Title : The comparison of clinical and radiological outcomes of total HIP arthroplasty with direct anterior approach versus posterior approach- A randomised control trial
Abstract:
Our study aimed to compare clinical and radiological outcomes of Total Hip Arthroplasty (THA) via Direct Anterior Approach (DAA) versus Posterior Approach (PA) in a South-east Asian population, particularly in India. We included 40 patients with unilateral symptomatic hip arthritis, evenly split between the two approaches. Follow-ups were conducted at intervals up to one year postoperatively. Muscle fatty atrophy and soft tissue damage were assessed using muscle damage and inflammatory markers (ESR, CRP, LDH, Creatine Kinase, Myoglobin, Creatinine) and MRI scans preoperatively, at 3 months, and 1 year postoperatively. Functional outcomes were evaluated using gait analysis, Harris Hip Scores, and Forgotten Joint Score-12. Radiographs and EOSTM scan evaluated implant positioning and leg length. Return to activities of daily living was tracked using a milestone diary. Results showed higher postoperative muscle damage and inflammatory markers in the PA group, notably elevated CRP levels at POD 1-2(p=0.035) and 2 weeks(p=0.020). MRI scans revealed significant differences in fatty atrophy: Gluteus medius, Gluteus minimus, Piriformis, Obturator Internus, Obturator Externus, and Quadratus femoris had higher incidences in the PA group, while the Tensor Fasciae Latae exhibited a higher incidence in the DAA group. DAA patients demonstrated superior gait parameters postoperatively, with significant improvements in mean velocity(p=0.023) and stride length(p=0.013). Acetabular cup positioning fell within the safe zone for both groups, with no complications or dislocations. In summary, our findings suggest that DAA may offer advantages over PA in terms of reduced muscle damage, inflammation, and improved early gait parameters in patients undergoing THA
