A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty

BMC Musculoskelet Disord. 2018 Jul 19;19(1):241. doi: 10.1186/s12891-018-2133-4.

Abstract

Background: The presented prospective randomized controlled single-centre study compares the clinical outcome up to 12 months after total hip arthroplasty using a minimally invasive single-incision direct anterior (DAA) and a direct transgluteal lateral approach.

Methods: A total of 123 arthroplasties were evaluated utilizing the Harris Hip Score (HHS), the extra short musculoskeletal functional assessment questionnaire (XSFMA), the Short Form 36 (SF-36) health survey, a Stepwatch™ Activity Monitor (SAM), and a timed 25 m foot walk (T25-FW). Postoperative x-ray images after THA were reviewed to determine inclination and stem positioning.

Results: At final follow-up, the XSFMA functional index scores were 10.3 (anterior) and 15.08 (lateral) while the bother index summed up to a score of 15.8 (anterior) and 21.66 (lateral) respectively, thus only differing significantly for the functional index (p = 0.040 and p = 0.056). The SF-36 physical component score (PCS) was 47.49 (anterior) and 42.91 (lateral) while the mental component score (MCS) summed up to 55.0 (anterior) and 56.23 (lateral) with a significant difference evident for the PCS (p = 0.017; p = 0.714). Patients undergoing THA through a DAA undertook a mean of 6402 cycles per day while those who had undergone THA through a transgluteal approach undertook a mean of 5340 cycles per day (p = 0.012). Furthermore, the obtained outcome for the T25-FW with 18.4 s (anterior) and 19.75 s (lateral) and the maximum walking distance (5932 m and 5125 m) differed significantly (p = 0.046 and p = 0.045). The average HHS showed no significant difference equaling 92.4 points in the anterior group and 91.43 in the lateral group (p = 0.477). The radiographic analysis revealed an average cup inclination of 38.6° (anterior) and 40.28° (lateral) without signs of migration.

Conclusion: In summary, our outcomes show that after 1 year THA through the direct anterior approach results in a higher patient activity compared to THA utilizing a transgluteal lateral approach while no differences regarding hip function are evident.

Trial registration: DRKS00014808 (German Clinical Trial Register DRKS); date of registration: 31.05.2018.

Keywords: Direct anterior approach; Minimally invasive; Prospective study; Total hip arthroplasty; Transgluteal approach.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroplasty, Replacement, Hip / standards
  • Arthroplasty, Replacement, Hip / trends*
  • Buttocks / diagnostic imaging
  • Buttocks / surgery
  • Female
  • Follow-Up Studies
  • Health Surveys / trends
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Minimally Invasive Surgical Procedures / standards
  • Minimally Invasive Surgical Procedures / trends*
  • Prospective Studies
  • Treatment Outcome