Orthop Clin North Am. 2016 Jul;47(3):497-504. doi: 10.1016/j.ocl.2016.03.003.
Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study.
Parvizi J, Restrepo C, Maltenfort MG.
Studies suggest that total hip arthroplasty (THA) performed through direct anterior (DA) approach has better functional outcomes than other surgical approaches. The immediate to very early outcomes of DA THA are not known. A prospective, randomized study examined the very early outcome of THA performed through DA versus direct lateral approach. The functional outcomes on day 1, day 2, week 6, week 12, 6 months, and 1 year were measured. Patients receiving DA THA had significantly higher functional scores during the early period following surgery. The difference in functional scores leveled out at 6 months.
Bone Joint J. 2016 Nov;98-B(11):1450-1454.
The monitoring of activity at home after total hip arthroplasty.
Toogood PA, Abdel MP, Spear JA, Cook SM, Cook DJ, Taunton MJ
Total hip arthroplasty (THA) has well known subjective benefits, but little is known objectively about the recovery of mobility in the early post-operative period.
PATIENTS AND METHODS:
A total of 33 patients aged > 60 years who underwent elective primary THA had their activity monitored for 30 days post-operatively using an at-home (Fitbit) ankle accelerometer. Their mean age was 70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance and the mean level of activity were determined. Comparisons between subgroups based on age, body mass index (BMI), surgical approach, and the destination of the patients when discharged were also performed.
The mean compliance over the 30 days was 26.7 days (16 to 30; 89%) of use. The mean number of steps increased from 235 (5 to 1152) to 2563 (87 to 7280) (p < 0.001) between the first and the 30th post-operative day. Age < 70 years and an anterior surgical approach were significantly associated with higher levels of activity (1600 to 2400 (p = 0.016 to 0.031) and 1000 to 1800 (p = 0.017 to 0.037) more steps per day, respectively) between the second and the fourth week post-operatively. There was also a trend towards higher levels of activity in those who were discharged to their home rather than to a nursing facility (a mean of 1500 more steps per day, p = 0.02). BMI greater or less than 30 kg/m2 was not predictive of activity (p = 0.45 to 0.98).
At-home remote mobility monitoring using existing commercially available technology is feasible in patients who have undergone THA. It showed a clear trend towards increased activity with the passage of time. Additionally, the remote device was able to detect differences in levels of activity clearly between patients in relation to variables of interest including age, BMI, surgical approach, and the destination of the patient at the time of discharge from hospital. Such monitoring may allow for the early identification and targeted intervention in patients who recover slowly.
J Orthop. 2016 Oct 26;14(1):53-58. eCollection 2017 Mar.
Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study.
Jelsma J1, Pijnenburg R2, Boons HW1, Eggen PJ1, Kleijn LL1, Lacroix H1, Noten HJ1.
Since years a discussion is held on the best approach to perform total hip replacement (THR). Risk of dislocation, abductor weakness and a possible difference in rehabilitation are mentioned. We performed this study to objectify that the use of the direct anterior approach (DAA) results in a faster rehabilitation after THR compared to the non-DAA (posterolateral and anterolateral) approach.
A single centre prospective cohort study was conducted. Pre- and 16-weeks postoperative completed PROMs like the VAS, PSC, GPE and HOOS were analyzed. A leg press and power test were performed. Functional capacity was determined by the TUG and the 6MWT.
A total of 119 patients were included for analysis: 87 in the DAA group, 32 in the non-DAA group. There were no differences in general baseline characteristics. The length of stay was significant (p = .000) shorter in the DAA group. At 16 weeks, the DAA group showed a significant greater improvement with respect to the VAS and HOOS. Also significant differences for all strength, power and functional capacity parameters between the pre- and postoperative measurements were found. A subgroup analysis at 6-weeks postoperative showed significant improvements in the TUG (p = .009) and 6MWT (p = .009) in the DAA group, but not in the non-DAA group.
PROMs, strength, power and functional capacity tests show significant improvement in all approaches after THR. There seems to be a small advantage in favour of the DAA, in particular directly postoperative and the first postoperative weeks.
Anterolateral approach; Direct anterior approach; Direct lateral approach; Posterolateral approach; Primary total hip replacement
J Arthroplasty. 2017 Apr;32(4):1171-1175. doi: 10.1016/j.arth.2016.10.031. Epub 2016 Nov 1.
The Impact of Surgical Technique on Patient Reported Outcome Measures and Early Complications After Total Hip Arthroplasty.
Sibia US1, Turner TR2, MacDonald JH1, King PJ1.
This study examines patient and surgeon reported outcome measures, complications during index admission, length of stay (LOS), and discharge disposition in a series of total hip replacements (THR) performed via the direct anterior (DA) or posterolateral (PL) approach.
Five surgeons performed 2698 total hip replacements (1457 DA vs 1241 PL) between January 2010 and June 2015. Complications during index admission were recorded using billing and claims data. Harris Hip Scores (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were collected in a subset of patients.
Patients in the DA group had shorter LOS (2.3 DA vs 2.7 PL days, P < .001) and a larger proportion of patient discharges to home (79.0% DA vs 68.7% PL, P < .001). Surgical (0.75% DA vs 0.73% PL, P = .961) and medical (8.4% DA vs 8.1% PL, P = .766) complications during index admission were equivalent between groups. HHS (n = 462) favored the DA group at an early follow-up (P < .001), but did not differ at 1 year (P = .478). Logistic regression revealed that patients in the DA group were more likely to report no pain, no limp, walk unlimited distances, and climb stairs without the use of the railing at 3- to 6-month follow-up (P < .001). HOOSs were equivalent at all follow-ups regardless of approach.
Patients in the DA group had shorter LOS and were more likely to be discharged home. The DA group had better HHS at 3- to 6-month follow-up than patients in the PL group, with no difference in medical or surgical complications during index admission.
ANZ J Surg. 2016 Jul;86(7-8):589-93. doi: 10.1111/ans.13598. Epub 2016 May 27.
Functional and clinical outcomes following anterior hip replacement: a 5-year comparative study versus posterior approach.
Balasubramaniam U1, Dowsey M1,2, Ma F1,2, Dunin A1,2, Choong P1,2.
With the evolution of total hip joint replacement techniques, there has been a trend towards minimally invasive surgery. The anterior approach (AA) to total hip arthroplasty has been widely associated with less soft tissue damage. The aim of our study was to compare clinical and 1-year functional outcomes for AA hip arthroplasty versus a posterior approach (PA).
We retrospectively reviewed 92 (50 anterior and 42 posterior) total hip replacements performed at our centre between 2006 and 2011. Clinical outcomes were recorded from hospital medical records and clinical audit system. Range of motion analysis, Harris hip score (HHS) and Short Form-12 score were recorded pre-operatively and at the 12-month follow-up marks. Additionally, we reviewed operative time, length of stay, discharge destination, complications, return to theatre and readmission rates.
The results of our study revealed significantly shorter average hospital length of stay for the AA versus PA (4.2 versus 6.0 days, P = 0.004). Interestingly, our study also showed significantly shorter operating time with the AA (83.0 versus 91.8 min, P = 0.048) and lower return to theatre rates (0 versus 9.5%, P = 0.026). Finally, multivariate analysis showed AA to be associated with higher HHS and pre-operative body mass index to be associated with lower HHS at 12-month post-operation (P = 0.02 and <0.001, respectively).
Our study showed improved HHS at 12 months as well as reduced hospital length of stay, operating time and return to theatre with an AA when compared with a PA.