Assessment of Early Gait Recovery After Anterior Approach Compared to Posterior Approach Total Hip Arthroplasty: A Smartphone Accelerometer-Based Study.
Nelms Nathaniel J,Birch Christopher E,Halsey David H,Blankstein Michael,McGinnis Ryan S,Beynnon Bruce D
The Journal of arthroplasty
BACKGROUND:The influence of total hip arthroplasty surgical approach on postoperative recovery is not well understood and often debated. This study compares anterior and posterior approach (PA) gait and patient-reported Hip Osteoarthritis Outcome scores (HOOS) in the early phases of recovery. METHODS:A prospective study evaluated 20 control subjects, 35 direct anterior approach (DAA), and 34 PA total hip arthroplasty patients. Subjects were assessed preoperatively and at 1 and 4 months postoperatively with HOOS and smartphone gait assessments of gait speed, step length, cadence, step symmetry, and horizontal and vertical center of mass displacements. RESULTS:The DAA and PA groups were not different in baseline HOOS or gait characteristics except for less horizontal center of mass displacement in the DAA group. At 1 month postoperatively, the DAA group had significantly faster gait speed at self-selected (P = .02) and fastest possible gait (P = .01) and longer step length at self-selected (P = .047) and fastest gait (P = .003) compared to the PA. At 4 months, there were no differences in DAA and PA gait measures. At 1 month postoperatively there were no significant differences in HOOS, but after 4 months HOOS were significantly higher in the DAA group. CONCLUSION:There were minimal differences between the two approaches in the recovery of gait mechanics with some gait parameters particularly gait speed and step length recovery favoring the DAA at 1 month postsurgery in this nonrandomized study.
Internet Promotion of Direct Anterior Approach Total Hip Arthroplasty by Members of the American Association of Hip and Knee Surgeons.
Shofoluwe Ademola I,Naveen Neal B,Inabathula Avinash,Ziemba-Davis Mary,Meneghini R Michael,Callaghan John J,Warth Lucian C
The Journal of arthroplasty
BACKGROUND:The direct anterior approach (DAA) in total hip arthroplasty is of significant interest to both patients and surgeons, largely due to intense marketing. This study addressed the question, "What is the level of promotion of DAA total hip arthroplasty on the internet by American Association of Hip and Knee Surgeons (AAHKS) members?" METHODS:An internet search was performed to identify surgeon-specific websites for each member of the AAHKS using the members' full name and a previously published set of criteria. Each website was evaluated utilizing a questionnaire to systematically identify claims made regarding proposed DAA-specific risks, benefits, as well as the presence/absence of supporting data. RESULTS:We identified 1855 qualified websites. The DAA was referenced on 22.8% (423/1855) of these websites. Claims regarding DAA-specific benefits included less invasive/muscle sparing (46.3%), quicker recovery (45.2%), decreased pain (28.1%), decreased hospital stay (22.0%), and decreased dislocation risk (16.3%). Potential DAA risks including lateral femoral cutaneous nerve injury, periprosthetic/greater trochanteric fracture, and wound complication/hematoma were addressed on only 4.7%, 3.1%, and 1.7% of websites, respectively. Supporting peer-reviewed literature was identified on only 3.6% of DAA websites. CONCLUSION:Over one-fifth of AAHKS members promoted the DAA on the internet. Member websites claimed DAA benefits such as faster recovery and decreased pain approximately 9 times more frequently than any potential risk of the procedure (P < .001). While AAHKS policy does not regulate member marketing, it is the responsibility of all orthopedic surgeons to disseminate accurate, validated information concerning the procedures we perform.