The Clinical Outcomes After Direct Anterior Approach and Microposterior Approach for Total Hip Arthroplasty

NCT03210844 | Unknown

• 1 other identifier: 201511088RINB
• Study Type: observational
• Target: 141
• Locations: 1 country
• Sites: 1

Brief Summary

Background The direct anterior approach (DAA) and micro-posterior approach (micro-PA) for total hip arthroplasty (THA) become popular approaches due to their fast recovery and good clinical outcomes. However, little is known if DAA is superior to micro-PA in implant positioning and functional outcomes for THA patients. Methods The investigators conducted a non-randomized comparative study to compare component positioning and clinical outcomes of the consecutive unilateral primary THA patients operated with DAA techniques and that of those operated with micro-PA techniques by a single surgeon. The investigators used DAA techniques with standard operation table and micro-PA techniques featuring indirect-contracture-releasing capsulotomy, preservation of short external rotators except piriformis and conjoint tendon, and tendon-to-bone capsulotendinous repair. The investigators used propensity-score matching analysis to compare the postoperative THA component positioning and clinical outcomes in DAA and micro-PA groups.

Conditions

Total Hip Arthroplasty

Keywords

total hip arthroplasty; direct anterior; posterior approach

Outcome Measures

Primary Outcomes (3)

• Radiographic component positions - femoral alignment

  femoral alignment - to measure the angle between the stem axis and proximal femur axis on X ray 3. Cup inclination angle

  Postoperative 2 year

• Radiographic component positions - Cup anteversion angle

  to measure the cup anteversio angle on the X ray

  Postoperative 2 year

• Radiographic component positions - Cup inclination angle

  to measure the cup inclination angle on the X ray

  Postoperative 2 year

Secondary Outcomes (10)

• Leg length control

  Postoperative 2 year

• Perioperative pain intensity

  postoperative 1st, 2nd and 3rd days

• Morphine usage

  postoperative 1st, 2nd and 3rd days

• Functional outcomes - Oxford hip score

  Postoperative 2 year

• Functional outcomes - EQ5D score

  Postoperative 2 year

Study Arms (2)

Direct anterior approach

For the DAA group, we used single-incision direct anterior approach with a standard operation table in J Arthroplasty. 2008 Oct;23(7 Suppl):64-8. Epub 2008/10/24. . The incision size was 6-10 cm depending on the body build of the patient. The acetabularreaming was performed with an offset hemispheric reamer and acetabular component was inserted underfluoroscopic guidance. Femoral broaching was performed using a double-offset broach handle.Fluoroscopy was used to check the positioning and filling of femoral stem, as well as leg lengths.

Procedure: Surgical approaches of total hip arthroplasty

Microposterior approach

The incision size was 6 - 10 cm depending on the body build of the patient. The differences of our micro-PA from Dorr's techniques were: First, no excision of the anterosuperior capsule and medial inferior capsule because the senior author believe that preservation of these structures could help to maintain the postoperative stability of the THA. Second, after the gluteus minimus muscle was elevated from the superior capsule, a superior capsulomy starting from 12 o'clock direction of acetabulum in decubitus position was made. The hip capsule was then incised in 12-to- 6-o'clock downward direction and curved down around femoral neck under the other short external rotators. We preserved short external rotators except piriformis tendon. Third, the capsular incision was continued inferiorly following 12-to- 6-o'clock downward direction of acetabulum to the transverse acetabular ligament. The tube structure of original hip capsule was divided into anterior and posterior half leaflets.

Procedure: Surgical approaches of total hip arthroplasty

Interventions

Surgical approaches of total hip arthroplasty PROCEDURE

Surgical approaches of total hip arthroplasty

Direct anterior approach; Microposterior approach

Eligibility Criteria

• Age: 20 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

patients with unilateral hip arthritis indicated for THA

patients with unilateral hip arthritis indicated for THA

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Sponsors & Collaborators

• National Taiwan University Hospital: lead

Study Sites (1)

National Taiwan University Hospital

Taipei, 106, Taiwan

Location

Study Officials

• Wang Chen-Ti

  National Taiwan University Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 25, 2017
• First Posted: July 7, 2017
• Study Start: October 1, 2013
• Primary Completion: July 30, 2017
• Study Completion: July 30, 2017
• Last Updated: July 7, 2017

Record last verified: 2017-06

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)