scholarly journals Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Gongyin Zhao ◽  
Ruixia Zhu ◽  
Shijie Jiang ◽  
Nanwei Xu ◽  
Hongwei Bao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Anterior Capsule ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. Results LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. Trial registration ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

scholarly journals Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

2019 ◽  
Author(s):  
Gongyin Zhao ◽  
Ruixia Zhu ◽  
Shijie Jiang ◽  
Nanwei Xu ◽  
Hongwei Bao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Prospective Trial ◽  
Direct Anterior Approach ◽  
Anterior Capsule ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

scholarly journals Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

2019 ◽  
Author(s):  
Gongyin Zhao ◽  
Ruixia Zhu ◽  
Shijie Jiang ◽  
Nanwei Xu ◽  
Hongwei Bao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Prospective Trial ◽  
Direct Anterior Approach ◽  
Anterior Capsule ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

scholarly journals Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial

2020 ◽  
Author(s):  
Gongyin Zhao ◽  
Ruixia Zhu ◽  
Shijie Jiang ◽  
Nanwei Xu ◽  
Hongwei Bao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Prospective Trial ◽  
Direct Anterior Approach ◽  
Anterior Capsule ◽  
Total Hip ◽  
Group A ◽  
Group B

Abstract Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.

Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial

2021 ◽  
Vol 103-B (2) ◽  
pp. 321-328
Author(s):  
Frans-Jozef Vandeputte ◽  
Jens Vanbiervliet ◽  
Cigdem Sarac ◽  
Ronald Driesen ◽  
Kristoff Corten
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Anterior Capsule ◽  
Total Hip ◽  
Implant Positioning ◽  
Sf 36 ◽  
One Year

Aims Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). Methods In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. Results At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). Conclusion No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321–328.

scholarly journals Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Stephen J Nelson ◽  
Murillo Adrados ◽  
Raj J Gala ◽  
Erik J Geiger ◽  
Matthew L Webb ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Operating Table ◽  
Leg Length ◽  
Neck Length ◽  
Anterior Capsule ◽  
Total Hip

BackgroundAchieving correct leg and femoral neck lengths remains a challenge during total hip arthroplasty (THA).  Several methods for intraoperative evaluation and restoration of leg length have been proposed, and each has inaccuracies and shortcomings.  Both the supine positioning of a patient on the operating table during the direct anterior approach (DAA) THA and the preservation of the anterior capsule tissue  are simple, readily available, and cost-effective strategies that can lend themselves well as potential solutions to this problem.TechniqueThe joint replacement is performed through a longitudinal incision (capsulotomy) of the anterior hip joint capsule, and release of the capsular insertion from the femoral intertrochanteric line. As trial components of the prosthesis are placed, the position of the released distal capsule in relationship to its original insertion line is an excellent guide to leg length gained, lost, or left unchanged.MethodsThe radiographs of 80 consecutive primary THAs were reviewed which utilized anterior capsule preservation and direct capsular measurement as a means of assessing change in leg/femoral neck length. Preoperatively, the operative legs were 2.81 +/- 8.5 mm (SD) shorter than the nonoperative leg (range: 17.7 mm longer to 34.1 mm shorter).  Postoperatively, the operative legs were 1.05 +/- 5.64 mm (SD) longer than the nonoperative leg (range: 14.9 mm longer to 13.7 mm shorter).ConclusionThe preservation and re-assessment of the native anterior hip capsule in relationship to its point of release on the femur is a simple and effective means of determining leg/femoral neck length during DAA THA.

scholarly journals High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

2020 ◽  
Author(s):  
Junmin Shen ◽  
Yonggang Zhou ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Yinqiao Du ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Total Hip ◽  
Group A ◽  
Group B ◽  
Dysplasia Of The Hip

Abstract Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative complications. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1years). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: There were no statistically significant differences between two groups in horizontal distance, offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, 7 hips (8.2%) showed a positive Trendelenburg sign. Besides, 6 patients (8.7%) presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and limp between two groups. The Kaplan-Meier implants survivorship rates at the final follow-up for all-causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip.

scholarly journals High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

2020 ◽  
Author(s):  
Junmin Shen ◽  
Yonggang Zhou ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Yinqiao Du ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Total Hip ◽  
Group A ◽  
Group B ◽  
Dysplasia Of The Hip

