Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study.

Autor: Jelsma J; Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands., Pijnenburg R; Physiotherapy Jeurissen & van Ingh, Fabriekstraat 24, 5753 AH Deurne, The Netherlands., Boons HW; Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands., Eggen PJ; Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands., Kleijn LL; Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands., Lacroix H; Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands., Noten HJ; Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of orthopaedics [J Orthop] 2016 Oct 26; Vol. 14 (1), pp. 53-58. Date of Electronic Publication: 2016 Oct 26 (Print Publication: 2017).
DOI: 10.1016/j.jor.2016.10.025
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Databáze: MEDLINE
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