The direct anterior approach for simultaneous bilateral total hip arthroplasty: a short-term efficacy analysis

Comparison of Perioperative Outcomes and Early Complications Between a Direct Anterior Approach or Posterolateral Approach in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Study

Background: Controversies remain on the best surgical approaches for unilateral total hip arthroplasty (THA). There are little data on simultaneous bilateral THA via direct anterior approach (SimBDAA-THA) or posterolateral approach (SimBPA-THA). Purpose: We sought to assess differences in perioperative outcomes and early medical and surgical complications between SimBDAA-THA and SimBPA-THA. Methods: This retrospective study involved patients who underwent either SimBDAA-THA in a supine position (n = 73) or SimBPA-THA in a lateral position (n = 162) at our institution from January 2015 to November 2021. The 2 groups were compared in terms of clinical and demographic characteristics, surgical parameters, and complications during 6-months of follow-up. Results: There were no differences in clinical and demographic characteristics between the 2 groups prior to surgery. Simultaneous bilateral THA via direct anterior approach significantly shortened the length of both the operation (117.50 ±19.42 vs 143.97 ± 32.20 min) and the hospitalization (140.64 ± 43.22 vs 156.24 ± 56.64 h) but increased perioperative loss of hemoglobin (3.28 ± 1.01 vs 3.21 ± 2.26 g/dL). There were no significant differences between the two groups in transfusion rate; levels of interleukin-6, C-reactive protein or creatine kinase; or complications. Conclusion: This retrospective study of patients at a single institution found minimal differences in perioperative outcomes or early medical and surgical complications between SimBDAA-THA and SimBPA-THA except operative time and length of hospitalization. Larger studies with longer follow-up should be conducted to identify whether a direct anterior approach is superior to a posterolateral one.

The impact of unified discharge standards on the clinical efficacy and prognosis of hemiarthroplasty in elderly patients with hip fractures

OBJECTIVES

The aim of this study was to investigate the impact of unified discharge standards on the clinical efficacy and prognosis of hemiarthroplasty in elderly patients with hip fractures.

METHODS

Retrospective study of 158 elderly patients with hip fractures who underwent artificial femoral head replacement in our hospital from March 2016 to July 2019 were enrolled. According to the unified discharge standards, patients were divided into the observation (65 cases who met discharge criteria) and control group (93 cases who failed to meet all discharge criteria). Histopathological feature, operation status, postoperative Harris Hip score, therapeutic outcome, postoperative complications, readmission and mortality rate were compared between the two groups.

RESULTS

Surgery duration and intraoperative blood loss exhibited no difference between the two groups, while transfusion volume and length of hospital stay were significantly increased in the observation group. There was no significant difference in the Harris Hip score between the two groups 12 months postoperatively. The incidence of postoperative complications during the follow-up period was notably lower in the observation group. In addition, the three-month readmission rate and one-year mortality rate were significantly lower in the observation group.

CONCLUSIONS

For elderly patients with hip fractures undergoing artificial femoral head replacement, the incidence of postoperative complications and postoperative readmission/mortality rate could be reduced through the establishment of unified discharge standards, which should be used in future clinical practice.

Randomized Clinical Study on the Efficacy of Direct Anterior Approach Combined With Tendon Release and Repair After Total Hip Arthroplasty

Background

To study the effect of reconstruction of the joint capsule and conjoint tendon on the functional recovery of the hip joint during direct anterior approach (DAA) total hip arthroplasty.

Methods

A total of 60 patients who underwent their first total hip arthroplasty surgery were selected. According to the set criteria, the selected patients were divided into observation group A (n = 30) and control group B (n = 30). In group A, the joint capsule and conjoint tendon (superior muscle, internal obturator muscle, and inferior muscle) were repaired in situ, while in group B, only the joint capsule was repaired in situ, and the conjoint tendon was not repaired. The surgical indicators, including hip joint function and clinical efficacy of the two groups, were compared.

Results

After 6 months of follow-up in groups A and B, no dislocation occurred. The Harris Hip scores of group A were higher than those of group B at 1-month post-operation, i.e., p < 0.05, as well as the valid muscle strength and conjoint tendon valid tension, were higher in group A than group B at 1-month postoperative follow-up, i.e., p < 0.05.

Conclusion

DAA for total hip arthroplasty on the premise of reconstructing the joint capsule structure can rebuild the tension of the conjoint tendon, enhance its muscle strength, and significantly improve the joint stability and function of the patient early stage. It is beneficial for the patient's rapid recovery and is worth implementing.