Treatment of total hip arthroplasty between two surgical access routes associated chronic pain, function and biomechanical parameters in older after osteoporotic femur fracture: cohort study

Abstract

Background: Total hip arthroplasty (THA) is a surgery widely used to reduce pain, improve function and quality of life in older people after femur fracture due to osteoporosis. The evident success of THA, especially in the long term, continues in relation to the different types of surgical approach, given the little understanding in older people. The aim of this study was to evaluate and compare the effect of THA between two surgical access routes, anterior and posterolateral, on the clinical, functional, and biomechanical parameters of older people after osteoporotic femur fracture.

Methods: Prospective and retrospective cohort study, in which 24 older people with femur fracture, who underwent THA in a Public Hospital, between the years 2020 and 2022, were evaluated. The older people were divided into two groups: THA via anterolateral surgical (n = 12) and THA via posterolateral surgery (n = 12). The following clinical information was collected from the patients' records. After the surgery, pain was evaluated using the visual analogue scale and function by the Harris Hip Score questionnaire, as well as hip and knee mobility (goniometer). For the radiographic parameters, acetabular component positioning, De Lee Zone, and the offset of the femoro-acetabular component were evaluated. A pressure platform was used for the biomechanical assessment of gait and balance.

Results: Older adults who underwent THA via the posterolateral route showed a reduction in chronic pain (p = 0.001), and greater functionality (p = 0.001), joint mobility of the hip (flexion and extension, p = < 0,001) and knee (extension) when compared to THA via the anterolateral. In relation to the gait, a reduction in plantar overload on the forefoot (peak pressure p = 0.007) and medial and lateral rearfoot areas (peak pressure p = 0.004 and p = 0.009, respectively; maximum force p = 0.021 and p = 0.015 respectively;) was observed, as well as a reduction in the contact area on the forefoot (p = 0.001) in older people who underwent THA by the posterolateral when compared to the anterolateral. An increase in body sway (p = 0.002) and medio-lateral sway (p = 0.020) was observed in older adults who underwent THA using the posterolateral route when compared to the anterolateral route, such as distance and velocity balance (p = 0.001).

Conclusion: Total hip arthroplasty via the posterolateral approach proved to be more successful when associated with reducing chronic pain, improving functional parameters and hip joint mobility, as well as facilitating a more efficient gait pattern with lower rates of plantar overload and enhanced body balance in older adults undergoing total hip arthroplasty after osteoporotic femur fracture. These findings are clinically relevant as they indicate that this approach not only provides significant pain relief but also improves the patients' quality of life by restoring hip functionality and mobility, while reducing the risk of falls and complications related to postural imbalance. The combination of these benefits suggests that the posterolateral approach could be a preferred option for elderly patients with osteoporotic fractures, aiming to optimize postoperative outcomes and improve long-term functional recovery.

Keywords: Arthroplasty; Balance; Function; Gait; Hip; Older; Pain; Surgery.

Fig. 1

Representation of the flowchart of the recruitment and evaluation protocol of older people after uncemented THA between two surgical access routes: anterolateral and posterolateral

Fig. 2

Measurement of the positioning angle of the acetabular component. a – line that touches the ischial tuberosities; (b) – line through the axis of the largest diameter formed by the projection of the metal rim on the radiograph; (c) – acetabular angle

Fig. 3

Radiographic areas of acetabular displacement (De Lee and Charnley, 1976)

Fig. 4

Femur offset - distance from the center of rotation of the femoral head to a line drawn on the long axis of the femur. Offset of the femoral component, distance from the center of the femoral head to the axis line of the distal part of the shaft

Fig. 5

Demonstration of gait analysis on the plantar pressure platform and body balance oscillation