Determining the best approach for a total hip arthroplasty (THA) implies that the procedure is kind on soft tissues, with the lowest complication rates, and easily reproducible. Although there have been several attempts to resolve this issue in the last decade, a definitive answer has not been found. Therefore, the investigators performed a prospective study to compare direct anterior versus posterior approach based on (1) hospital stay, (2) functional outcome, (3) pain, (4) implant position (5) complications and (6) surgical time.
In this multicentric, prospective, randomized clinical trial, 55 total hip arthroplasties were performed on 50 patients between February 2011 and July 2013. Patients meeting the inclusion criteria underwent surgical treatment using the DAA or PA, according to a randomization process. Radiological analysis assessed implant position, limb lengthening, and potential implant related complications. X-rays were performed at subsequent follow-up visits and consisted of an antero-posterior (AP) pelvic X-ray and a lateral projection of the hip. Two independent observers, not involved with patients or surgeries, reviewed all postoperative radiographs independently.Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study. Patients underwent either the posterior or direct anterior approach.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study
Hospital stay
Length in days of hospital stay
Time frame: Between 0 days and 1 month, average of 4 days
functional recovery
The Harris Hip Score (HHS) was used to measure pain and function.Grading for the Harris Hip Score is interpreted on a scale of 0 to 100 as follows: results \<70 are Poor; 70 - 79 are Fair; 80-89 are Good; 90 -100 are Excellent
Time frame: 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively
pain assessment: VAS
Visual Analog Scale (VAS) was used. The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations, including those with rheumatic diseases. The pain VAS is a continuous scale comprised of a horizontal (HVAS) or vertical (VVAS) line, usually 10 centimeters (100 mm) in length, anchored by 2 verbal descriptors, one for each symptom extreme. The pain VAS is a single-item scale, anchored by "no pain" (score of 0) and "pain as bad as it could be" or "worst imaginable pain" (score of 100 \[100-mm scale\]) . It is one total score, without subscale. As the lowest score of zero means no pain, it is the best possible outcome. As the highest score of 100 means the worst imaginable pain, it is the worst possible outcome.
Time frame: 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively
implant position
Radiological assessment
Time frame: 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively
number of patients with per/post surgical complications.
Possible complications are: peroperative fracture, hip dislocation, infection, neurologic complication, vascular complication or hematoma.
Time frame: 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively
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surgical time
Surgical time in minutes
Time frame: Up to 240 minutes