A analysis of complications in the first 100 cases with hip arthroplasty by the direct anterior approach

GUO Wen-li; JIN Tao-ran; LI Hao; ZHENG Lian-jie

doi:10.3969/j.issn.2095-252X.2017.09.003

Abstract：Objective To discuss the complications of direct anterior approach ( DAA ) in the early experience to help the beginners to shorten the learning curve and assist patients in getting better results. Methods We retrospectively analyzed the data of first 100 patients with hip arthroplasty by DAA from June 2014 to February 2016 in our hospital. There were 59 patients ( 68 hips ) in total hip arthroplasty ( THA ) and 41 patients ( 41 hips ) in hip hemiarthroplasty ( HHA ). Classification of diseases: 61 cases were of femoral neck fracture, 19 cases of femoral head necrosis, 20 cases of hip arthritis. There were 31 males and 69 females with the mean age of ( 71 ± 12 ) years ( range:43 - 95 years ). The patients were required to have a regular follow-up at 1 month, 3 months, 6 months and 12 months after operations, and then followed up once a year. Results There were 88 patients followed up for ( 15 ± 5 ) months ( range: 6 - 22 months ). The mean length of stay was ( 13 ± 4 ) days ( range: 5 - 22 days ). The average duration of THA was ( 108 ± 25 ) min and the average HHA was ( 80 ± 15 ) min. The blood loss was THA ( 388 ± 78 ) ml and HHA ( 119 ± 45 ) ml. There were 20 cases of lateral femoral cutaneous nerve ( LFCN ) injury, 2 cases of large trochanter avulsion fracture, 2 cases of femoral fracture, 1 case of acetabular fracture, 2 cases of large trochanteric incision, 23 cases of pre-femoral pain, 1 case of dislocation, 2 cases of incision superficial infection, 2 cases of incision hematoma formation, 9 cases of unequal length of both lower limbs. There were no deep infection, severe bone cement reaction or DVT in our cases. The hip Harris scores were ( 91 ± 23 ) for THA and ( 89 ± 19 ) for HHA. Conclusions DAA has a long learning curve and a high rate of complications in early stage but the incidence of complications will be significantly reduced with the accumulation of experience.