Compared with PA, DAA can improve bone mineral density and postoperative gait recovery：Retrospective study

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Methods A total of 76 patients diagnosed with femoral head necrosis and completed the first unilateral total hip arthroplasty from October 2021 to March 2022 were enrolled as the study subjects, and were divided into two groups according to different surgical methods. The gait indexes and bone density in Gruen1 and 7 regions were analyzed retrospectively. Results Gait indexes of DAA group and PA group were significantly improvedmafter surgery compared with those before surgery; bone mineral density (BMI) at 1 month and 3 months after surgery in Gruen1 area was significantly improved compared with that in 1 week after surgery. Stride length, stride speed, stride frequency, percentage of single support phase of affected limb to gait cycle, hip motion and BMI at 1 month and 3 months after surgery in DAA group were all better than those in posterior approach group, and the differences were statistically significant (P 0 ,P < 0.05). Conclusion Total Hip Arthroplasty(THA) with DAA has certain advantages in the postoperative functional rehabilitation of patients, which can improve the bone density of patients and improve the postoperative gait recovery of patients. Total Hip Arthroplasty direct anterior approach posterior approach bone mineral density gait Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 1 Introduction Total Hip Arthroplasty (THA) is the most effective way to relieve pain, quickly restore function, improve walking ability and improve quality of life in end-stage hip patients, and its good therapeutic effect has been widely recognized in clinical practice. [1,2] With the intensification of the aging of the global population, the health problem of the elderly has become more and more a concern of today's society, among which, as the "last fracture in life" - hip fracture, not only greatly reduces the quality of life of the elderly, and even threatens their lives. [3] However, THA can effectively solve this problem, so more and more elderly patients are receiving it. Total hip replacement can be divided into posterior approach, lateral approach and direct anterior approach according to different surgical approaches, each of which is widely used in clinical practice. [4–6] Total hip arthroplasty (DAA-THA) under direct anterior approach has gained momentum in recent years. Data show that the number of DAA-THAs in the United States has increased five to six times in seven years. [7,8] During the posterior approach, the gluteus medius muscle is damaged, leading to abductor weakness, and the lateral femoris muscle is also removed. [9] However, the direct anterior approach, which uses the anatomic space between muscles and nerves as the surgical entrance, has the advantages of lower dislocation rate, earlier recovery of function and less muscle injury than other approaches. [10] However, some studies have confirmed that posterior approach total hip replacement has certain advantages in terms of operation time, intraoperative blood loss and fracture incidence. [11] As mentioned above, with the progress of aging, osteoporosis has become a hot topic in the medical field, and patients with osteoporosis are prone to fractures, including hip fractures. [12] At present, there are few studies on the relationship between BMD and gait in early postoperative patients with different approaches. This study aims to review and compare the differences between gait and BMD in patients with total hip arthroplasty after direct anterior approach and posterior approach, and analyze the relationship between the two, as reported below. 2 Patients and Methods This study was approved by our institutional review board (approval number:2022-K-337-01), and informed consent was obtained from all patients. For this retrospective comparative study, data on THA performed by a senior surgeon at a single center between 2021 and 2022 were reviewed. Inclusion criteria restricted the study to patients who are 50–75 years old and diagnosed with femoral head necrosis underwent primary unilateral total hip replacement. And these patients’ Body mass index ≤ 25kg/m 2 with no dysfunction of the non-operative hip joint and no obvious abnormality of lower limb walking. Patients were excluded if the index procedure was bilateral THA, the contralateral hip had previously been replaced, history of prior trauma or surgery to the hips and developmental dysplasia of the hip and could not cooperate with the completion of postoperative follow-up and incomplete