genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2026-32-3-288-295genort-3493Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПроспективное сравнение функциональных результатов прямого переднего и заднего доступов при тотальном эндопротезировании тазобедренного суставаA prospective comparison of functional results between direct anterior and posterior approaches in total hip replacementhttps://orcid.org/0000-0001-6129-0740YeotiwadG.YeotiwadG.

Additional Professor

Mumbai Maharashtra

Additional Professor

Mumbai Maharashtra

ganesh.yeotiwad@gmail.comShindeM. B.ShindeM. B.

Mahesh B. Shinde -  Assistant Professor

Mumbai Maharashtra

Assistant Professor

Mumbai Maharashtra

mahesh.shinde.1466@gmail.comhttps://orcid.org/0000-0002-2074-9014DasguptaB.DasguptaB.

Professor and Head

Mumbai Maharashtra

Professor and Head

Mumbai Maharashtra

bibhasdasgupta@gmail.comhttps://orcid.org/0009-0006-0709-9869YadavA.YadavA.

Assistant Professor

Mumbai Maharashtra

Assistant Professor

Mumbai Maharashtra

spy1711amit20@gmail.comhttps://orcid.org/0009-0002-0713-280XTaringT.TaringT.

Senior Resident

Mumbai Maharashtra

Senior Resident

Mumbai Maharashtra

myocracker00@gmail.comhttps://orcid.org/0009-0005-9365-0882SharmaA.SharmaA.

Senior Resident

Mumbai Maharashtra

Senior Resident

Mumbai Maharashtra

Atharva.rs1996@gmail.comhttps://orcid.org/0009-0000-3805-2445SarweyK.SarweyK.

Junior Resident

Mumbai Maharashtra

Junior Resident

Mumbai Maharashtra

kshitijsarwey@gmail.comhttps://orcid.org/0009-0009-2745-4241JethliaS.JethliaS.

Junior Resident

Mumbai Maharashtra

Junior Resident

Mumbai Maharashtra

sanketjethliya1@gmail.comhttps://orcid.org/0009-0003-8072-4075RevankarS.RevankarS.

Senior Resident

Mumbai Maharashtra

Senior Resident

Mumbai Maharashtra

srevankar269@gmail.comhttps://orcid.org/0009-0009-4346-0692PrajapatiM.PrajapatiM.

Senior Resident

Mumbai Maharashtra

Senior Resident

Mumbai Maharashtra

prajapatimaheshkumar1989@gmail.comhttps://orcid.org/0009-0005-7824-7446ShahJ.ShahJ.

Senior Resident

Mumbai Maharashtra

Senior Resident

Mumbai Maharashtra

jaishah2712@gmail.comhttps://orcid.org/0009-0000-4843-6151ShrivastavaC.ShrivastavaC.

Senior Resident

Mumbai Maharashtra

Senior Resident

Mumbai Maharashtra

chitranshu476001@gmail.comhttps://orcid.org/0009-0006-4326-6222PatilY.PatilY.

Medical Student

Mumbai Maharashtra

Medical Student

Mumbai Maharashtra

yogeshwaripatil2708@gmail.comHBT Medical college and DR R N COOPER Hospital JuhuИндияHBT Medical college and DR R N COOPER Hospital JuhuIndia202625062026323288295Copyright © Yeotiwad G., Shinde M.B., Dasgupta B., Yadav A., Taring T., Sharma A., Sarwey K., Jethlia S., Revankar S., Prajapati M., Shah J., Shrivastava C., Patil Y., 20262026Yeotiwad G., Shinde M.B., Dasgupta B., Yadav A., Taring T., Sharma A., Sarwey K., Jethlia S., Revankar S., Prajapati M., Shah J., Shrivastava C., Patil Y.Yeotiwad G., Shinde M.B., Dasgupta B., Yadav A., Taring T., Sharma A., Sarwey K., Jethlia S., Revankar S., Prajapati M., Shah J., Shrivastava C., Patil Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/3493Введение

Введение. Тотальное эндопротезирование тазобедренного сустава (ТЭТС) является высокоэффективным методом лечения пациентов с запущенными заболеваниями тазобедренного сустава. Современные исследования все чаще сравнивают хирургические подходы для оптимизации восстановления и улучшения результатов. Прямой передний доступ (ППД) обеспечивает преимущества в плане сохранения мышц и более быстрого раннего восстановления, но является технически сложным и требует более длительного обучения. Задний доступ (ЗД) остается широко используемым, но имеет более высокий риск вывиха.

