Decisional conflict in surgical patients: Should surgeons care?

Abstract

Background:The choice of surgical approach for total hip arthroplasty (THA) remains a contentious issue with regards to clinical outcome optimization and restoring patient function. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis. Methods:Patients undergoing THA for primary osteoarthritis of the hip were assigned to 1 of 3 surgical approaches: anterior, posterior and lateral. Standardized implants were used at the time of surgery. Three-dimensional gait analysis was performed preoperatively and at 6 and 12 weeks postoperatively. At each time point, we compared temporal parameters, kinematics and kinetics. Results:We included 30 patients in our analysis (10 anterior, 10 posterior, and 10 lateral). The groups were similar with respect to age (p = 0.27), body mass index (p = 0.16), and Charlson Comorbidity Index score (p = 0.66). Temporal parameters were similar among the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6 weeks (p = 0.041). Affected leg ipsilateral trunk lean during stance was higher in the lateral group than in the other cohorts at 6 weeks (p = 0.008) and 12 weeks (p = 0.040). The anterior and posterior groups showed increased external rotation at 6 weeks (p = 0.003) and 12 weeks (p = 0.012) compared with the lateral group. Conclusion:Temporal gait parameters were similar following THA for all approaches. Differences in gait kinematics and kinetics exist; however, given the small absolute differences, the clinical importance of these changes remains un determined.Contexte : Le choix de l'approche chirurgicale pour la pose d'une prothèse totale de la hanche (PTH) ne fait pas l'unanimité sur le plan de l'optimisation des résultats cliniques et du rétablissement fonctionnel des patients. Le but de cette étude était de déterminer l'incidence de l'approche choisie sur les résultats de l'analyse quantitative de la démarche. Méthodes :Les patients qui se font poser une PTH en raison d'une arthrose primaire de la hanche ont été opérés selon l'une des 3 approches suivantes : antérieure, postérieure ou latérale. Des implants standards ont été utilisés pour la chirurgie. Une analyse tridimensionnelle de la démarche a été effectuée avant l'intervention, puis après 6 et 12 semaines. À chaque étape, nous avons comparé les paramètres temporels, cinématiques et cinétiques. Résultats :Nous avons inclus 30 patients dans notre analyse, soit 10 par approche. Les groupes présentaient des caractéristiques similaires en ce qui concerne l'âge (p = 0,27), l'indice de masse corporelle (p = 0,16) et l'indice de comorbidité de Charlson (p = 0,66). Les paramètres temporels étaient similaires d'un groupe à l'autre à toutes les étapes de l'étude. Six semaines après l'intervention, le groupe opéré selon l'approche latérale présentait une bascule pelvienne à la station debout du côté du membre affecté plus prononcée que le groupe opéré selon l'approche antérieure (p = 0,041). Il présen...

Total hip arthroplasty through an anterior approach

“…Gait analysis laboratories have been used in recent studies to evaluate the effect of surgical approach on gait patterns. The anterior approach is shown to have improved early rotation range of motion (ROM) 52 and pelvic tilt closer to normal 53 compared to the posterior, but no clinically significant differences seem to emerge. 36,54 Similarly, comparison of the anterior and lateral/anterolateral approaches in postoperative gait patterns show that the anterior approach has some advantages in terms of velocity, 55,56 and closer to normal gait parameters.…”

“…36,54 Similarly, comparison of the anterior and lateral/anterolateral approaches in postoperative gait patterns show that the anterior approach has some advantages in terms of velocity, 55,56 and closer to normal gait parameters. 53,57,58 The ultimate clinical effect of gait pattern alteration remains unclear, as well as the optimal way to evaluate the effect of surgical approach on muscle tissue.…”

Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis

“…Advocates of the DAA suggested that the DAA is an intermuscular and internervous approach with less muscle and soft-tissue dissection [8]. Conversely, surgeons who favor the LA cite advantages of extensile exposure with low rates of postoperative instability [9]. Several randomized controlled trials (RCTs) have compared the DAA to the lateral approach for THA.…”

Comparação Das Abordagens Anterior, Lateral E Posterior Na Artroplastia Total De Quadril: Uma Revisão Bibliográfica

“…Stephen Petis et al (2017) abordou as três abordagens (Anterior, Lateral e Posterior) num estudo prospectivo analisando 30 pacientes submetidos a ATQ. Para o autor a escolha da abordagem cirúrgica da ATQ continua sendo uma questão controversa à respeito da otimização de resultados clínicos.…”

“…O trabalho concluiu que diferenças cinemáticas na marcha existem entre as abordagens e são estatisticamente significativas; no entanto, a relevância clínica desses achados é limitada devido a literatura estabelecida. (PETIS, 2017) Os resultados obtidos estão relacionados a heterogeneidade dos estudos, em que muitos deles contém comparações diferentes entre si e entre as abordagens, e com métodos distintos. Assim como muitos estudos deste tema relatam resultados duvidosos, devido ao pequeno número da amostra e tempo de seguimento aleatório.…”