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Acta Orthop ; 89(5): 484-489, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30350758

RESUMO

Background and purpose - The minimally invasive direct anterior (DA) approach for total hip arthroplasty (THA) is supposed to reduce surgical tissue trauma. We hypothesized that patients operated with the DA technique would have less postoperative pain and better hip function compared with a group operated with a conventional direct lateral (DL) approach. Patients and methods - 100 patients with hip osteoarthritis scheduled for THA were equally randomized to surgery through either DA or DL. Pain was assessed on a VAS scale, hip function with TUG, 10mWT, HHS, and quality of life with EQ-5D. Patients were followed up after the first 3 days, 8 weeks, and at 1 and 5 years postoperatively. Results - The DA group registered less pain with activity on the second day (VAS 42 vs. 55), performed TUG 6 seconds faster on the third day and had 8 points higher HHS and higher EQ-5D index (0.86 vs 0.78) at 8 weeks; all differences were statistically significant. No clinically relevant differences between groups in pain, hip function, or quality of life were seen at 1 or 5 years. 7 surgical approach related complications appeared in the DA group, none in the DL. Interpretation - The results indicate that the presumably less traumatic approach results in reduced immediate postoperative pain and better hip function and higher quality of life in the early postoperative period. However, this positive effect is not seen at later time points. Instead, complications appear to be over-represented, thus questioning the use of the method.


Assuntos
Artroplastia de Quadril/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteoartrite do Quadril/cirurgia , Dor Pós-Operatória/prevenção & controle , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/reabilitação , Feminino , Seguimentos , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/reabilitação , Osteoartrite do Quadril/reabilitação , Medição da Dor/métodos , Complicações Pós-Operatórias , Qualidade de Vida , Recuperação de Função Fisiológica
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