Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2021; 12(11): 877-890
Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.877
Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial
George Macheras, Sophia Stasi, Michail Sarantis, Athanasios Triantafyllou, Dimitrios Tzefronis, Stamatios A Papadakis
George Macheras, Michail Sarantis, Dimitrios Tzefronis, 4th Orthopaedic Department, “KAT” General Hospital of Attica, Athens 14561, Kifissia, Greece
George Macheras, Sophia Stasi, Athanasios Triantafyllou, Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica, Athens 12243, Egaleo, Greece
Stamatios A Papadakis, 2nd Orthopaedic Department, “KAT” General Hospital of Attica, Athens 14561, Kifissia, Greece
Author contributions: Macheras G, Stasi S, Sarantis M, Triantafyllou A, Tzefronis D and Papadakis S designed research; Stasi S, Tzefronis D, Sarantis M and Triantafyllou A performed literature research; Macheras G and Papadakis S were the two chief orthopedic surgeons; Tzefronis D and Sarantis M were the orthopedic surgeons’ assistants; Stasi S performed the postoperative physiotherapy; Stasi S wrote the manuscript; Macheras G and Triantafyllou A edited the manuscript.
Institutional review board statement: The Scientific Research Council of the "KAT" General Hospital of Attica, Athens, Greece approved the study's protocol (ref: No8/19-03-2019).
Clinical trial registration statement: The study has been registered at www.isrctn.com following identification number: ISRCTN15066737 https://doi.org/10.1186/ISRCTN15066737.
Informed consent statement: All study participants provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sophia Stasi, PhD, Academic Fellow, Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica, Ag. Spyridonos Street, Athens 12243, Egaleo, Greece. stasi@uniwa.gr
Received: May 4, 2021
Peer-review started: May 4, 2021
First decision: June 7, 2021
Revised: June 27, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: November 18, 2021
Processing time: 195 Days and 9.9 Hours
Abstract
BACKGROUND

The increased prevalence of obesity has resulted in orthopedic surgeons being likely to face many patients with a high body mass index (BMI) who warrant total hip arthroplasties (THAs) over the coming years. Studies' findings considered the postoperative clinical, and functional outcomes in these patients are controversial, and selecting the most appropriate surgical approach remains debatable.

AIM

To compare pain-levels, functionality, and quality-of-life in obese and nonobese osteoarthritic patients who have undergone primary total hip arthroplasty through either direct-anterior-approach (DAA) or Hardinge-approach.

METHODS

One hundred and twenty participants (> 50 years) were divided into four groups according to the surgical approach (DAA or Hardinge) and patients' BMI (nonobese < 30 kg/m2 vs obese ≥ 30 kg/m2). Outcomes were measured preoperatively and postoperatively (6th and 12th week). Pain was measured with Face Pain Scale-Revised (FPS-R). Functionality was measured with Timed Up & Go (TUG) test and Modified Harris Hip Score-Greek version (MHHS-Gr). Quality-of-life was evaluated with the 12-item-International Hip Outcome Tool-Greek version (iHOT12-Gr) (Clinical Trial Identifier: ISRCTN15066737).

RESULTS

DAA vs Hardinge: (week 6) DAA-patients showed 12.2% less pain, more functionality (14.8% shorter TUG-performance time, 21.5% higher MHHS-Gr), and 38.16% better quality-of-life (iHOT12-Gr) compared to Hardinge-patients (all P values < 0.001). These differences were further increased on week 12 (all P values ≤ 0.05)]. DAA-obese vs Hardinge–obese: (week 6) DAA-obese patients had less pain, shorter TUG-performance time, better MHHS-Gr and iHOT12-Gr scores than Hardinge-obese (all P values < 0.01). (Week 12) Only the TUG-performance time of DAA-obese was significantly shortened (22.57%, P < 0.001). DAA-nonobese vs DAA-obese: no statistically significant differences were observed comparing the 6th and 12th weeks' outcomes.

CONCLUSION

DAA-groups reported less pain, more functionality and better quality-of-life, compared to the Hardinge-groups. The DAA benefited obese and nonobese patients, similarly yet faster, suggesting that it should be the more preferred choice for obese patients, instead of Hardinge. However, more comparative studies with more extended follow-up periods are needed to confirm our results and better evaluate all patients' long-term outcomes.

Keywords: Total hip arthroplasty; Osteoarthritis; Obesity; Pain; Functional ability; Quality-of-life

Core Tip: The selection of the best total hip arthroplasties (THA)-surgical approach for obese hip osteoarthritis patients is a matter of debate. In the present study, both obese and nonobese patients of direct anterior approach (DAA) groups reached equivalent pain-levels, functionality, and quality-of-life. Moreover, the comparison between obese patients showed that DAA leads faster to better functional ability and quality-of-life than the Hardinge approach. These findings suggested that DAA is a better suited THA surgical approach than Hardinge for patients with increased body mass index.