BACKGROUND AND PURPOSE In the past decade, a shift occurred in surgical total hip arthroplasty (THA) approaches to the posterolateral (PLA) and direct anterior approach (DAA). Comparisons of postoperative activities and participation between surgical approaches for THA are sparse. We therefore investigated the association between PLA and DAA for THA regarding the construct "activity and participation" (ICF model) during the first postoperative year. PATIENTS AND METHODS This was an observational cohort study on osteoarthritis patients scheduled for primary THA in 2 hospitals. Questionnaires to assess the ICF domain "activity and participation" were completed preoperatively, and 3, 6, and 12 months postoperatively (HOOS Activities of daily living (ADL) and Sport and Recreation Function (SR), Hospital for Special Surgery Hip Replacement Expectations Survey, and questions regarding return to work). Each hospital exclusively performed one approach (PLA [Alloclassic-Zweymüller stem] or DAA [Taperloc Complete stem]) for uncemented THA. Hospital was included as instrumental variable, thereby addressing bias by (un)measured confounders. Adjusted mixed-effect models were used, stratified by employment. RESULTS Total population: 238 PLA (24% employed) and 622 DAA (26% employed) patients. At 12 months, the PLA group had a lower ADL score (-7, 95% CI -12 to -2 points). At 6 months, significantly fewer PLA patients had fulfillment of the expectation sports-performance (OR = 0.3, CI 0.2-0.7]. Other outcomes were comparable. Employed population: At 6 and 12 months, PLA patients scored clinically lower on ADL (respectively -10, CI -19 to 0 and -9, CI -19 to 0 points) and SR (respectively -13, CI -21 to -4 and -9, CI -18 to -1 points). At 6 months, fewer PLA patients fulfilled the expectation joining recreational activities (OR = 0.2, CI 0.1-0.7]. Fulfillment of other expectations was comparable between groups. PLA patients less often returned to work within 3 months (31% vs. 45%), but rates were comparable at 12 months (86% vs. 87%). INTERPRETATION Overall, functional recovery regarding "activity and participation" was comparable for PLA and DAA. Among employed patients, DAA resulted in better functional recovery and more fulfillment of expectations compared with PLA patients. DAA might also facilitate faster return to work.

中文翻译：

---

初次全髋关节置换术后的活动和参与；860 名患者的后外侧入路与直接前路入路对比。

背景和目的在过去的十年中，全髋关节置换术（THA）入路发生了向后外侧入路（PLA）和直接前入路（DAA）的转变。不同 THA 手术方法的术后活动和参与度的比较很少。因此，我们在术后第一年调查了 PLA 和 DAA 之间关于 THA 构建“活动和参与”（ICF 模型）的关联。患者和方法 这是一项针对 2 家医院计划进行初次 THA 的骨关节炎患者的观察性队列研究。术前以及术后 3、6 和 12 个月完成了评估 ICF 领域“活动和参与”的问卷（HOOS 日常生活活动 (ADL) 和运动和娱乐功能 (SR)，特种外科医院髋关节置换期望调查，以及有关重返工作岗位的问题）。每家医院都专门对非骨水泥全髋关节置换实施一种入路（PLA [Alloclassic-Zweymüller 假体柄] 或 DAA [Taperloc Complete 假体柄]）。医院被列为工具变量，从而解决了（未）测量的混杂因素造成的偏差。使用调整后的混合效应模型，按就业分层。结果 总人口：238 名 PLA（24% 就业）和 622 名 DAA（26% 就业）患者。12 个月时，PLA 组的 ADL 评分较低（-7，95% CI -12 至 -2 分）。6 个月时，达到预期运动表现的 PLA 患者显着减少（OR = 0.3，CI 0.2-0.7）。其他结果具有可比性。就业人群：6 个月和 12 个月时，PLA 患者的 ADL 临床得分较低（分别为-10，CI -19 至 0 和 -9，CI -19 至 0 分）和 SR（分别为 -13，CI -21 至 -4 和 -9，CI -18 至 -1 分）。6 个月时，更少PLA 患者满足了参加娱乐活动的期望（OR = 0.2，CI 0.1-0.7]。其他期望的实现情况在各组之间具有可比性。PLA 患者在 3 个月内重返工作岗位的情况较少（31% 与 45%），但比率较低12 个月时具有可比性（86% 与 87%）。解释 总体而言，PLA 和 DAA 的“活动和参与”功能恢复具有可比性。在就业患者中，与 PLA 患者相比，DAA 实现了更好的功能恢复和更多的期望实现.DAA 还可能有助于更快地重返工作岗位。