Direct Anterior Approach Versus Direct Lateral Approach in Total Hip Arthroplasty
Condition: Coxarthrosis
MeSH terms: Osteoarthritis, Hip
Study type: Interventional

Summary: 
      The purpose of this study is to compare the direct anterior approach and the direct lateral
      approach in primary total hip arthroplasty, regarding the postoperative function and pain,
      complications, radiological finds (X-ray), postoperative hemorrhage, markers for muscle
      damage (i.e creatine kinase (CK), lactate dehydrogenase(LDH/LD) , aspartate
      aminotransferase(AST), C-reactive protein (CRP),Troponin and Myoglobin) or other clinical
      outcomes.
    

Detailed description: 
      This is a prospective randomised controlled clinical trial and follow-up study comparing
      primary total hip arthroplasty performed either through a direct anterior approach or a
      lateral approach. At our hospital(i.e. Emergency County Hospital Cluj-Napoca), the lateral
      transgluteal approach was standard for more than 40 years. Starting 2008,the minimally
      invasive anterior approach was gradually implemented with the aim to facilitate early
      rehabilitation and improve functional results. Reduced blood loss, earlier functional
      recovery, low dislocation rates and shorter stays in hospital have been attributed to the
      muscle-sparing properties of the anterior approach.
    

Intervention name(s): direct anterior approach; direct lateral approach
Intervention type(s): Procedure; Procedure
Intervention description(s): The procedure begins by positioning the patient supine on a normal table . Both feet are draped separately to assist with dislocating and proximal femural shaft exposure.The surgical incision begins 2-4 cm lateral to the anterior superior iliac spine of the pelvis . It is then carried distally and laterally for about 8-12 cm. After protecting the lateral femoral cutaneous nerve, the fascia overlying the tensor fascia latae (TFL) is incised, and a plane is then developed between the TFL and sartorius. After coagulating the ascending branch of the lateral femoral circumflex artery, a capsulectomy is performed. Placement of the final acetabular component is facilitated by the use of an offset inserter handle.
Femoral preparation begins by placing the operative limb in a position of extension, adduction and external rotation to improve the accessibility of the proximal femur.
Once the final implants are in situ, the hip is reduced and assessed.; The procedure begins by positioning the patient in the supine decubitus position.
A longitudinal incision is made extending 3-5 cm proximal and about 5-8 cm distal to the tip of the greater trochanter . The fascia is split at the interval between the TFL and gluteus. The tendon and muscle fibres of the gluteus medius are then visualized and split . The gluteus minimus and joint capsule are split. The surgeon then dislocates the femoral head, and performs a femoral neck osteotomy.
The acetabulum is prepared .Soft tissue landmarks and reamer positioning relative to the floor are used to verify acetabular version and inclination.
When preparing the proximal femur, the hip is adducted and externally rotated, with the knee flexed. The femural stem is then press-fitted. Once the final implants are in situ and the hip is reduced, the stability of the construct is assessed.
Other intervention name(s): modified Smith-Peterson approach; Hardinge approach
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Coxarthrosis; Hip arthroplasty; Direct Anterior Approach; Direct Lateral Approach