title: Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach.
abstract: OBJECTIVE
  The development of minimal-incision techniques for total hip replacement with preservation of soft tissue is generally associated with faster rehabilitation, reduction of postoperative pain and increased patient comfort. The aim of this study was to compare a minimal-incision anterior approach with a transgluteal lateral technique for hip replacement surgery with respect to postoperative pain, consumption of rescue medication, length of hospital stay and time to reach a defined range of motion.
  
  
  METHODS
  In this retrospective cohort study we investigated 100 patients with a minimal-incision anterior approach (group I) and 100 patients with a transgluteal lateral approach (group II) retrospectively undergoing unilateral hip replacement. The study variables were pain at rest and during physiotherapy, amount of rescue medication, the time to reach a defined flexion and time in hospital.
  
  
  RESULTS
  The patients of group I consumed less rescue medication (19.6 ± 6.9 mg vs. 23.6 ± 11.3 mg;  p = 0.005) and experienced less pain on the day of surgery (1.3 ± 1 vs. 2.3 ± 1.3, p = 0.0001) and the first postoperative day (0.41 ± 0.8 vs. 0.66 ± 1.1, p = 0.036). The time to reach the defined range of motion (6.4 ± 2 days vs. 7.4 ± 2.1 days; p = 0.001) and the length of hospital stay were shorter (10.2 ± 1.9 days vs. 13.4 ± 1.6 days; p = 0.0001) for group I. However, pain during physiotherapy was higher on the third and sixth through ninth days after surgery in comparison to group II (p = 0.001-0.013).
  
  
  CONCLUSIONS
  The implantation of a hip prosthesis through a minimal-incision anterior approach is successful in reducing postoperative pain and consumption of pain medication. Time to recovery and length of hospital stay are also influenced positively. Pain increases during physiotherapy, and may be mitigated by adopting limited weight bearing during the early postoperative period.
authors: Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians University, Brettreichstr. 11, 97074, Würzburg, Germany. s-goebel.klh@uni-wuerzburg.de
authors: Sascha
authors: S
authors: Goebel
authors: Andre F
authors: AF
authors: Steinert
authors: Judith
authors: J
authors: Schillinger
authors: Jochen
authors: J
authors: Eulert
authors: Jens
authors: J
authors: Broscheit
authors: Maximilian
authors: M
authors: Rudert
authors: Ulrich
authors: U
authors: Nöth
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