Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Abstract

Purpose: The development of minimal-incision techniques for total hip replacement with preservation of soft tissue is generally associated with faster rehabilitation, reduction of postoperative pain and increased patient comfort. The aim of this study was to compare a minimal-incision anterior approach with a transgluteal lateral technique for hip replacement surgery with respect to postoperative pain, consumption of rescue medication, length of hospital stay and time to reach a defined range of motion.

Methods: In this retrospective cohort study we investigated 100 patients with a minimal-incision anterior approach (group I) and 100 patients with a transgluteal lateral approach (group II) retrospectively undergoing unilateral hip replacement. The study variables were pain at rest and during physiotherapy, amount of rescue medication, the time to reach a defined flexion and time in hospital.

Results: The patients of group I consumed less rescue medication (19.6 ± 6.9 mg vs. 23.6 ± 11.3 mg; p = 0.005) and experienced less pain on the day of surgery (1.3 ± 1 vs. 2.3 ± 1.3, p = 0.0001) and the first postoperative day (0.41 ± 0.8 vs. 0.66 ± 1.1, p = 0.036). The time to reach the defined range of motion (6.4 ± 2 days vs. 7.4 ± 2.1 days; p = 0.001) and the length of hospital stay were shorter (10.2 ± 1.9 days vs. 13.4 ± 1.6 days; p = 0.0001) for group I. However, pain during physiotherapy was higher on the third and sixth through ninth days after surgery in comparison to group II (p = 0.001-0.013).

Conclusion: The implantation of a hip prosthesis through a minimal-incision anterior approach is successful in reducing postoperative pain and consumption of pain medication. Time to recovery and length of hospital stay are also influenced positively. Pain increases during physiotherapy, and may be mitigated by adopting limited weight bearing during the early postoperative period.

Figures

Fig. 1

Mean pain intensity at rest by VAS up to day 10 after surgery for both groups

Fig. 2

Mean pain intensity during physiotherapy by VAS up to day 10 after surgery for both groups

Fig. 3

Average consumption of pain medication (piritramide) of the two study groups during the first 24 hours postoperatively

Fig. 4

Average time interval in days of both study groups to reach the defined flexion (group I = 90 ° flexion, group II = 70 ° flexion)

Fig. 5

Average time interval in days of both study groups until discharge from hospital

Fig. 6

For illustration of the internervous safe zone between the position of one o'clock and half past two for incision of the capsule of the hip according to the findings of Kampa et al. [11]. The area from eleven o'clock to three o'clock illustrates the initial extent of the capsulectomy for the MIS