الفهرس 
Anatomy of the Hip JointOnly 14 pages are availabe for public view
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Abstract
Background: Total hip arthroplasty (THA) surgical approaches can affect early clinical outcomes and the ability to regain an early normal gait, but this is still an open question. This study aimed to compare the clinical differences between lateral and anterior approaches for THA and to determine their impacts on gait analysis.
Patients and Methods: Patients undergoing THA for osteonecrosis or primary osteoarthritis were randomized and assigned to one of the two surgical techniques. The surgical team and implant used in the study were both standardized. Three-dimensional gait analysis was done by a single experienced physical medicine specialist at six weeks, three months, and 18 months to compare temporal distance parameters, kinetics and kinematics of the gait.
Results: In our study, 34 patients (16 lateral and 18 anterior) were involved. The two groups were comparable in terms of age, sex, ASA class, weight, height, BMI, and VAS score. At six weeks, the direct anterior approach group (DAAG) showed a significant early improvement (P 0,001) in HHS. But at the subsequent follow-up time periods, both groups remained comparable. In terms of temporal parameters, both groups’ stride length, step length, stance time, and swing time were comparable, however at 6 weeks, DAAG showed a substantial improvement in gait speed (P 0.001). In terms of kinetics, the peak vertical GRF and hip flexion moment were comparable across the two groups. At the time of the 6-week gait analysis, the DAAG saw a substantial increase in hip extension (P<0.01) and external rotation (P<0.01) moments while the LAG experienced a significant decrease in hip abduction and internal rotation moments. However, at subsequent time points, these changes were not significant. In terms of kinematics, the hip flexion and external rotation angles were comparable between the two groups, however at six weeks of gait analysis, the DAAG showed an increase in peak hip abduction angle and a decrease in peak hip extension angle (both P<0.001). However, during the 3- and 18-month follow-up, these differences remained insignificant.
Conclusion: We draw the conclusion that the anterior approach to the hip induces less muscle injury and has a faster postoperative rehabilitation process than the lateral approach to the hip. This benefit was evident at the early follow-up at 6 weeks. However, during the 3 month and 18 month follow-ups, the two strategies were comparable to one another.