collection of clinical data. All THAs in this study were performed using DAAs with an uncemented hemispherical acetabular component (Triden®PSL, X3TM Polyethylene liners; Stryker, Kalamazoo, Michigan) and an unce- mented tapered wedge femoral component (Accolade TMZF® with Biolox® Delta ceramic head;Stryker, Kalama- zoo, Michigan). Age, sex, body mass index (BMI), surgical procedure and preoperative diagnosis were recorded for each patient at admission. Patients were divided into two groups in a double-blind way, one group received THA with direct forward approach and the other group received THA with posterior approach. Gait analysis (Sweden Qualisys-Oqus700 + system measurement) was performed for each patient before surgery. The stride length, stride speed, stride length, the percentage of the single supporting phase of the affected limb in the gait cycle, stride frequency and hip joint motion (hip joint flexion and extension, abduction and adduction, internal and external rotation) were recorded. The patient also underwent bone mineral density measurement (dual-energy X-ray measurement). The bone mineral density(BMD) measurement areas in this study were Gruen1 area (lesser trochanter of femur) and Gruen7 area (greater trochanter of femur).(Fig. 1) These indexes were remeasured at 1 week, 1 month and 3 months after surgery. The data was recorded by a researcher. Statistical method SPSS25.0 statistical software was used to process the data, which was in line with normal state. The measurement data with homogeneous variance were expressed in x ± s format. The t test of two independent samples was used for comparison between groups. The Chi-square test or Fisher exact probability method was used for comparison of counting data. The correlation between BMD and gait was evaluated by Pearson rank correlation coefficient with α = 0.05, P < 0.05, the difference was statistically significant. 3 Result 3.1 Basic data comparison As shown in Table 1, a total of 80 patients included in this study were divided into two groups according to surgical methods, with 40 patients in each group. In the PA group, 4 people lost their weight during the study. There were 22 men and 18 women in the DAA group, and 17 men and 19 women in the PA group. The average age in the DAA group was (63.02±4.53) years, the average age in the PA group was (62.58±4.17) years, the average height of patients in the DAA group was (1.67±0.08) m, and the average height of patients in the PA group was (1.68±0.07) m. The mean weight of patients in the DAA group was (63.29±7.80) kg, and the mean height of patients in the PA group was (64.50±6.73) kg. The BMI of patients in the DAA group was (22.77±1.77) kg/m2, and the BMI of patients in the PA group was (22.91±1.21) kg/m2. In the DAA group, 19 patients underwent surgery on the left lower limb and 21 patients underwent surgery on the right lower limb. In the PA group, 20 patients underwent surgery on the left lower limb and 16 patients underwent surgery on the right lower limb. There was no statistical difference between the two groups. Table 1 Preoperative demographic analysis of patients Group(mean±standard deviation) Age Height Weight BMI Sex Operative limb Male Female Left Right DAA(n=40) 63.02±4.53 1.67±0.08 63.29±7.80 22.77±1.77 22 18 19 21 PA(n=36) 62.58±4.17 1.68±0.07 64.50±6.73 22.91±1.21 17 19 20 16 t 0.441 -0.593 -0.720 -0.429 X 2 =0.459 X 2 =0.492 p 0.661 0.555 0.474 0.669 0.498 0.483 * p<0.05 ** p<0.01 3.2 Comparison of preoperative bone mineral density and gait analysis indexes The patients in this study underwent gait analysis and bone mineral density examination after admission, and their data were analyzed. The analysis results are shown in Table 2. step, stride, Percentage of gait cycle with single support phase of affected limb, pace, step frequency, hip in two groups extension, adduction degree of hip joint abduction, internal and external rotation of the hip joint, bone density in gruen1 There was no significant difference in bone density in gruen7 region (P< 0.05). Table 2 Comparison of preoperative gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement (x±s) Group(mean ± standard deviation) DAA(n=40) PA(n=36) t p * p<0.05 ** p<0.01 Preoperative step 35.38±2.33 35.83±2.46 -0.835 0.406 Preoperative stride 69.28±2.55 68.48±2.95 1.279 0.205 Percentage of gait cycle with single support phase of affected limb before operation 22.59±2.34 22.31±2.61 0.492 0.624 Preoperative pace 54.63±3.22 54.44±3.71 0.227 0.821 Preoperative step frequency 42.34±1.48 42.28±0.99 0.229 0.819 Preoperative hip extension 30.45±2.58 29.53±2.60 1.549 0.126 Preoperative