Abstract Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative limp. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: There were no statistically significant differences between two groups in horizontal distance, offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the WOMAC and Harris hip scores were excellent in both groups. Of the 85 hips, 7 (8.2%) showed a positive Trendelenburg sign. Besides, 6 patients (8.7%) had a symptom of claudication. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and claudication between two groups. The Kaplan-Meier 8-year implants survivorship rates for all-causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip, preferably combined with COC interface or high crosslinked polyethylene liner.

scholarly journals Assessment of the Learning Curve of Supercapsular Percutaneously Assisted Total Hip Arthroplasty in an Asian Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Pengfei Lei ◽  
Zhan Liao ◽  
Jiang Peng ◽  
Guang Li ◽  
Qian Zhou ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Learning Curves ◽  
Harris Hip Score ◽  
Intraoperative Blood Loss ◽  
Total Hip ◽  
Significant Difference ◽  
Group A ◽  
Group B

The supercapsular percutaneously assisted total hip (SuperPATH) approach is a microinvasive approach that was developed to minimize surgical disruption of soft tissue during routine total hip arthroplasty (THA). This study was aimed at assessing early outcomes and learning curves of the SuperPATH approach in one Chinese hospital’s experience. Early outcomes of the first consecutive 78 SuperPATH cases (80 hips) performed by the same surgeon were evaluated. The patients were divided into 4 groups according to the surgical order. The incision, intraoperative blood loss, hospital stay, Harris hip score, and complication occurrence in each group were evaluated. Learning curves were assessed using operative time and intraoperative blood loss as surrogates. The operation time and intraoperative blood loss of groups A and B were more than those of groups C and D, and the difference was statistically significant (P<0.05); however, there was no statistically significant difference between the two groups (group A vs. group B, P=0.426; group A vs. group B, P=0.426). There was no statistically significant difference in terms of incision length and hospital stay, and Harris hip score at the last follow-up was increased with statistically significant difference when compared with that preoperatively among the 4 groups. One case of periprosthetic fracture occurred in group A. No other complication, such as joint dislocation, sciatic nerve injury, prosthesis loosening, periprosthetic infection, and deep vein thromboembolism, occurred in the 4 groups. In summary, for surgeons who are familiar with the standard posterolateral approach, they could achieve more familiarity with SuperPATH after 40 cases of surgery.

Bone remodelling of the proximal femur after total hip arthroplasty with 2 different hip implant designs: 15 years follow-up of the thrust plate prosthesis and the Bi-Metric stem

2018 ◽  
Vol 28 (6) ◽  
pp. 606-612 ◽  
Author(s):  
Janus D Christiansen ◽  
Mogens B Laursen ◽  
Ashir Ejaz ◽  
Poul T Nielsen
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Mineral Density ◽  
Total Hip ◽  
Group A ◽  
Group B ◽  
Thrust Plate Prosthesis

Introduction: The thrust plate prosthesis (TPP) was introduced to preserve bone in patients undergoing total hip arthroplasty. We assessed the long-term results of hip arthroplasty in patients who received the TPP compared to a traditional intramedullary stem (Bi-Metric). Methods: In this prospective observational cohort study, we evaluated bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA), radiological imaging and clinical outcome using Harris Hip Score (HHS). Twenty patients received the TPP (group A) and 18 patients received the Bi-Metric stem (group B). Baseline was the 1st postoperative day, and subsequent follow-up was performed at 6 months, 1, 2, 8, 12 and 15 years after surgery. A four regions of interest (ROI) protocol was developed to assess BMD. Results: In ROI1, bone resorption was significantly higher for group A at 6 months with a mean difference of 10% (95% confidence interval [CI], 4–16; p = 0.003) and 8% (95% CI, 1–15; p = 0.03) at 8 years. Regarding ROI4, group A had a lesser decrease in general compared to group B. The radiological findings did not reveal any subsidence or detectable implant migration. HHS improved from 53 (23–69) to 93 (55–100) in group A and from 51 (24–72) to 94 (78–100) in group B. Conclusion: The TPP was not found to be inferior to the Bi-Metric stem regarding bone preservation. The decrease in BMD in ROI4 was greater in group B. Clinical and radiological results also revealed that the TPP was not inferior to the Bi-Metric stem.

scholarly journals Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 54 ◽  
Author(s):  
Yu Ozaki ◽  
Tomonori Baba ◽  
Yasuhiro Homma ◽  
Hironori Ochi ◽  
Taiji Watari ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Patient Reported Outcomes ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Significant Difference ◽  
Patient Reported

Introduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL). Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS). Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01). Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA.

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