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Pain and rehabilitation after total hip arthroplasty are approach dependent: results 6 weeks and 2 years after surgery in a multisurgeon, single-center, and prospective cohort study

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was the evaluation of pain, function, and overall satisfaction after total hip arthroplasty (THA) using three different standard surgical approaches (DAA (direct anterior approach), lateral, and posterior approach) 2 years postoperatively. Additionally, we compared the results with recently published results of the same study population 6 weeks postoperatively.

Methods

In a multisurgeon, prospective, single-center cohort study, a total of initial 188 patients who underwent total hip arthroplasty (THA) between February 2019 and April 2019 were analyzed on pain, function, and satisfaction within the first days, 6 weeks, and 2 years postoperatively according to three different approaches (DAA, lateral, and posterior approach). Our research group recently published results directly and 6 weeks postoperatively. We evaluated the same study collectively 2 years postoperatively and compared the results with the data 6 weeks postoperatively. One hundred twenty-five patients could be included. Outcome parameters for the present study were the pain level according to the visual analogue scale (VAS), the modified Harris hip score (mHHS), and an overall satisfaction scale 2 years postoperatively.

Results

Mean overall satisfaction 2 years postoperatively was 9.7 ± 1 (3–10). Satisfaction was significantly better for the DAA than for the lateral approach (p = 0.005). There were no significant differences between the lateral and posterior approaches (p = 0.06) and between the DAA and the posterior approaches (p = 0.11). In total, the mean pain level was 0.4 ± 0.9 (0–5) at 6 weeks and 0.5 ± 1.1 (0–7) at 2 years postoperatively (p = 0.3). Regarding the different approach groups, pain levels 6 weeks and 2 years postoperatively were significantly lower for the DAA than for the lateral approach (p = 0.02). There were no significant differences between DAA and posterior approach (p = 0.05) and the lateral and posterior approach (p = 0.26). The mean mHHS significantly increased from 84.7 + 14.5 (37.4–100) 6 weeks to 95 + 12.5 (23.1–100.1) 2 years postoperatively (p < 0.0001). Regarding the different approaches, mHHS was significantly higher for the DAA than for the lateral approach (p = 0.03). Differences between the DAA and the posterior approach (p = 0.11) and between the lateral and posterior approaches (p = 0.24) were insignificant.

Conclusion

At 2 years postoperative, DAA showed significantly better overall satisfaction, pain level, and mHHS than the lateral approach. The differences between DAA and the posterior approach and lateral and posterior approaches were insignificant. Whether the superior results of the DAA to the lateral approach persist over a longer period must be clarified by further studies.

Study design

Prospective cohort study, level of evidence 2.

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References

  1. Zimmerer A, Steinhaus M, Sickmüller E et al (2021) Pain and rehabilitation after total hip arthroplasty are approach dependent: a multisurgeon, single-center, prospective cohort study. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-03921-0

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ethgen O, Bruyere O, Richy F et al (2004) Health related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86(5):963–974

    Article  PubMed  Google Scholar 

  3. Lavernia CJ, Alcerro JC (2011) Quality of life and cost-effectiveness 1 year after total hip arthroplasty. J Arthroplasty 26(5):705–709

    Article  PubMed  Google Scholar 

  4. Dailiana ZH, PapakostidouI VS et al (2015) Patient-reported quality of life after primary major joint replacement: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-015-0814-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pennington MW, Grieve R, van der Meulen JH (2015) Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty. Bone joint J 97B(6):762–770

    Article  Google Scholar 

  6. Graves SC, Dropkin BM, Keeney BJ et al (2016) Does surgical approach affect patient-reported function after primary THR? Clin Orthop Relat res 474(4):971–981

    Article  PubMed  Google Scholar 

  7. Wang T, Shao L, Xu W et al (2011) Comparison of morphological changes of the gluteus medius and the abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches. Int Orhopaed 43(11):2467–2475

    Article  Google Scholar 

  8. Talia AJ, Coetzee C, Tirosh O et al (2018) Comparison of outcome measure and complication rates following three different approaches for primary total hip arthroplasty. Trials 19(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  9. Miller LE, Gondusky JS, Bhattacharyya S et al (2018) Does surgical approach affect outcomes in total hip arthroplasty through 90 days of follow-up? A systematic review with meta-analysis. J Arthr 33(4):1296–1302

    Article  Google Scholar 

  10. Higgins BT, Barlow DR, Haegerty NE et al (2015) Anterior vs posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthr 30(3):419–434

