Postoperative gait mechanics in patients after total hip arthroplasty: a systematic review and meta-analysis

Moyer, R.; Lanting, Brent A.; Churchill, Laura; Marsh, Jackie; Howard, James L.; Somerville, L

doi:10.1016/j.joca.2017.02.208

Cited by 3 publications

(4 citation statements)

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“… 33 Interestingly, different approaches reportedly yield a difference in gait biomechanics postoperatively. 34 Moreover, the sagittal plane hip ROM (peak flexion‐peak extension) was associated with HHS scores 35 ; however, weaker hip flexion at 2 and 6 weeks in the DAA group was not found in this study, in contrast with the literature. 36 …”

Section: Discussioncontrasting

confidence: 86%

“…33 Interestingly, different approaches reportedly yield a difference in gait biomechanics postoperatively. 34 Moreover, the sagittal plane hip ROM (peak flexion-peak extension) was associated with HHS scores 35 ; however, weaker hip flexion at 2 and 6 weeks in the DAA group was not found in this study, in contrast with the literature. 36 Advantages of FJS-12 in DAA In the present study, the FJS-12 score revealed significant differences in the short-term outcome between the DAA and PA groups.…”

Section: Advantage Of Daa For Hip Motioncontrasting

confidence: 88%

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Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty

Shen

Yao

et al. 2022

Orthopaedic Surgery

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Objectives Prosthesis awareness is the perception of foreign bodies, which has a critical effect on the function of the prosthetic joint. In total hip arthroplasty (THA), the direct anterior approach (DAA) has more advantages than the posterior approach (PA), including superior rehabilitation outcomes. This study was to evaluate the recovery of “prosthesis awareness” through these two approaches. Methods Three hundred and seventy‐six patients who received THA with either DAA (n = 41) or PA (n = 335) from January 2016 to December 2017 were retrospectively analyzed. The Forgotten Joint Score‐12 (FJS‐12), Harris hip score (HHS), and visual analog scale (VAS) analyses were used to evaluate the recovery of “prosthesis awareness” in these patients 2 weeks, 1, 3, 6, and 12 months after surgery. The student t‐test, Wilcoxon rank sum test, chi‐square test, and MANOVA were used to compare the differences among groups. Results We found that DAA patients had higher FJS‐12 scores than PA patients at 2 weeks (42.15 ± 3.36 vs. 38.09 ± 3.28, p = 0.042), 1 month (49.06 ± 5.14 vs. 41.11 ± 5.21, p = 0.038), and 3 months (53.23 ± 4.07 vs. 48.09 ± 3.71, t = 3.152, p = 0.045). And the recovery rates of FJS‐12 scores in DAA and PA groups at 2 weeks, 1 month, and 3 months after surgery were 75.46% ± 6.04%, 84.05% ± 6.57%, 91.37% ± 7.13%, and 74.14% ± 5.54%, 78.16% ± 6.01%, 88.23% ± 6.42%, respectively. To compare the recovery effects of the two procedures in more detail, we classified the 12 items in FJS‐12 that evaluate different types of gravity center motions into three categories: low‐movement group (LG), middle‐movement group (MG), and high‐movement group (HG). Interestingly, DAA patients had significantly higher HG than PA patients at 2 weeks, 1 month, and 3 months after operation (t = 3.225, p = 0.022 at 2 weeks, t = 3.081, p = 0.041 at 1 month and t = 2.783, p = 0.046 at 3 months), whereas no significant differences were observed in LG‐ and MG‐related items. In addition, there were no significant differences in HHS and VAS scores between DAA and PA patients at 2 weeks (p = 0.102, p = 0.093), or from 1 month to 12 months (each p > 0.05). Conclusions DAA‐mediated THA is superior to PA in terms of prosthesis adaptability and recovery of hip joint motion in the first 3 months after surgery, especially concerning high‐movement gravity center motions.

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Section: Discussioncontrasting

confidence: 86%

Section: Advantage Of Daa For Hip Motioncontrasting

confidence: 88%

Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty

Shen

Yao

et al. 2022

Orthopaedic Surgery

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“…This is the first randomised controlled study in literature to have compared isometric hip muscle strength following THA with PA and ALA. Muscle strength following THA with DLA, PA and AA has been compared several times before but very few studies have compared PA and ALA. 20 In a 1982 study by Gore et al, 21 ALA and PA were compared and it was reported that, ALA resulted in abductor weakness. However, this effect was only observed in males and as the study is from 4 decades ago, the results are not comparable to those of contemporary studies.…”

Section: Discussionmentioning

confidence: 99%

Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial

et al. 2021

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Background: There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA). Methods: A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups. Results: Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance ( p < 0.05) and there was no difference in HHS ( p < 0.05) at the 6- and 12-months follow-up evaluations. Conclusion: Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm. Trial registration number: ClinicalTrials.gov NCT04640740 (retrospectively registered).

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“…[4] Studies comparing the two surgical approaches have shown conflicting results, leaving uncertainty about the choice of surgical approach for THA. [3,[5][6][7][8][9][10] A recent systematic review concluded that PA was superior to LA in terms of dislocation rate, Trendelenburg gait, heterotopic ossification, and stem malposition following primary THA. [11] On the other hand, a more recent systematic review concluded that LA is more optimal concerning pain, functional outcomes, and complication rate following primary THA.…”

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confidence: 99%

Post-operative clinical outcomes and complications of posterior versus lateral approach for primary total hip arthroplasty: A retrospective cohort study

Halawani

Ghaddaf

Alomari

et al. 2022

JMSR

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Objectives: Total hip arthroplasty (THA) is considered one of the therapeutic procedures frequently performed in orthopedic surgery. It is believed that the surgical approach could influence the clinical outcomes following THA. We performed a retrospective cohort study to compare the postoperative clinical outcomes and complications between the posterior approach (PA) and the lateral approach (LA) for primary THA. Methods: We enrolled patients who underwent primary THA through PA or LA. We sought to evaluate the postoperative complications including the need for intra- or postoperative blood transfusion, dislocation rate, and venous thromboembolism events, and the clinical outcomes, including length of hospital stay, operative time, and perioperative blood loss. Results: A total of 211 patients (71 patients in PA vs. 140 patients in LA) were deemed eligible to be included in this study. There was no significant difference between PA and LA in post-operative clinical outcomes concerning operative time, and perioperative blood loss except for the length of hospital stay (PA median = 6.0 days vs. LA median = 9.0 days; P < 0.001) patients. After adjustment for the potential confounders, the length of hospital stay was found to be similar between the two groups (P = 0.06). Similarly, no difference was found between PA and LA in post-operative complications concerning the need for intra-operative blood transfusion, dislocation rate, and venous thromboembolism events except for the need for postoperative blood transfusion (RR = 1.82, 95% CI 1.16–2.87), which continued to be significantly higher in PA even after adjustment for the potential confounders (P ≤ 0.01). Conclusion: PA and LA herald similar outcomes for patients undergoing primary THA concerning the postoperative clinical outcomes and complications except for the need for post-operative blood transfusion.

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Postoperative gait mechanics in patients after total hip arthroplasty: a systematic review and meta-analysis

Cited by 3 publications

References 0 publications

Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty

Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty

Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial

Post-operative clinical outcomes and complications of posterior versus lateral approach for primary total hip arthroplasty: A retrospective cohort study

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