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.
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