1 research outputs found
Comparative evaluation of the clinical efficacy and safety of surgical approaches in total hip arthroplasty
Background Advanced coxarthrosis is a leading cause of disability in patients. Total arthroplasty is regarded as the "gold standard" for the treatment
of hip pathologies that are not amenable to conservative treatment. Arthroplasty introduced into clinical practice has significantly improved functional
status of patients. The data are largely contradictory and indicate certain difficulties and risks at the stages of treatment and rehabilitation of patients after
surgery. The shortcomings can be overcome by improving the treatment methods for the cohort of patients based on the results of large-scale comparative
studies exploring the effectiveness of different approaches to all stages of treatment of arthroplastic patients. The objective was to search for the most
justified and promising surgical approaches in terms of clinical efficacy and safety of total hip arthroplasty (THA). Material and methods The search
for publications was produced using the databases of Scopus, PubMed and the electronic scientific library eLIBRARY in Russian and English languages
using the keywords: total hip arthroplasty, minimally invasive approach, anterolateral approach in THA, direct lateral approach in THA, posterior
approach in THA, comparative assessment of approaches in hip arthroplasty, advanced replacement techniques, incidence of postoperative complications
in THA, direct anterior approach in THA. Results and discussion A number of studies have shown that interventions using direct anterior access (DAA)
are characterized by less blood loss, less frequent blood transfusions, less operating time and shorter hospital stay. There was a more rapid recovery of
the hip function during early postoperative period with less need for opioid analgesics with DAA. Complication rate was higher with DAA than in the
comparison group, which directly correlated with the learning curve. Conclusion DAA was shown to be an advanced approach that resulted in enhanced
clinical efficacy and safety of surgical treatment in the majority of patients with coxarthrosis with sufficient experience of the surgeon. The method can be considered as low-traumatic. Unlike other approaches, DAA was accompanied by less injury to intact tissues; smaller skin incision; less blood loss;
precipitated postoperative rehabilitation; less severity of postoperative pain and less need for opioid analgesia. However, DAA is inferior to classical
approaches in primarily complicated hip pathologies