A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy

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• 作者：Timothy J. Lin ; MD ; MS^a ; ¹ ; Ilya Bendich ; MD ; MBA^b ; ² ; Alex S. Ha ; MD^b ; ³ ; Benjamin J. Keeney ; PhD^a ; ^b ; ; Wayne E. Moschetti ; MD ; MS^a ; ^b ; Ivan M. Tomek ; MD^a ; ^b ; ⁴
• 关键词：total hip arthroplasty ; direct anterior approach ; posterior approach ; radiographic outcomes ; acetabular inclination angle
• 刊名：The Journal of Arthroplasty
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：32
• 期：2
• 页码：616-623
• 全文大小：644 K
• 卷排序：32

文摘

Radiographic outcomes after total hip arthroplasty (THA) have been linked to clinical outcomes. The direct anterior approach (DAA) for THA has been criticized by some for providing limited exposure and compromised implant position but allows for routine use of intraoperative fluoroscopy. We sought to determine whether radiographic measurements differed by THA approach using prospective cohorts.MethodsTwo reviewers blinded to surgical approach examined 194 radiographs, obtained 4-6 weeks after primary THA, and obtained measurements for acetabular inclination angle, acetabular anteversion, radiographic limb length discrepancy (LLD), and femoral offset. All surgeries were performed at a tertiary academic medical center in rural New England by an experienced fellowship-trained arthroplasty surgeon. Measurements for inclination angle, anteversion, LLD, and offset were made into binary yes/no responses based on whether the mean measurement (between the 2 reviewers) was acceptable or not based on established criteria. Multivariate logistic regression analyses were performed using preoperative and intraoperative characteristics to identify predictors of acceptability for each measurement.ResultsThe DAA group had higher rates of acceptable acetabular angle (96 vs 85%, P = .005) and was protective against an unacceptable angle in an adjusted predictive model (odds ratios 0.16, P = .005). There were no significant differences between approaches for acceptable anteversion, LLD, or offset. Body mass index of 30-34 was associated with higher odds of unacceptable inclination angle compared to the nonobese group (adjusted odds ratio, 6.82, P = .013).ConclusionDAA for THA was associated with lower odds of unacceptable inclination angle compared to the posterior approach, with no differences in anteversion, LLD, or offset.