Analysing the clinical results and the differences basicly plantar pressure,and trendelenburg's sign at the patients who had unilateral total hip arthroplasty surgery with two different surgical approaches as classical lateral hardinge approach and pai modification of lateral intermuscular approach

Introduction: In the literature there are few many reported articles about the gait analyses, Trendelenburg?s sign, and hip abductor muscle function after the total hip arthroplasty with the lateral approach.In our study, we are looking for the clinical results and the differences at the patients who had unilateral total hip arthroplasty surgery with two different surgical approaches as classical lateral Hardinge approach and Pai modification of lateral intermuscular approach. We analyze three different parameters between the patients; first, the plantar pressures by the help of dynamic pedobarography, second Trendelenburg?s sign and third cilnical results by Harris hip score.Materials and Methods: We selected 28 patients who had been operated in our clinic; Gazi University Faculty of Medicine, Department of Orthopaedics and Traumatology, between the dates September 2010 and August 2011 bacause of the unilateral degenerative hip arthritis. The patients had been seperated by the bloc randomisation technique. The preferred approach for the first group is classical lateral Hardinge approach and 13 patients had been selected for this group. In the second group there were 15 patients and the preferred approach was Pai modification of lateral intermuscular approach. The cementless, standart off-set stem was used for whole the patients.Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software (Automask, Novel-ortho, Germany); that seperates the foot to the four different parts which are called masks. Trendelenburg?s sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and at last clinic visit. All the parameters were compared as preoperatively and postoperatively at the sixth month.SPSS 15.0 was used to analyze the results.Results: In total; 21 (%75) of the 28 patients were women and 7 (%25) were men. The age ranges of the all patients varied between 30 and 77 years oldand the average age for the whole patients was 54,78 years during the time of surgery. In the first group which were operated by the help of classical lateral Hardinge approach; 10 (%76) of the 13 patients were women and 3 (%24) were men, and the average age was 57,62 years; in the second group 11 (%73) of the 15 patients were women and 4 (%27) were men and the average age was 52,33 years during the time of surgery.When the pedobarography results and the first three masks were anlaysed, we reached that; contact area, peak pressures and total contact time were less at the operation side preoperatively than the healthy side. Also at the second mask; which is the significance of the midstance phase, contact time was again less at the operation side.In both groups after the six months from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgey. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas.Before the surgery, Trendelenburg?s sign was positive in three patients in the first group and 1 patient in the second group; and there were no statistically differences for Trendelenburg?s sign between the two groups preoperatively. In the first group at the sixth month visit, 4 patients had Trendelenburg?s sign and 2 of them had also postive results before the surgery. In the second group only one new patient had Trendelenburg?s sign at the sixth month visit. After the analyse of the results by chi-square test; no significant differences were seen.For whole the patients the average preoperative Harris hip score was 41,50 (19-61) points. At the time of the last visit, the average Harris hip score was found as 86,68 (66-100) points. In the first group, the avarage preoperative Harris hip score was 39,46 (22-56) points and at the postoperative sixth month visit, the average Harris Hip Score was found as 84,08 (67-100) points. In the second group, the avarage preoperative Harris hip score was 43,27 (19-61) points and at the postoperative sixth month visit, the average Harris Hip Score was found as 88,93 (66-100) points. There were no statistically differences for both groups.Conclusion: The fuctional and clinical early results are similar in both lateral hip approaches for unilateral total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well.Pedobarography is an effective, cheap and easy way to analyse the changes at the hip muscles before and after the hip arthritis surgery but it is not exactly enough to show the grade 1 Trendelenburg?s sign.Key words: Total hip arthroplasty, pedobarography, Trendelenburg?s sign, lateral hip approaches for total hip arthroplasty, Harris hip score, gait analyses