adduction degree of hip joint abduction 7.15±0.33 7.17±0.23 -0.348 0.729 Preoperative internal and external rotation of the hip joint 10.03±0.69 9.71±0.77 1.897 0.062 Preoperative bone density in gruen1 region 0.68±0.04 0.67±0.04 1.709 0.092 Preoperative bone density in gruen7 region 0.59±0.21 0.59±0.23 -0.039 0.969 3.3 Comparison of bone mineral density and gait analysis indexes 1 week after operation The gait analysis indexes and bone mineral density of the patients were reviewed one week after surgery. The average Step of the patients in the DAA group was (39.95±2.22) cm, and that of the PA group was (37.96±2.10) cm, with statistical difference between the two groups (P<0.05). The mean Stride of DAA group was (78.17±2.13) cm and that of PA group was (75.04±2.63) cm, and there was a statistical difference between the two groups (P<0.05). The mean value of Percentage of gait cycle with single brace phase in affected limb was 26.07±1.97% in DAA group and 24.42±2.38% in PA group, and there was statistical difference between the two groups (P< 0.05). The average Pace of the DAA group was 62.58±3.15cm/s, and the average pace of the PA group was 58.94± 2.94cm /s, and there were statistical differences between the two groups (P< 0.05). The mean hip extension of the DAA group was (35.83±1.72) degrees, and that of the PA group was (31.19±2.07) degrees, and there were statistically significant differences between the two groups (P< 0.05). The mean value of hip internal and external rotation was (12.41±0.41) degrees in the DAA group and (11.27±0.74) degrees in the PA group. There was no significant difference in hip internal and external rotation values between the two groups (P=0.160). The mean BMD in Gruen1 area was (0.67±0.04) g·cm-2 in DAA group and (0.66±0.04) g·cm-2 in PA group one week after surgery, with no statistical difference between the two groups (P=0.422). The mean BMD in Gruen7 area 1 week after surgery was (0.56±0.24) g·cm-2 in DAA group and (0.56±0.24) g·cm-2 in PA group, with no statistical difference between the two groups (P=0.945). Table 3 Comparison of gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement 1week after surgery (x±s) Group(mean ± standard deviation) DAA(n=40) PA(n=36) t p * p<0.05 ** p<0.01 Step 1 week after surgery 39.95±2.22 37.96±2.10 4.009 0.000** Stride length 1 week after surgery 78.17±2.13 75.04±2.63 5.723 0.000** Percentage of gait cycle with single brace phase in affected limb 1 week after surgery 26.07±1.97 24.42±2.38 3.321 0.001** Pace 1 week after surgery 62.58±3.15 58.94±2.94 5.184 0.000** Step frequency 1 week after surgery 48.51±0.92 45.52±1.36 11.068 0.000** Hip extension 1 week after surgery 35.83±1.72 31.19±2.07 10.643 0.000** Internal and external rotation of the hip 1 week after surgery 12.41±0.41 11.27±0.74 8.182 0.000** Hip adduction and abduction degree 1 week after surgery 7.45±0.31 7.35±0.28 1.420 0.160 Bone density in gruen1 zone 1 week after surgery 0.68±0.03 0.64±0.03 4.876 0.000** Bone density in gruen7 zone 1 week after surgery 0.56±0.24 0.56±0.24 0.069 0.945 3.4 Comparison of bone mineral density and gait analysis indexes 1 month after operation The patient’s gait indexes and bone mineral density were reviewed one month after surgery. After data analysis, as shown in Table 4, step, stride, Percentage of gait cycle with single support phase of affected limb, pace, step frequency, hip of DAA group extension, internal and external rotation of the hip joint, bone density in gruen1 region, bone density in gruen7 region values were all higher than those in PA group, except bone density in gruen7 region (P=0.581), which had statistical significance (P<0.05). The adduction degree of hip joint abduction in the DAA group was lower than that in the PA group, and the values of the two groups were statistically significant (P<0.05). Table 4 Comparison of gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement 1 month after surgery (x±s) Group(mean ± standard deviation) DAA(n=40) PA(n=36) t p * p<0.05 ** p<0.01 Step 1 month after surgery 46.67±2.62 42.28±2.68 7.213 0.000** Stride length 1 month after surgery 87.42±2.28 83.56±2.47 7.071 0.000** Percentage of gait cycle with single brace phase in affected limb 1 month after surgery 33.33±2.71 30.72±2.41 4.403 0.000** Pace 1 month after surgery 71.92±4.23 65.78±3.39 6.943 0.000** Step frequency 1 month after surgery 58.41±1.00 47.33±0.84 51.897 0.000** Hip extension 1 month after surgery 39.80±2.81 34.44±2.31 9.011 0.000** Internal and external rotation of the hip 1 month after surgery 15.17±0.92 13.63±0.34 9.839 0.000** Hip adduction and abduction degree 1 month after