Direct Anterior Approach Versus Direct Lateral Approach in Total Hip Arthroplasty

Direct Anterior Approach Versus Direct Lateral Approach in Cementless Total Hip Arthroplasty

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.

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.

Inclusion Criteria:

• Clinical and radiological diagnosis of coxarthrosis
• Those deemed capable of giving informed consent, understanding the aims of the study and expressing willingness to comply with the post-operative review programme.

Exclusion Criteria:

• Previous surgery on affected hip
• The patient has inflammatory arthritis.
• The patient has any type of infection.
• The subject has a known metal allergy.
• Patients with co-existent ipsilateral knee disease or back problems
• Those with a known co-existent medical condition where death is anticipated within five years due to the pre-existing medical condition.
• Patients requiring bilateral hip replacement.
• Patient with active major psychiatric illness
• Patients whose body mass index (BMI; kg/m2) >35.
• Patients with active or suspected infection or sepsis.
• Patients with renal failure and/or renal insufficiency.