Comparison of the early efficacy between direct anterior approach and posterolateral approach in total hip arthroplasty and analysis of the risk factors of postoperative persistent pain

ObjectiveTo compare the early efficacy between direct anterior approach(DAA) and posterolateral approach(PLA) in total hip arthroplasty, and analyze the risk factors of postoperative persistent pain.

MethodsThe clinical data of 100 patients treated with total hip arthroplasty were retrospectively analyzed, and the patients were divided into the DAA group(40 cases) and PLA group(60 cases).The length of incision, operation time, intraoperative blood loss, haemoglobin decrease on the first day after operation, postoperative time to get out of bed, postoperative hospital stay, VAS score of pain after 1, 3 and 5 days of operation, Harris score of hip joint function after 1, 3 and 6 months of operation, and occurrence of related complications were compared between two groups.The risk factors in 30 patients with postoperative persistent pain were further analyzed.

ResultsOne hundred cases were followed up for more than 6 months.Compared with the PLA group, the incision length was shorter, the postoperative time to get out of bed and hospital stay were shorter, the VAS score after 1, 3 and 5 days of operation were lower, and the Harris score after 1 and 3 months of operation were shorter in the DAA group(P<0.05).The differences of the operative time, intraoperative blood loss, hemoglobin decrease value after 1 day of operation, and Harris score of hip function after 6 months of surgery between two groups were not statistically significant(P>0.05).The results of multivariate logistic analysis showed that the younger age, higher body mass index and longer operative time were the independent risk factors of persistent pain after primary hip arthroplasty(P<0.01).

ConclusionsCompared with the PLA, the DAA total hip arthroplasty has the advantages of less wound exposure, less postoperative pain, early ambulation time and faster recovery of hip joint function in the early postoperative period, especially in patients' self-feeling recovery.The age<60 years old, body mass index >26 kg/m² and operation time >1.0 h are the risk factors of persistent pain after primary hip arthroplasty.