Abstract
Introduction
Despite well-fixed implants, persistent pain following total hip arthroplasty (THA) remains a concern. Various surgical approaches have been advocated, yet whether patient-reported pain differs amongst techniques has not been investigated. This study's purposes were to determine differences in patient-reported pain based on surgical approach (direct anterior –DA versus posterolateral-PL) or PL approach incision length. Our hypothesis was that no differences in patient-reported pain would be present.
Methods
A retrospective, IRB-approved investigation from 2 centers was performed. 7 fellowship trained arthroplasty surgeons (3 DA, 3 PL, 1 both) enrolled patients undergoing primary THA for non-inflammatory arthritis. PL approach patients were categorized based on incision length (6–8cm, 8–12cm, 12–15cm). Exclusion criteria were a prior hip surgery, revision procedure, or limited postoperative mobility. All THAs were performed using a cementless titanium, proximally coated, tapered femoral stem and hemispherical acetabular component. All patients had a minimum of 1-year clinical follow-up with radiographically well-fixed components.
A pain-drawing questionnaire was administered in which patients identify the location and intensity of pain on an anatomic diagram. Independent Student's t-tests and Chi-square analyses were performed (p<0.05 = significant). Power analysis indicated 800 patients in each cohort would provide adequate power to detect a 4% difference in patient-reported pain (alpha = 0.05, beta = 0.80).
Results
1848 Patients (982 DA, 866 PL) were included. PL patients were younger (59.4 + 12.9 vs. 62.7 + 9.7; p<0.001) and had shorter follow-up (3.3 + 1.3 vs. 3.7 + 1.3 years; p<0.001) versus DA patients. There was no difference in postoperative UCLA score (6.0 + 1.9 vs. 6.0 + 2.0; p>0.9).
PL patients reported increased moderate to severe trochanteric (21% vs. 14%; p<0.001) and groin pain (24% vs. 19%; p=0.004) than DA patients. There were no differences in anterior or lateral thigh, posterior thigh, low back, or buttock pain between the two cohorts (p=0.05–0.7). PL approach incision length did not impact the incidence or severity of patient-reported pain (p=0.3–0.7).
Conclusion
When specifically queried, a significant proportion of patients experience persistent pain following THA via either a PL or DA approach. PL patients reported greater trochanteric and groin pain, although PL incision length did not impact the incidence or severity of patient-reported pain.
Summary Statement
A significant proportion of patient experience persistent pain following THA, with an increased reporting of trochanteric and groin pain in those receiving a posterolateral versus anterior approach.
