A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty

摘要

The presented prospective randomized controlled single-centre study compares the clinical outcome up to 12 months after total hip arthroplasty using a minimally invasive single-incision direct anterior (DAA) and a direct transgluteal lateral approach. A total of 123 arthroplasties were evaluated utilizing the Harris Hip Score (HHS), the extra short musculoskeletal functional assessment questionnaire (XSFMA), the Short Form 36 (SF-36) health survey, a Stepwatch? Activity Monitor (SAM), and a timed 25?m foot walk (T25-FW). Postoperative x-ray images after THA were reviewed to determine inclination and stem positioning. At final follow-up, the XSFMA functional index scores were 10.3 (anterior) and 15.08 (lateral) while the bother index summed up to a score of 15.8 (anterior) and 21.66 (lateral) respectively, thus only differing significantly for the functional index (p?=?0.040 and p?=?0.056). The SF-36 physical component score (PCS) was 47.49 (anterior) and 42.91 (lateral) while the mental component score (MCS) summed up to 55.0 (anterior) and 56.23 (lateral) with a significant difference evident for the PCS (p?=?0.017; p?=?0.714). Patients undergoing THA through a DAA undertook a mean of 6402?cycles per day while those who had undergone THA through a transgluteal approach undertook a mean of 5340?cycles per day (p?=?0.012). Furthermore, the obtained outcome for the T25-FW with 18.4?s (anterior) and 19.75?s (lateral) and the maximum walking distance (5932?m and 5125?m) differed significantly (p?=?0.046 and p?=?0.045). The average HHS showed no significant difference equaling 92.4 points in the anterior group and 91.43 in the lateral group (p?=?0.477). The radiographic analysis revealed an average cup inclination of 38.6° (anterior) and 40.28° (lateral) without signs of migration. In summary, our outcomes show that after 1 year THA through the direct anterior approach results in a higher patient activity compared to THA utilizing a transgluteal lateral approach while no differences regarding hip function are evident. DRKS00014808 (German Clinical Trial Register DRKS); date of registration: 31.05.2018.