Total Hip Arthroplasty
Conditions
Keywords
Direct anterior approach, posterior approach
Brief summary
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.
Detailed description
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.
Interventions
PROCEDURETotal hip arthroplasty
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
Sponsors
Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
However, the decision to discharge subjects was made by physiotherapists blinded to treatment and based on objective criteria. These criteria were: 1) being autonomous for transfer from bed/chair to upright position 2) being able to walk with walking aid 3) climbing stairs in a safe way 4) having a pain level contained by painkillers. No restrictions were recommended for either group. The same rehabilitation and pain protocols were used for both approaches. In addition, statistical analyses were performed by an independent consultant who remained blinded to treatment group assignment.
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* primary total hip replacement due to osteoarthrosis or osteonecrosis * patients older than 50 years.
Exclusion criteria
* inflammatory arthritis, * any previous ipsilateral hip surgery * suffering from proximal femoral deformity * BMI over 40 * active infection * severe contralateral hip disease, muscle contractures or neuromuscular pathology * requiring structural bone grafts.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital stay | Between 0 days and 1 month, average of 4 days | Length in days of hospital stay |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| functional recovery | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | 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 |
| pain assessment: VAS | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | 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. |
| implant position | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | Radiological assessment |
| number of patients with per/post surgical complications. | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | Possible complications are: peroperative fracture, hip dislocation, infection, neurologic complication, vascular complication or hematoma. |
| surgical time | Up to 240 minutes | Surgical time in minutes |
Outcome results
None listed