[Comparison of short-term effectiveness of staged bilateral total hip arthroplasty via different approaches].

Objective: To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches.

Methods: Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups.

Results: All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group ( P <0.05). The operation time was significantly longer in DAA group than in DLA group ( P <0.05). There was no significant difference in acetabular anteversion angle between 2 groups ( t =1.122, P =0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference ( χ 2 =0.869, P =0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group ( P <0.05); there was no significant difference at 18 months after operation between 2 groups ( P >0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation ( P <0.05); there was no significant difference at 4 and 8 weeks between 2 groups ( P >0.05). The prosthesis did not loosen and sink during the follow-up.

Conclusion: Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.