No clinically meaningful difference in 1-year patient-reported outcomes among major approaches for primary total hip arthroplasty.
Autor: | Bircher JB; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Kamath AF; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Piuzzi NS; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Barsoum WK; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Brooks PJ; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Hampton RJ; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Higuera CA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Klika A; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Krebs VE; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Mesko NW; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Molloy RM; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Mont MA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Murray TG; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Muschler GF; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Nickodem RJ; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Patel PD; Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA., Spindler KP; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Stearns KL; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Strnad GJ; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Suarez JC; Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA., Warren JA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA., Zajicheck A; Department of Biostatistics, Cleveland Clinic, Cleveland, OH, USA., Bloomfield MR; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA. |
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Jazyk: | angličtina |
Zdroj: | Hip international : the journal of clinical and experimental research on hip pathology and therapy [Hip Int] 2022 Sep; Vol. 32 (5), pp. 568-575. Date of Electronic Publication: 2021 Mar 07. |
DOI: | 10.1177/1120700021992013 |
Abstrakt: | Background: Debate continues around the most effective surgical approach for primary total hip arthroplasty (THA). This study's purpose was to compare 1-year patient-reported outcome measures (PROMs) of patients who underwent direct anterior (DA), transgluteal anterolateral (AL)/direct lateral (DL), and posterolateral (PL) approaches. Methods: A prospective consecutive series of primary THA for osteoarthritis ( n = 2390) were performed at 5 sites within a single institution with standardised care pathways (20 surgeons). Patients were categorised by approach: DA ( n = 913; 38%), AL/DL ( n = 505; 21%), or PL ( n = 972; 41%). Primary outcomes were pain, function, and activity assessed by 1-year postoperative PROMs. Multivariable regression modeling was used to control for differences among the groups. Wald tests were performed to test the significance of select patient factors and simultaneous 95% confidence intervals were constructed. Results: At 1-year postoperative, PROMs were successfully collected from 1842 (77.1%) patients. Approach was a statistically significant factor for 1-year HOOS pain ( p = 0.002). Approach was not a significant factor for 1-year HOOS-PS ( p = 0.16) or 1-year UCLA activity ( p = 0.382). Pairwise comparisons showed no significant difference in 1-year HOOS pain scores between DA and PL approach ( p > 0.05). AL/DL approach had lower (worse) pain scores than DA or PL approaches with differences in adjusted median score of 3.47 and 2.43, respectively ( p < 0.05). Conclusions: Patients receiving the AL/DL approach had a small statistical difference in pain scores at 1 year, but no clinically meaningful differences in pain, activity, or function exist at 1-year postoperative. |
Databáze: | MEDLINE |
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