Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings
© The Author(s) 2012
Received: 9 January 2012
Accepted: 13 March 2012
Published: 25 April 2012
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We implanted an uncemented prosthesis in both group A (198 patients: Bauer’s standard lateral approach and spinal or general anesthesia) and group B (221 patients: minimally invasive direct anterior approach and general anesthesia). We always use hemispherical cups coupled with different types of stems. In the majority of cases we used straight stems followed by anatomical stems, while lately we have started to use short stems that are expressly designed for minimally invasive access. Having said that, cemented implants can also be used with a minimally invasive direct anterior approach, as reported by expert authors such as Matta and Rachbauer [1, 2]. We use cemented implants in cases of femoral neck fracture that are treated with hemiarthroplasty.
Both groups followed the same rehabilitation protocol and had the same rehabilitation goals. Complete functional recovery was achieved earlier and therefore the length of hospital stay (LOS) was reduced in group B. Patients in group A achieved a sufficient degree of autonomy to allow discharge on day 10 on average, and started walking without crutches around week 8. Patients in group B achieved the same goals at day 7 and walked autonomously in week 2. This difference is due, in our opinion, to the tissue sparing associated with the minimally invasive anterior approach.
NRS on postoperative day 1
p < 0.05
Meperidine + NSAID
Morphine + NSAID
Tramadol + NSAID
Oxycodone + paracetamol
Conflict of interest
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