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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 9 mars 2019
Doi : 10.1016/j.otsr.2019.02.008
Received : 21 October 2018 ;  accepted : 1 February 2019
Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry
 

Gautier Bon , Elias Ben Kacem, Pierre Marie Lepretre, Thierry Weissland, Patrice Mertl, Massinissa Dehl, Antoine Gabrion
 Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire d’Amiens Picardie, Amiens, France 

Corresponding author. Service de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire d’Amiens Picardie–Site Sud D 408, 80054 Amiens cedex, France.France
Abstract
Introduction

In total hip arthroplasty (THA), the anterior approach is attractive, being intermuscular, with theoretic functional benefit. Such benefit has been frequently claimed, but there are few data from randomized comparative studies using more precise metrics than patient satisfaction. We therefore conducted a randomized trial comparing early functional results between anterior and posterior approaches on gait analysis and functional scores.

Hypothesis

The study hypothesis was that there is no difference between the two approaches in terms of early recovery of walking.

Materials and method

A single-center single-surgeon prospective randomized study was conducted between February 2017 and April 2018. Inclusion criteria comprised: age<85 years, body-mass index (BMI)<32, and hip osteoarthritis with indication for THA. Preoperatively, the 2 groups were comparable for age, gender, BMI, Charnley, Harris, Postel-Merle-d’Aubigné and Oxford-12 scores and locomotor parameters (triaxial acceleration, step regularity and walking power). Preoperative and 3-, 6- and 12-week assessment comprised triaxial acceleration in walking and Postel-Merle-d’Aubigné, Harris and Oxford SF-12 scores.

Results

One hundred patients were randomized to the anterior approach (AA: n =50) and posterior approach (PA: n =50) groups. Hospital stay was comparable between groups: PA, 2.8±1.78 days [range, 2.29-3.31 days]; AA, 2.84±1.25 days [range, 2.48-3.2 days] (p =0.8). Operative time was significantly longer in AA: 70.1±11 minutes vs. 56.7±11.79 (p <0.0001). There were no significant differences in locomotor parameters (p 0.122 to 0.987) or functional scores (p 0.052 to 0.968) over the 3-month follow-up. There was no difference in cup inclination: PA, 39.6±6.87° [range, 37.65-41.55°] vs. AA, 37.74±4.2° [range, 36.55-38.93°] (p =0.09). There were 8/50 cases (16%) of neurapraxia of the lateral cutaneous nerve of the thigh in the AA group; rates for other complications did not differ between groups.

Conclusion

Early functional results and especially objective locomotor parameters following THA were comparable between anterior and posterior approaches at 3 to 12 weeks. The approach should be chosen according to the surgeon's experience.

Level of evidence

II, low-power prospective randomized study.

The full text of this article is available in PDF format.

Keywords : Anterior approach, Posterior approach, Total hip arthroplasty, Gait, Functional scores




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