Lambert C E Visser, Noa H M Ponds, Ellie B M Landman, Stijn A A N Bolink
{"title":"全髋关节置换术中从直侧入路到直接前入路的过渡：一项回顾性单中心研究。","authors":"Lambert C E Visser, Noa H M Ponds, Ellie B M Landman, Stijn A A N Bolink","doi":"10.1177/11207000241285388","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The muscle-sparing direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity for reduced postoperative pain and faster rehabilitation. The aim of this study was to evaluate the potential benefits of transitioning from straight lateral approach (SLA) THA to DAA THA, and investigate whether these benefits outweigh potential disadvantages of the DAA learning curve.</p><p><strong>Method: </strong>Patients undergoing surgery between 2015 and 2020 (<i>n</i> = 2275) were categorised into three periods: pre-transition period (2015-2016) utilizing SLA exclusively, transition period (2017-2018) incorporating both SLA and DAA, and post-transition period (2019-2020) employing only DAA. The Hip disability and Osteoarthritis Outcome Score - Physical function Short-form (HOOS-PS) was recorded pre-surgery and one-year post-surgery. Furthermore, complications, blood loss, duration of surgery and length of stay were compared between groups.</p><p><strong>Results: </strong>A larger improvement in HOOS-PS score was found for DAA in comparison with SLA (37.13 ± 18.62 vs. 32.55 ± 22.83; <i>p</i> < 0.001). Significant improvements were found for the DAA group regarding duration of surgery (70:02 ± 15:54 min vs. 79:47 ± 15:03 min; <i>p</i> < 0,001) and length of stay (1.68 ± 1.80 days vs. 3.39 ± 1.85 days; <i>p</i> < 0,001) compared to the SLA group. Total number of complications was higher for SLA (<i>n</i> = 87 (9.2%)) compared to DAA (<i>n</i> = 77 (6.5%); <i>p</i> = 0.018), with more femoral fractures for SLA (<i>n</i> = 35 (3.7%) vs. <i>n</i> = 6 (0.5%); <i>p</i> < 0.001) whereas more dislocations were found for DAA (<i>n</i> = 24 (2.0)% vs. <i>n</i> = 7 (0.7%); <i>p</i> = 0.017). More specifically, a higher number of dislocations occurred during the DAA transition period when compared to the SLA pre-transition period (<i>n</i> = 12 (2.7%) vs. <i>n</i> = 4 (0.6%); <i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>Transitioning from SLA to DAA for THA improves patient-reported outcomes but does not seem to result in a higher overall complication rate. 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The aim of this study was to evaluate the potential benefits of transitioning from straight lateral approach (SLA) THA to DAA THA, and investigate whether these benefits outweigh potential disadvantages of the DAA learning curve.</p><p><strong>Method: </strong>Patients undergoing surgery between 2015 and 2020 (<i>n</i> = 2275) were categorised into three periods: pre-transition period (2015-2016) utilizing SLA exclusively, transition period (2017-2018) incorporating both SLA and DAA, and post-transition period (2019-2020) employing only DAA. The Hip disability and Osteoarthritis Outcome Score - Physical function Short-form (HOOS-PS) was recorded pre-surgery and one-year post-surgery. Furthermore, complications, blood loss, duration of surgery and length of stay were compared between groups.</p><p><strong>Results: </strong>A larger improvement in HOOS-PS score was found for DAA in comparison with SLA (37.13 ± 18.62 vs. 32.55 ± 22.83; <i>p</i> < 0.001). Significant improvements were found for the DAA group regarding duration of surgery (70:02 ± 15:54 min vs. 79:47 ± 15:03 min; <i>p</i> < 0,001) and length of stay (1.68 ± 1.80 days vs. 3.39 ± 1.85 days; <i>p</i> < 0,001) compared to the SLA group. Total number of complications was higher for SLA (<i>n</i> = 87 (9.2%)) compared to DAA (<i>n</i> = 77 (6.5%); <i>p</i> = 0.018), with more femoral fractures for SLA (<i>n</i> = 35 (3.7%) vs. <i>n</i> = 6 (0.5%); <i>p</i> < 0.001) whereas more dislocations were found for DAA (<i>n</i> = 24 (2.0)% vs. <i>n</i> = 7 (0.7%); <i>p</i> = 0.017). More specifically, a higher number of dislocations occurred during the DAA transition period when compared to the SLA pre-transition period (<i>n</i> = 12 (2.7%) vs. <i>n</i> = 4 (0.6%); <i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>Transitioning from SLA to DAA for THA improves patient-reported outcomes but does not seem to result in a higher overall complication rate. 