Minimally invasive anterolateral approach versus direct anterior approach total hip arthroplasty in the supine position: a prospective study based on early postoperative outcomes

Abstract

Background Minimally anterolateral approach (MAA) and direct anterior approach (DAA) have been reported as beneficial for total hip arthroplasty (THA) due to their ability to reduce postoperative pain and lead to quicker rehabilitation by preserving muscle insertions. As there is an ongoing debate on the effect of these two approaches on early postoperative outcomes, this prospective study aimed to assess the difference in early clinical, radiological, and patient-reported outcomes between the two minimally invasive approaches. Methods A total of 98 patients, 50 in the MAA group and 48 in the DAA group, were included in the study. Patients with complete data were evaluated preoperatively and postoperatively at 2, 6, and 12 weeks. Clinical measurements, including the ability to climb stairs and walk, 6-min walk test (6MWT), the Forgotten Joint Scale (FJS-12), Japanese Orthopedic Association (JOA) Hip scores, radiological evaluation, and complications were analyzed. Results There were no significant differences in clinical outcomes and implant alignments between MAA and DAA groups. In regards to patient-reported outcomes, the FJS-12 was significantly higher in the MAA group compared to group DAA at 2 and 6 weeks postoperatively. However, there was no significant difference in the FJS-12 between the two groups 12 weeks after surgery. The differences also included shorter operative times (62.4 ± 9.05 min vs. 71 ± 8.01 min), less blood loss (132.6 ± 43.31 ml vs. 159.23 ± 37.25 ml), lower Hb drop (29.56 ± 8.02 g/L vs. 36.4 ± 7.12 g/L), and fewer blood transfusions in the MAA group (4.0% vs. 18.8%). The incidence of the lateral femoral cutaneous nerve (LFCN) neuropraxia after surgery was 7 (14.6%) in the DAA group and 0 in the MAA group. One fracture was found in each group and managed conservatively. Conclusion MAA and DAA approach yielded excellent and similar early clinical outcomes. However, better patient-reported outcomes could be achieved by MAA THA. The MAA resulted in a safer approach associated with shorter operative times, less blood loss, lower Hb drop, fewer blood transfusions, and LFCN neuropraxia than DAA. A longer follow-up is needed to further examine differences between these procedures.

Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes

“…The mean HHS of this cohort had already improved significantly at the 1-month follow-up, exhibiting quick improvement that could be attributed to the MIS, while the mean score was in the excellent outcomes group. Similar results have been reported from other smaller cohorts regarding the ALMIS technique, as well as other minimally invasive approaches for THA [ 21 , 22 , 23 ].…”

Clinical outcomes following direct anterior approach during total hip arthroplasty without hip extension: a retrospective comparative study

“…Indications for primary THA include a painful hip from OA, osteonecrosis of the femoral head, posttraumatic arthritis, rheumatoid arthritis, congenital/adult hip dysplasia (≤ grade II) with secondary arthritis, acute traumatic fracture of the femoral head or neck. Contraindications include a large posterior acetabular defect, significant preoperative heterotopic ossification (except anterior heterotopic ossification), BMI ≥ 30 kg/m 2 [ 10 ], high grade of developmental dysplasia of the hip (> grade II), serious organic or infectious diseases. Thirdly, during the development of the NHE method, the study groups were small; therefore, the relevant conclusions drawn regarding the complication rates (fracture, anaemia, or infection) may be inaccurate.…”

“…The inclusion criteria were as follows: end-stage hip osteoarthropathy, age 20–80 years, body mass index (BMI) < 30 kg/m 2 [ 10 ], and American Society of Anaesthesiologists (ASA) grade < 4. This study met the diagnostic criteria for hip osteoarthritis (OA) provided by the Guidelines for the Diagnosis and Treatment of OA [ 11 ].…”

Learning Curve for Short-Stem Total HIP Arthroplasty through an Anterolateral Approach

“…The medullary canal was opened, and again under radiological control, the femoral bone was prepared with rasps according to the planned size. Finally, after trial reduction, the determined stem and head were implanted [ 10 , 11 ].…”