Comparison of early complications for primary total hip arthroplasty using modified direct anterior approach and lateral approach.

BACKGROUND: Total hip arthroplasty is a surgical procedure with reliable results, regardless of the approach used. The anterior approach has advantages by respecting muscle insertions, reflected in the lower number of complications and shorter recovery time compared to other approaches. OBJECTIVE: The goal of the study was to assess the progression of 150 total hip arthroplasty procedures in the first 90 postoperative days. 75 patients underwent a modified direct anterior approach (MDAA) using a minimally invasive technique with a special table, and 75 patients underwent a direct lateral approach (DLA). METHODS: An observational retrospective study was conducted, including 150 arthroplasties, performed by the same surgeon, using two surgical approaches. 75 cases with direct lateral approach (DLA) and 75 cases with modified direct anterior approach (MDAA), between January 2007 and December 2020. Baseline characteristics, surgical variables, and postoperative complications were compared between the two groups. RESULTS: At 90 days, both groups presented a similar percentage of minor complications (32% vs. 42%), however, there was a higher number of major complications due to DLA (40% vs. 12% p < 0.0001) overall, where motor neurological complications have a higher incidence (14 [18.6%]). No differences were found in terms of the Harris functional scale. CONCLUSION: MDAA is a safe and reliable technique with satisfactory results. It presents predictable early complications, such as other approaches. Although it allows a faster recovery, at 90 days, the evolution and satisfaction are similar between both approaches with excellent and good outcomes in > 90% of cases.

ANTECEDENTES: La artroplastia total de cadera es un procedimiento quirúrgico con buenos resultados, independientemente del abordaje empleado. El abordaje anterior presenta ventajas al respetar las inserciones musculares, lo que se refleja en un menor número de complicaciones y menos tiempo de recuperación en comparación con otros abordajes. OBJETIVO: El objetivo del estudio fue valorar la evolución de 150 reemplazos totales de cadera en los primeros 90 días comparando 75 pacientes operados por abordaje anterior directo y 75 pacientes operados por abordaje lateral. MÉTODO: Se realizó un estudio retrospectivo observacional, incluyendo 150 artroplastias realizadas entre enero de 2007 y diciembre de 2020 por el mismo cirujano empleando dos abordajes quirúrgicos: 75 casos con abordaje lateral directo y 75 casos con abordaje anterior directo modificado. Se compararon las características basales, las variables quirúrgicas y las complicaciones posoperatorias entre ambos grupos. RESULTADOS: A 90 días, ambos grupos presentaron un porcentaje similar de complicaciones menores (32 vs. 42%); sin embargo, hubo un mayor número de complicaciones mayores con el abordaje lateral directo (40 vs. 12%; p < 0.0001) de forma global, siendo las complicaciones neurológicas motoras las que presentaron mayor incidencia (14; 18.6%). No se encontraron diferencias en cuanto a la escala funcional de Harris. CONCLUSIONES: El abordaje anterior directo modificado es una técnica segura y confiable, con resultados satisfactorios. Presenta complicaciones tempranas predecibles y similares a las de otros abordajes. Aunque permite una más rápida recuperación, a 90 días la evolución y la satisfacción son similares para ambos abordajes, con desenlaces excelentes y buenos en más del 90% de los casos.

Iliopsoas Hematoma After Total Hip Arthroplasty Using a Minimally Invasive Modified Direct Anterior Approach: A Case Report.

CASE: The modified direct anterior approach (MDAA) is a recently popular surgical technique for total hip arthroplasty (THA), with well-documented challenges. Characterized as acute hip and back pain, we present the case of a 78-year-old woman who developed an iliopsoas hematoma after an MDAA THA and discuss the management of this incident. CONCLUSIONS: Iliopsoas hematoma after THA poses a unique challenge and should be considered in patients with acute hip and back pain, with loss of strength on the affected limb after an MDAA THA.