Comparison of postoperative effectiveness of less invasive short external rotator sparing approach versus standard posterior approach for total hip arthroplasty

Abstract

Background Most of the studies assessing the corrective posterior total hip arthroplasty (THA) mainly focused on the mini-incision approach. Studies exploring the short external rotator sparing approach are rare. Therefore, this study aimed to compare the effectiveness of standard posterior approach and short external rotator sparing approach. Methods This prospective observational study included 126 patients who underwent THA in June 2017–June 2018. Patients were assigned to standard (standard posterior approach) and corrective (short external rotator sparing approach) groups based on the surgical method. Surgical data were recorded postoperatively. Postoperative hip joint recovery was assessed using the times to ambulation and independent stair use, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris score, and Oxford hip score (OHS) at 2 and 8 postoperative weeks. The visual analog scale (VAS) was used for postoperative pain assessment. Results Postoperative changes of creatine kinase (CK), myoglobin, CRP, and prosthesis position were similar in both groups (P > 0.05). However, intraoperative blood loss (P < 0.001) and postoperative 6-h drainage volume (P = 0.03), hospital stay, blood transfusion rate, and times to ambulation and independent stair use were significantly reduced in the corrective group. Postoperatively, Oxford, and WOMAC scores significantly decreased in both groups. After surgery, the VAS score was more overtly decreased in the corrective group compared with the standard group. Conclusions This study concluded that the less invasive short external rotator sparing approach for THA caused less damage, reducing perioperative blood loss, shortening functional recovery time, maintaining prosthesis stability, and improving postoperative pain.

Evaluation of the association between the conjoined tendon-preserving posterior approach in total hip arthroplasty and early postoperative functional recovery: a retrospective cross-sectional study.

“…The CPP approach was shown to be consistently favored and superior in gaining ability to walk postoperatively. Previous studies have reported an average postoperative hospital stay of around 1 week, regardless of whether MIS-THA or conventional THA, anterior or posterior approach was used [7,18,20,27,28]. One of the reasons for the longer postoperative hospital stay in this study was that participants needed to live alone without anyone support after discharge.…”

“…However, studies comparing postoperative function between THA with MIS techniques and conventional techniques have been inconsistent in their conclusions, with some reporting signi cant improvement with MIS-THA, others reporting a limited advantage, and others nding no signi cant difference between MIS-THA and conventional THA. [18][19][20][21][22][23]. The conjoined tendon-preserving posterior (CPP) approach is also a minimally invasive posterior approach that preserves short external rotator muscles, except for the quadratus femoris and obturator externus muscles, and the posterior and anterior capsular ligaments without cutting them [24].…”