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      Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12

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          Introduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL).

          Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS).

          Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01).

          Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA.

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          Most cited references 29

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          The operation of the century: total hip replacement.

          In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities. Advances in bioengineering technology have driven development of hip prostheses. Both cemented and uncemented hips can provide durable fixation. Better materials and design have allowed use of large-bore bearings, which provide an increased range of motion with enhanced stability and very low wear. Minimally invasive surgery limits soft-tissue damage and facilitates accelerated discharge and rehabilitation. Short-term objectives must not compromise long-term performance. Computer-assisted surgery will contribute to reproducible and accurate placement of implants. Universal economic constraints in healthcare services dictate that further developments in total hip replacement will be governed by their cost-effectiveness.
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            Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty.

            Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6 weeks, and 3, 6 and 12 months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. Secondary end points included assessment by several outcome instruments. DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6 weeks, and higher HOOS Symptoms scores at 3 months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases. Copyright © 2013 Elsevier Inc. All rights reserved.
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              The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure.

              With improving patient outcome after joint arthroplasty, new assessment tools with increased discriminatory power especially in well-performing patients are desirable. The goal of the present study was to develop and validate a new score ("Forgotten Joint Score," or FJS) introducing a new aspect of patient-reported outcome: the patient's ability to forget the artificial joint in everyday life. After a pilot study, the FJS was validated and showed high internal consistency (Cronbach α = .95). Ceiling effects were considerably lower for the FJS (9.2%) compared with the Western Ontario and McMaster Universities subscales (16.7%-46.7%). Known-group comparisons proved the FJS to be highly discriminative in a validation sample of 243 patients. The FJS not only reflects differences between "good" and "bad" but also between "good," "very good," and "excellent" outcomes. This concise score is appealing for its more adequate measurement range and because it measures the new, promising concept of the "forgotten joint." Copyright © 2012 Elsevier Inc. All rights reserved.

                Author and article information

                Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo Japan
                Author notes
                [* ]Corresponding author: tobaba@
                SICOT J
                SICOT J
                EDP Sciences
                27 November 2016
                : 4
                : ( publisher-idID: sicotj/2018/01 )
                30480545 6256966 10.1051/sicotj/2018051 sicotj180075 10.1051/sicotj/2018051
                © The Authors, published by EDP Sciences, 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Figures: 1, Tables: 4, Equations: 0, References: 28, Pages: 6
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