Functional states of the hip joint in the early postoperative period with direct anterior arthroplasty with a skin incision «bikini»

BACKGROUND: The prevalence of coxarthrosis at age of 18 years and older has reached 13% in recent years. Total hip arthroplasty is considered the gold standard for the treatment of late-stage coxarthrosis and other hip pathologies. Due to the more frequent intervention performed in recent years and increasing patient expectations, the choice of optimal surgical access will improve the outcomes of the treatment method. However, given the lack of statistical data on the qualitative difference in the postoperative condition of patients using different surgical accesses during hip arthroplasty, there is no consensus on the optimal access choice.

AIM: To carry out a comparative assessment of the hip joint functional states in the postoperative period after endoprosthesis using direct anterior and anterolateral accesses.

MATERIALS AND METHODS: The study included 163 patients with coxarthrosis, 71 men and 92 women, who were subsequently divided into 2 groups: the comparison and the main one. To investigate the effectiveness of the proposed approach to endoprosthesis, the results were evaluated by dynamic assessment of joint function using the Barthel scale, the Stand and Walk test, the Leken algo-functional index, the Harris Hip Score scale, and the Health Assessment Questionnaire. The Statistical analysis was performed using StatSoft Statistica 10 and Microsoft Excel 2016 software packages. Intergroup comparisons of quantitative indicators were performed using the Mann-Whitney rank test in case of nonparametric distribution of indicator values and/or significant difference in groups.

RESULTS: The findings showed that in the postoperative period, the use of direct anterior access in hip arthroplasty was associated with faster recovery of hip joint functionality and shorter inpatient stay compared with anterolateral access, which was confirmed by statistically significant intergroup differences.

CONCLUSION: The clinical efficacy from using the direct anterior access can be seen in statistically significantly (p <0.05) higher scores on the Barthel self-care scale, the results of the "Stand up and walk" test 2–6 weeks after surgery, as well as better dynamics of the Harris Hip Score, Leken Index, and Health Assessment Questionnaire 1–3 months after hip arthroplasty.