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引用次数: 0
摘要
简介：全髋关节置换术（THA）中的直接前路（DAA）由于能减少术后疼痛并加快康复速度而广受欢迎。本研究旨在评估从直侧入路（SLA）THA过渡到DAA THA的潜在益处，并调查这些益处是否超过DAA学习曲线的潜在缺点：将2015年至2020年期间接受手术的患者（n = 2275）分为三个时期：过渡前时期（2015-2016年）仅使用SLA，过渡时期（2017-2018年）同时使用SLA和DAA，过渡后时期（2019-2020年）仅使用DAA。手术前和手术后一年记录髋关节残疾和骨关节炎结果评分--身体功能简表（HOOS-PS）。此外，还对各组的并发症、失血量、手术时间和住院时间进行了比较：结果：与 SLA（37.13 ± 18.62 vs. 32.55 ± 22.83；p p p n = 87（9.2%））相比，DAA（n = 77（6.5%）；P = 0.018），SLA 的股骨骨折更多（n = 35 (3.7%) vs. n = 6 (0.5%)；P n = 24 (2.0)% vs. n = 7 (0.7%)；P = 0.017）。更具体地说，与SLA过渡前相比，DAA过渡期间发生的脱位数量更高（n = 12 (2.7%) vs. n = 4 (0.6%)；p = 0.008）：结论：在 THA 中从 SLA 过渡到 DAA 可改善患者报告的结果，但似乎不会导致更高的总体并发症发生率。结论：从 SLA 过渡到 DAA 可改善患者报告的结果，但似乎不会导致总体并发症发生率升高，这表明 DAA 的优势大于学习曲线的潜在劣势。
Transition from straight lateral to direct anterior approach in total hip arthroplasty: a retrospective single-centre study.
Introduction: The muscle-sparing direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity for reduced postoperative pain and faster rehabilitation. The aim of this study was to evaluate the potential benefits of transitioning from straight lateral approach (SLA) THA to DAA THA, and investigate whether these benefits outweigh potential disadvantages of the DAA learning curve.
Method: Patients undergoing surgery between 2015 and 2020 (n = 2275) were categorised into three periods: pre-transition period (2015-2016) utilizing SLA exclusively, transition period (2017-2018) incorporating both SLA and DAA, and post-transition period (2019-2020) employing only DAA. The Hip disability and Osteoarthritis Outcome Score - Physical function Short-form (HOOS-PS) was recorded pre-surgery and one-year post-surgery. Furthermore, complications, blood loss, duration of surgery and length of stay were compared between groups.
Results: A larger improvement in HOOS-PS score was found for DAA in comparison with SLA (37.13 ± 18.62 vs. 32.55 ± 22.83; p < 0.001). Significant improvements were found for the DAA group regarding duration of surgery (70:02 ± 15:54 min vs. 79:47 ± 15:03 min; p < 0,001) and length of stay (1.68 ± 1.80 days vs. 3.39 ± 1.85 days; p < 0,001) compared to the SLA group. Total number of complications was higher for SLA (n = 87 (9.2%)) compared to DAA (n = 77 (6.5%); p = 0.018), with more femoral fractures for SLA (n = 35 (3.7%) vs. n = 6 (0.5%); p < 0.001) whereas more dislocations were found for DAA (n = 24 (2.0)% vs. n = 7 (0.7%); p = 0.017). More specifically, a higher number of dislocations occurred during the DAA transition period when compared to the SLA pre-transition period (n = 12 (2.7%) vs. n = 4 (0.6%); p = 0.008).
Conclusions: Transitioning from SLA to DAA for THA improves patient-reported outcomes but does not seem to result in a higher overall complication rate. Suggesting the advantages of the DAA outweigh the potential disadvantages of the learning curve.
期刊介绍：
HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice.
The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit.
HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are:
• Biomaterials
• Biomechanics
• Conservative Hip Surgery
• Paediatrics
• Primary and Revision Hip Arthroplasty
• Traumatology
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