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Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

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Abstract

Purpose

We conducted this study to establish if the transition from a lateral approach (LA) to the direct anterior approach (DAA) for a low volume hip arthroplasty surgeon during the steep learning curve can be performed maintaining the muscle sparing approach of the DAA without increasing the complication rates.

Methods

In this controlled, prospective, randomized clinical study we investigated 70 patients (35 DAA, 35 LA) with similar demographics that underwent a total hip arthroplasty. Assessment of the two approaches consisted of determining the invasiveness through serum markers for muscle damage (i.e. myoglobin, creatine kinase and lactate dehydrogenase), the operative parameters such as post-operative pain and rescue medication consumption, the component positioning and complication rates.

Results

Post-operative myoglobin levels were higher (p < 0.001) in the LA group (326.42 ± 84.91 ng/mL) as compared to the DAA group (242.80 ± 71.03 ng/mL), but with no differences regarding other biomarkers for muscle damage. Pain levels were overall lower in the DAA group, with a statistical and clinical difference during surgery day (p < 0.001) associated with lower (p < 0.001) rescue medication consumption (median 1 (1; 3) mg morphine vs. 3 (2; 4) mg morphine). Most patients in the LA group reported chronic post-operative pain throughout all three evaluated months, while the majority of patients in the DAA group reported no pain after week six. Component positioning did not differ significantly between groups and neither did complication rates.

Conclusion

The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

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Authors and Affiliations

  1. Department of Orthopaedics, Traumatology and Paediatric Orthopaedics, Iuliu Haţieganu University of Medicine and Pharmacy, 47 Traian Mosoiu street, Cluj-Napoca, 400132, Romania

    Dan-Viorel Nistor, Sergiu Caterev, Dan Cosma, Dan Osvald Gheorghe Lucaciu & Adrian Todor

  2. Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Sorana-Daniela Bolboacă

Authors
  1. Dan-Viorel Nistor
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  2. Sergiu Caterev
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  3. Sorana-Daniela Bolboacă
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  4. Dan Cosma
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  5. Dan Osvald Gheorghe Lucaciu
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  6. Adrian Todor
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Correspondence to Dan-Viorel Nistor.

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There are no funding sources in support of this research.

Ethical approval

Institutional Review Board approval was obtained prior to starting this research. All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Nistor, DV., Caterev, S., Bolboacă, SD. et al. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?. International Orthopaedics (SICOT) 41, 2245–2252 (2017). https://doi.org/10.1007/s00264-017-3480-8

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  • DOI: https://doi.org/10.1007/s00264-017-3480-8

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