Цель работы — определить, сохраняются ли преимущества раннего восстановления, отмеченные при применении ППД, в течение года наблюдения, и как эти преимущества соотносятся с возросшими техническими требованиями и потенциальными рисками, связанными с этим методом.

Материалы и методы

Материалы и методы. В данном одноцентровом проспективном исследовании (январь 2024 г. – июнь 2025 г.) сравнивали результаты лечения 36 пациентов, которым проводили первичное эндопротезирование тазобедренного сустава с использованием ППД или ЗД. Все процедуры выполняла одна хирургическая бригада с применением стандартизированного операционного пособия. В исследование включены пациенты с первичным эндопротезированием тазобедренного сустава (18 пациентов в группе ППД и 18 в группе ЗД) с сопоставимыми исходными гендерно-возрастными характеристиками. Наблюдение за пациентами проводили в течение одного года. С использованием слепой оценки и статистического анализа оценивали следующие параметры: боль (VAS), функция (HHS), рентгенологическая точность и осложнения.

Результаты

Результаты. Продолжительность операции была больше в группе ППД, но срок пребывания в стационаре, прогрессирование послеоперационной боли, функциональное восстановление и рентгенологические результаты были схожими. В группе ЗД произошло два интраоперационных перелома, а в группе ППД — одна ранняя инфекция, все случаи были успешно купированы. Оба подхода показали эквивалентные результаты с низким уровнем осложнений.

Обсуждение

Обсуждение. Схожие функциональные результаты эндопротезирования тазобедренного сустава с использованием ЗД и ППД через год наблюдения указывают на то, что квалификация хирурга и отбор пациентов имеют большее значение, чем выбор метода операции.

Заключение

Заключение. Оба подхода показали сопоставимые результаты через год после операции; ППД обеспечивал более раннее восстановление, но более длительное время операции, при этом частота осложнений была аналогичной.

Introduction Total hip arthroplasty (THA) is highly effective for advanced hip disease, and modern research increasingly compares surgical approaches to optimise recovery and outcomes. The direct anterior approach (DAA) offers muscle-sparing benefits and faster early recovery but is technically demanding with a steeper learning curve. The posterior approach (PA) remains widely used due to familiarity but may carry a higher risk of dislocation. This study prospectively compares outcomes of DAA and PA over one year, evaluating operative time, pain, function, radiographic accuracy, and complications.

The purpose was to determine whether the early recovery advantages reported with DAA persist over one year follow-up and how these benefits compare with the increased technical demands and potential risks associated with the approach.

Materials and Methods This single-centre prospective study (Jan 2024–Jun 2025) compared outcomes of 36 primary THA patients treated with the direct anterior (DAA) or posterior approach (PA). One surgical team performed all procedures using standardised perioperative care. Patients were followed for one year. The assessed parameters were pain (VAS), function (HHS), radiographic accuracy, and complications using blinded evaluation and appropriate statistical analysis.

Results A total of 36 THA patients were enrolled (18 in DAA group and 18 in PA group) with comparable baseline demographics. Operative time was longer in the DAA group, but hospital stay, postoperative pain progression, functional recovery, and radiographic outcomes were similar. Two intraoperative fractures occurred in the PA group and one early infection in the DAA group, all successfully managed. Overall, both approaches showed equivalent one-year outcomes with low complication rates.

Discussion This study compared functional outcomes between the PA approach and DAA approach in hip THR. Both approaches sgowed comparable one-year outcomes; DAA offered earlier recovery but longer operative time, with similar complication rates.

Conclusion Despite longer DAA operative times, both approaches showed similar one-year outcomes, emphasizing that surgeon’s skill and patient selection matter more than approach choice.

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The authors declare that there are no conflicts of interest present.