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The Bone & Joint Journal
Vol. 98-B, Issue 6 | Pages 754 - 760
1 Jun 2016
Malek IA Royce G Bhatti SU Whittaker JP Phillips SP Wilson IRB Wootton JR Starks I

Aims

We assessed the difference in hospital based and early clinical outcomes between the direct anterior approach and the posterior approach in patients who undergo total hip arthroplasty (THA).

Patients and Methods

The outcome was assessed in 448 (203 males, 245 females) consecutive patients undergoing unilateral primary THA after the implementation of an ‘Enhanced Recovery’ pathway. In all, 265 patients (mean age: 71 years (49 to 89); 117 males and 148 females) had surgery using the direct anterior approach (DAA) and 183 patients (mean age: 70 years (26 to 100); 86 males and 97 females) using a posterior approach. The groups were compared for age, gender, American Society of Anesthesiologists grade, body mass index, the side of the operation, pre-operative Oxford Hip Score (OHS) and attendance at ‘Joint school’. Mean follow-up was 18.1 months (one to 50).


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_12 | Pages 31 - 31
1 Nov 2015
Malek I Whittaker J Wilson I Phillips S Wootton J Starks I
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Introduction. The Direct Anterior Approach (DAA) offers potential advantages of quicker rehabilitation compared to posterior approach THR. The aim of this study was to compare hospital based and early clinical outcomes between these two groups with utilisation of Enhanced Recovery After Surgery (ERAS) protocol. Patients/Materials & Methods. Prospectively collected data for both cohorts were matched for age, gender, ASA grade, BMI, operation side, Pre-operative Oxford Hip score (OHS) and attendance at multi-disciplinary joint school. The pain scores at 0,1,2,3 post-op days, the day of mobilization, inpatient duration, complications, 28 days readmission rates and OHS at 6 and 24 months were compared. Results. Four hundred and fifty two THR (DAA: 219, Posterior: 233) were matched. There was no difference in OHS at 6 months (p=0.07). There was also no difference in pain scores at 0, 1, 2, and 3rd post op days, the day of first mobilization (p=0.32), length of stay (p= 0.3), 28 days readmission (p=0.11) or OHS at 24 months (p=0. 09). 68% of DAA vs 58 % of posterior approach patients achieved planned in-patient duration target of 3 days (p= 0.04). There were six peri-prosthetic femoral fractures in DAA group vs one in posterior approach group (p=0.097). No significant difference was identified for complications, re-operation or 28 days readmission rates between two groups. Discussion. The DAA procedures were performed by two surgeons with extensive prior experience in DAA approach. The potential advantages and complications especially during early learning curve have to be carefully considered by operating surgeon who wishes to start performing DAA approach. The ERAS protocol can potentially reduce the difference in early recovery between two groups. Conclusion. There is no significant difference in clinical outcomes between DAA and posterior approach THR with utilisation of ERAS protocol except potential of discharge from the hospital within three days following the DAA procedure


Aims

The aim of this study was to examine the efficacy and safety of multiple boluses of intravenous (IV) tranexamic acid (TXA) on the hidden blood loss (HBL) and inflammatory response following primary total hip arthroplasty (THA).

Patients and Methods

A total of 150 patients were allocated randomly to receive a single bolus of 20 mg/kg IV TXA before the incision (group A), a single bolus followed by a second bolus of 1 g IV-TXA three hours later (group B) or a single bolus followed by two boluses of 1 g IV-TXA three and six hours later (group C). All patients were treated using a standard peri-operative enhanced recovery protocol. Primary outcomes were HBL and the level of haemoglobin (Hb) as well as the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers of inflammation. Secondary outcomes included the length of stay in hospital and the incidence of venous thromboembolism (VTE).