Effect of modified direct anterior approach on gait and joint function in patients undergoing primary total hip arthroplasty / 中国医师进修杂志

ABSTRACT

Objective:To explore the effect of total hip arthroplasty via modified direct anterior approach on hip function, balance function and gait parameters in patients undergoing primary total hip arthroplasty.Methods:Eighty-nine patients who underwent total hip arthroplasty for the first time in Anqing First People′s Hospital of Anhui Medical University from January 2020 to December 2021 were selected as the study subjects by prospective study, and they were divided into the observation group (modified direct anterior approach total hip arthroplasty, 45 cases) and the control group [direct anterior approach (DAA) total hip arthroplasty, 44 cases] according to the random number table method. Perioperative indexes of the two groups were observed and complications were counted, and hip function, balance function, gait parameters and follow-up imaging data were compared between the two groups at 1 year after postoperative follow-up.Results:After treatment, the anal exhaust time, hospital stay, blood loss, ambulation time and postoperative feeding time in observation group were shorter or less than those in control group:(9.15 ± 1.33) h vs. (10.89 ± 1.53) h, (5.07 ± 2.21) d vs. (7.04 ± 2.23) d, (53.48 ± 12.43) ml vs. (64.44 ± 12.53) ml, (4.07 ± 0.21) d vs. (6.15 ± 1.24) d, (0.47 ± 0.13) d vs. (0.75 ± 0.24) d, P<0.05. At 3, 6 and 12 months after treatment, the hip function scores in the two groups were risen compared with those before treatment ( P<0.05), and the above hip function scores in observation group were higher compared to control group: (65.47 ± 8.38) points vs. (57.91 ± 2.83) points, (76.12 ± 5.31) points vs. (72.25 ± 2.44) points, (85.27 ± 4.45) points vs. (83.24 ± 4.55) points, P<0.05. The balance function scores of the two groups at 3, 6 and 12 months after treatment were enhanced compared with those before treatment ( P<0.05), and the balance function scores in observation group were higher than those in control group: (35.26 ± 1.22) points vs. (29.51 ± 1.49) points, (39.42 ± 4.36) points vs. (37.57 ± 2.21) points, (45.57 ± 2.01) points vs. (43.36 ± 2.18) points, P<0.05. The stride distance and stride length in the observation group were higher compared to the control group: (0.78 ± 0.12) m vs. (0.71 ± 0.19) m, (0.46 ± 0.04) m vs. (0.32 ± 0.08) m, while the stride frequency and gait asymmetry index were lower than those in the control group: (89.74 ± 8.05) steps/min vs. (98.68 ± 9.04) steps/min, 0.10 ± 0.02 vs. 0.16 ± 0.05, P<0.05. After treatment, the incidence rate of complications in the observation group was lower than that in the control group: 2.44%(1/41) vs. 19.51%(8/41), P<0.05. At 1-month follow-up after surgery, there were no statistical differences in acetabular cup anteversion angle, abduction angle, femoral stem peripheral zona pellucida score, and lower limb lebgth between the two groups ( P>0.05). Conclusions:Modified direct anterior approach total hip arthroplasty can promote postoperative recovery, improve hip function, enhance balance function, reduce risk of complications, and improve gait parameters.