Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study

Abstract Background One of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are avail...

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Autores principales:	Davide Castioni, Olimpio Galasso, Bruno Iannò, Michele Mercurio, Giorgio Gasparini
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Total hip arthroplasty Surgical approach; health-related quality-of-life Complications Trendelenburg; residual pain Serum creatine phosphokinase Activities of daily living Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/69e4e1ceb6a049f8ac6578d7d1467c3f
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spelling	oai:doaj.org-article:69e4e1ceb6a049f8ac6578d7d1467c3f2021-11-14T12:28:13ZPosterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study10.1186/s12891-021-04679-71471-2474https://doaj.org/article/69e4e1ceb6a049f8ac6578d7d1467c3f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04679-7https://doaj.org/toc/1471-2474Abstract Background One of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are available for their comparison in terms of health-related quality-of-life (HRQoL). The aim of this study was to assess the role of the PA and LA in the HRQoL and hip functionality of patients who underwent primary and elective THA for osteoarthritis, after a minimum 2-year follow-up. Methods One hundred twenty-eight patients (140 THAs: 68 with PA and 72 with LA) were evaluated in a matched cohort study. Data gathered included the body mass index, the American Society of Anesthesiologists score, surgery time, serum creatine phosphokinase (CpK) levels, estimated intraoperative blood loss and intra- or postoperative complications. Preoperatively and at the last follow-up, the activities of daily living, and the instrumental activities of daily living (IADL) scales, the Western Ontario and Mac Master University (WOMAC) Questionnaire, the Harris Hip Score (HHS) and the Visual Analogue Scale (VAS) were used to assess HRQoL and functionality. The Short Form-36 Health Survey (SF-36) Questionnaire was administered at the last follow-up. Results Postoperatively, CpK was higher in the LA group compared to the PA (695 ± 648 vs. 447 ± 326 UI/L, p < 0.001). At a mean follow-up of 47 ± 22 months for the LA group and 42 ± 29 months for the PA group, IADL, VAS, HHS and WOMAC scores significantly improved for both groups (all p < 0.001), but PA reported better VAS, residual pain and WOMAC scores (p = 0.002, p = 0.004 and p = 0.018, respectively). The PA group demonstrated a significant higher mental SF-36 subscale values than the LA group (49 ± 13 vs. 42 ± 19, p = 0.001). The LA group showed a higher number of Trendelenburg signs (p = 0.029). On the contrary, the PA group showed a higher number of leg lengthening (p = 0.020); however, most of these cases was less than the clinically significant value of 10 mm (p = 0.738). Conclusions Patients who underwent THA performed with the PA reported greater improvement in HRQoL with lower residual pain, postoperative muscle damage and Trendelenburg signs than those who underwent the LA.Davide CastioniOlimpio GalassoBruno IannòMichele MercurioGiorgio GaspariniBMCarticleTotal hip arthroplastySurgical approach; health-related quality-of-lifeComplicationsTrendelenburg; residual painSerum creatine phosphokinaseActivities of daily livingDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss S2, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Total hip arthroplasty Surgical approach; health-related quality-of-life Complications Trendelenburg; residual pain Serum creatine phosphokinase Activities of daily living Diseases of the musculoskeletal system RC925-935
spellingShingle	Total hip arthroplasty Surgical approach; health-related quality-of-life Complications Trendelenburg; residual pain Serum creatine phosphokinase Activities of daily living Diseases of the musculoskeletal system RC925-935 Davide Castioni Olimpio Galasso Bruno Iannò Michele Mercurio Giorgio Gasparini Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
description	Abstract Background One of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are available for their comparison in terms of health-related quality-of-life (HRQoL). The aim of this study was to assess the role of the PA and LA in the HRQoL and hip functionality of patients who underwent primary and elective THA for osteoarthritis, after a minimum 2-year follow-up. Methods One hundred twenty-eight patients (140 THAs: 68 with PA and 72 with LA) were evaluated in a matched cohort study. Data gathered included the body mass index, the American Society of Anesthesiologists score, surgery time, serum creatine phosphokinase (CpK) levels, estimated intraoperative blood loss and intra- or postoperative complications. Preoperatively and at the last follow-up, the activities of daily living, and the instrumental activities of daily living (IADL) scales, the Western Ontario and Mac Master University (WOMAC) Questionnaire, the Harris Hip Score (HHS) and the Visual Analogue Scale (VAS) were used to assess HRQoL and functionality. The Short Form-36 Health Survey (SF-36) Questionnaire was administered at the last follow-up. Results Postoperatively, CpK was higher in the LA group compared to the PA (695 ± 648 vs. 447 ± 326 UI/L, p < 0.001). At a mean follow-up of 47 ± 22 months for the LA group and 42 ± 29 months for the PA group, IADL, VAS, HHS and WOMAC scores significantly improved for both groups (all p < 0.001), but PA reported better VAS, residual pain and WOMAC scores (p = 0.002, p = 0.004 and p = 0.018, respectively). The PA group demonstrated a significant higher mental SF-36 subscale values than the LA group (49 ± 13 vs. 42 ± 19, p = 0.001). The LA group showed a higher number of Trendelenburg signs (p = 0.029). On the contrary, the PA group showed a higher number of leg lengthening (p = 0.020); however, most of these cases was less than the clinically significant value of 10 mm (p = 0.738). Conclusions Patients who underwent THA performed with the PA reported greater improvement in HRQoL with lower residual pain, postoperative muscle damage and Trendelenburg signs than those who underwent the LA.
format	article
author	Davide Castioni Olimpio Galasso Bruno Iannò Michele Mercurio Giorgio Gasparini
author_facet	Davide Castioni Olimpio Galasso Bruno Iannò Michele Mercurio Giorgio Gasparini
author_sort	Davide Castioni
title	Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
title_short	Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
title_full	Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
title_fullStr	Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
title_full_unstemmed	Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
title_sort	posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/69e4e1ceb6a049f8ac6578d7d1467c3f
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Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study

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