10): 2041-2048.
12. Meemans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J, 2017, 99-B(6): 732-740.
13. Grob K, Manestar M, Ackland T, et al. Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint: An Anatomical Study. J Bone Joint Srug (Am), 2015, 97(17): 1426-1431.
14. Rudin D, Manestar M, Ullrich O, et al. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. J Bone Joint Srug (Am), 2016, 98(7): 561-567.
15. Watts CD, Houdek MT, Wanger ER, et al. High Risk of Wound Complications Following Direct Anterior Total Hip Arthroplasty in Obese Patients. J Arthroplasty, 2015, 30(12): 2296-2298.
16. Purcell RL, Parks NL, Gargiulo JM, et al. Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty. J Arthroplasty, 2016, 31(9 Suppl): 162-165.
17. Russo MW, Macdonell JR, Paulus MC, et al. Increased Complications in Obese Patients Undergoing Direct Anterior Total Hip Arthroplasty. J Arthroplasty, 2015, 30(8): 1384-1390.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of short-term effectiveness of staged bilateral total hip arthroplasty via different approaches

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