RUDN University doctors find the best option for hip joint replacement surgery

A doctor from RUDN University and his American colleagues from Sinai Hospital in Baltimore and the College of Osteopathy in Philadelphia, compared two methods of surgical intervention used for replacing the hip joint with an endoprosthesis, and determined which one is less traumatic and allows faster postoperative recovery. It turned out that with anterolateral access, i.e. a single skin incision, patients experience less pain after surgery and recover faster than with direct lateral access. The results of the study are published in HIP International.

The hip joint, the largest one in human body, is almost constantly in use. Over time, it wears out, and osteoarthritis develops, in which a person experiences acute pain. If the joint is damaged irreversibly, it becomes necessary to replace it with an endoprosthesis. Hip arthroplasty operations are performed regularly, and their outcome largely depends on the type of access, that is, on how the surgeon gets to the bones that need to be replaced. The more tissue is damaged during the surgery, the longer the period of rehabilitation. Therefore, doctors try different minimally invasive methods, in which muscles and tendons are not affected.

Anton Semenistyj from the Department of Traumatology and Orthopedics of RUDN University and his colleagues from the United States studied two types of endoprosthesis surgeries that differ in ways to access the joint: anterolateral and direct lateral, and concluded that the former is less traumatic and its use reduces the postoperative recovery time.

Direct lateral access involves vertical and horizontal incisions of tissues. The intersection forms the entry point through which the operation is conducted. Anterolateral access is a single incision over the greater trochanter of the femur.

To find out which one of them is more favorable to patients, physicians monitored 220 patients for three years. There were approximately equal numbers of men and women, of average age of 64 and 62 years, respectively. Each patient was observed for the period of 12 to 35 months, depending on the complexity of the case. Researchers focused on the postoperative period. Doctors evaluated the pain intensity of patients after surgery, the frequency of opioid use, the length of hospital stay, and complications.

Analysis of the data showed that the intensity of pain in the first days after the operation was lower in patients who had anterolateral access during surgery. Therefore, there were less opioids injected: an average of 28 milligrams per day, against 32 in the group with direct lateral access.

Moreover, patients after surgery with anterolateral access were twice as likely to be discharged rather than referred for rehabilitation.

No statistically significant differences were observed between the two groups concerning the frequency of all types of postoperative complications of all types. However, with direct lateral access, almost twice as many patients had experienced weakness of the abducting muscles (65 patients versus 33 patients with anterolateral access) for long periods of time. The periods of stay in the hospital were approximately the same.

Thus, doctors have identified several benefits of using anterolateral access for hip replacement. However, for greater certainty, the researchers plan to increase the number of patients observed, as well as to take into account the long-term effects of the operation.

More information:
Nicole E George et al. Short-term outcomes of the supine muscle-sparing anterolateral versus direct lateral approach to primary total hip arthroplasty, HIP International (2019). DOI: 10.1177/1120700018812717

Provided by RUDN University