    Article  Google Scholar 

  11. Wang Z, Hou J-z, Wu C-h et al (2018) A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res 13(1):335

    Article  Google Scholar 

  12. Miller LE, Kamath AF, Boettner F et al (2018) In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials. JPR 11:1327–1334

    Article  Google Scholar 

  13. Kobayashi H, Homma Y, Baba T et al (2016) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int Orthopaed (SICOT) 40(9):1813–1819

    Article  Google Scholar 

  14. Radoicic D, Zec V, Elassuity WI et al (2018) Patient’s perspective on direct anterior versus posterior approach total hip arthroplasty. Int Orthopaed 42(12):2771–2775

    Article  Google Scholar 

  15. Parvizi J, Rasouli MR, Jaberi M et al (2013) Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss? Int Orthopaed 37(12):2357–2362

    Article  Google Scholar 

  16. Seah S, Quinn M, Tirosh O et al (2019) Postoperative opioid consumption after total hip arthroplasty: a comparison of three surgical approaches. J Arthr 34(11):2676-2680 17

    Article  Google Scholar 

  17. Peters RM, van Beers LWAH, van Steenbergen LN et al (2018) Similar superior patient-reported outcome measures for anterior and posterolateral approaches after total hip arthroplasty. J Arthroplasty 33(6):1786–1793

    Article  PubMed  Google Scholar 

  18. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An endresult study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755

    Article  CAS  PubMed  Google Scholar 

  19. Byrd JWT (2003) Hip arthroscopy: patient assessment and indications. Instr Course Lect 52:711–719

    PubMed  Google Scholar 

  20. Faul F, Erdfelder E, Buchner A et al (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160

    Article  PubMed  Google Scholar 

  21. Gazendam A, Bozzo A, Ekhtiari S et al (2022) Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis. Arch Orthop Trauma Surg 142(10):2893–2902

    Article  PubMed  Google Scholar 

  22. Mjaaland KE, Kivle K, Svenningsen S, Nordsletten L (2019) Do postoperative results differ in a randomized trial between a direct anterior and a direct lateral approach in THA? Clin Orthop Relat Res 477(1):145–155

    Article  PubMed  Google Scholar 

  23. Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthr 28(9):1634–1638

    Article  Google Scholar 

  24. Martusiewicz A, Delagrammaticas D, Harold RE et al (2019) Anterior versus posterior approach total hip arthroplasty: patient reported and functional outcomes in the early postoperative period. Hip Int 14:112070001988141

    Google Scholar 

  25. Weber M, Benditz A, Woerner M et al (2017) Trainee surgeons affect operative time but not outcome in minimally invasive total hip arthroplasty. Sci Rep 7(1):6152

    Article  PubMed  PubMed Central  Google Scholar 

  26. Restrepo C, Parvizi J, Pour AE et al (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthr 25(5):671-679.e1

    Article  Google Scholar 

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Funding

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Authors and Affiliations

  1. ARCUS Sports Clinic Pforzheim, Rastatterstr. 17-19, 75179, Pforzheim, Germany

    Benjamin Ulmar, Katarzyna Remiszewska, Luis Contreras Navas, Matthias Hauschild, Stefan Kinkel & Alexander Zimmerer

  2. Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany

    Benjamin Ulmar

  3. Outpatient Clinics for Orthopedics, Department of Joint- and Limb Surgery, University of Aachen (RWTH), Sanatoriumstrasse 10, 52064, Aachen, Germany

    Marco Schneider

  4. University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany

    Marco Schneider

  5. Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany

    Alexander Zimmerer

Authors
  1. Benjamin Ulmar
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  2. Katarzyna Remiszewska
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  3. Luis Contreras Navas
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  4. Matthias Hauschild
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  5. Marco Schneider
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  6. Stefan Kinkel
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  7. Alexander Zimmerer
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Corresponding author

Correspondence to Alexander Zimmerer.

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The authors report no conflict of interest.

Ethical approval

This study was approved by IRB/Ethikkommission Landesärztekammer Baden-Württemberg, Germany.

Informed consent

All patients consented to the study.

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Ulmar, B., Remiszewska, K., Navas, L.C. et al. Pain and rehabilitation after total hip arthroplasty are approach dependent: results 6 weeks and 2 years after surgery in a multisurgeon, single-center, and prospective cohort study. Arch Orthop Trauma Surg 143, 6431–6437 (2023). https://doi.org/10.1007/s00402-023-04854-6

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  • DOI: https://doi.org/10.1007/s00402-023-04854-6

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