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Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients:A randomized controlled trial

查看全文 作　　者：George [1,2]Macheras;Sophia [2]Stasi;Michail [1]Sarantis;Athanasios [2]Triantafyllou;Dimitrios [1]Tzefronis;Stamatios A [3]Papadakis 高影响力作者 机构地区：[1]4^(th) Orthopaedic Department,“KAT”General Hospital of Attica,Athens 14561,Kifissia,Greece;[2]Laboratory of Neuromuscular and Cardiovascular Study of Motion(LANECASM),Physiotherapy Department,University of West Attica,Athens 12243,Egaleo,Greece;[3]2^(nd) Orthopaedic Department,“KAT”General Hospital of Attica,Athens 14561,Kifissia,Greece高影响力机构 出　　处：《World Journal of Orthopedics》索引2021年第12卷第11期,共14页高影响力期刊 摘　　要：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/m^(2)vs obese≥30 kg/m^(2)).Outcomes were measured preoperatively and postoperatively(6^(th)and 12^(th)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).DAAnonobese 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. 关 键 词：Total hip arthroplasty OSTEOARTHRITIS OBESITY PAIN Functional ability QUALITY-OF-LIFE
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