ObjectiveTo explore the effects of total hip arthroplasty through the gap between the piriformis and gluteal muscles approaches on the outcome and quality of life of elderly patients with hip fractures.

MethodsA total of 96 elderly patients(108 hips) with hip fractures were divided into the group A(50 cases, 55 hips) treated with posterolateral approach total hip arthroplasty and group B(46 cases, 53 hips) treated through the gap between the piriformis and gluteal muscles approaches.The perioperative condition(including the operation time, maximum length of the incision, intraoperative blood loss, postoperative down time), postoperative complications, preoperative hip HHS score, VAS pain score and lower limb function change situation, imaging indexes after six months of operation(including outreach angle, inclination angle and eccentricity) and quality of life(SF-36 scale) in two groups were recorded.

ResultsThe operation time and incision length in group A were shorter than those in group B, and the first landing time after operation in group A wasd longer than that in group B(P < 0.05 to P < 0.01).After 1, 3, and 7 days of operation, the HISS score in group A were lower than those in group B, and the VAS score in group A was higher than that in group B(P < 0.05 to P < 0.01).The differences of the scores of HISS and VAS after 14, 30, 90 and 180 days of operation between two groups were not statistically significant(P>0.05).The "stand up and walk" timing test after 30 and 90 days of operation in groups B were significantly better than those in group A, the one-leg standing test time after 30 days of opertaion in group B was longer than that in group A, the 6 min walk test distance at postoperative 90 days in groups B was significantly better than that in group A(P < 0.05).There was no statistical significance in the lower limb function between two groups at other time points(P>0.05).The rake angle in group A was smaller than that in group B, and the eccentricity in group A was larger than that in group B(P < 0.05).The scores of limb function, social function, mental health and total health of SF-36 scale in group B were better than those in grop A(P < 0.05).

ConclusionsCompared with the traditional posterolateral approach for total hip arthroplasty, the transpiriformis and gluteal muscle approach has less damage and faster recovery for elderly patients with hip fractures, and the short-term efficacy indicators of which are significantly better than that of traditional surgical methods.The total hip arthroplasty through the gap between the piriformis and gluteal muscles approaches is in line with the concept of rapid recovery, but the duration of surgery significantly increases, the patient′s postoperative anterior inclination is larger, and the eccentricity is smaller.Clinical follow-up is still needed to explore the long-term efficacy.