surgery 9.60±0.75 10.62±0.26 -8.071 0.000** Bone density in gruen1 zone 1 month after surgery 0.75±0.03 0.73±0.04 2.857 0.006** Bone density in gruen7 zone 1 month after surgery 0.63±0.23 0.60±0.22 0.554 0.581 3.5 Comparison of bone mineral density and gait analysis indexes 3 months after operation The patient’s gait indexes and bone mineral density were reviewed 3 months after surgery. After data analysis, as shown in Table 5, step, stride, Percentage of gait cycle with single support phase of affected limb, pace, step frequency, hip of DAA group extension, internal and external rotation of the hip joint, bone density in gruen1 region, bone density in gruen7 region values were better than those in PA group one month after operation, and were all higher than those in PA group(P< 0.05), with statistical significance except bone density in gruen7 region (P=0.259). The adduction degree of hip joint abduction in the DAA group was lower than that in the PA group, and the values of the two groups were statistically significant (P<0.05). Table 5 Comparison of gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement 3 month after surgery (x±s) Group(mean ± standard deviation) DAA(n=40) PA(n=36) t p * p<0.05 ** p<0.01 Step 3 month after surgery 54.46±2.36 51.23±2.39 5.929 0.000** Stride length 3 month after surgery 99.44±2.77 91.64±2.54 12.730 0.000** Percentage of gait cycle with single brace phase in affected limb 3 month after surgery 37.48±3.34 35.31±2.62 3.125 0.003** Pace 3 month after surgery 101.63±3.79 94.08±3.43 9.048 0.000** Step frequency 3 month after surgery 60.65±1.50 59.77±0.75 3.283 0.002** Hip extension 3 month after surgery 44.63±2.74 37.72±1.97 12.485 0.000** Internal and external rotation of the hip 3 month after surgery 15.33±0.41 14.09±0.59 10.476 0.000** Hip adduction and abduction degree 3 month after surgery 10.65±0.45 12.59±0.32 -21.557 0.000** Bone density in gruen1 zone 3 month after surgery 0.76±0.05 0.74±0.03 2.308 0.024* Bone density in gruen7 zone 3 month after surgery 0.78±0.24 0.71±0.25 1.137 0.259 3.6 Correlation analysis between gait data and bone mineral density There was a positive correlation between gait indexes and BMD at 1 month and 3 months in the direct anterior approach group and the posterior approach group (R> 0 ,P< 0.05), as shown in FIG. 3-10. Bone mineral density in gruen1 area was significantly correlated with hip flexion and extension in the PA group one month after surgery (R 2 =0.1506, P=0.0531). 4 Discussion In this study, we found that there was no statistically significant difference in bone mineral density in Gruen1 zone and Gruen7 zone 1 week after surgery between the DAA surgery group and the PA surgery group. At 1 month after surgery, the difference of bone mineral density in Gruen1 region between the two groups was most obvious. In our study, there was no statistical difference in bone mineral density in Gruen7 region between the two groups during the 3-month follow-up, indicating that there was no significant difference in the change of femoral lesser trochanter bone mass between the two groups. One week after surgery, there was no significant difference in the adduction degree of hip joint between the two groups, and other gait indexes were statistically different. The gait data 1 month and 3 months after operation were statistically different, and the mean value of DAA group was more optimistic than that of PA group. For patients with end-stage hip disease, total hip replacement is the most effective treatment in clinical practice. There are three classic approaches to total hip replacement: direct anterior approach, posterior approach, and lateral approach. Posterior approach is still the mainstream of hip replacement in the world today, and direct anterior approach is rarely used by clinicians. [7] Many studies have been conducted on the prognostic effect and sequelae of the surgical method. Many studies believe that the accuracy of prosthetic position, length of stay, postoperative functional recovery, leg length difference, postoperative pain, proprioceptive recovery and postoperative prosthetic dislocation of patients under DAA surgery have positive effects compared with PA surgery [13,14] , however, little research attention has been paid to the correlation analysis of bone mineral density and gait analysis under two different surgical methods. After THA, patients experience surgical site infection, prosthesis related complications (dislocation, fracture, loosening, and dislocation), surgical trauma related complications (nerve damage and ectopic ossification), dysfunction (leg length difference and Trendelenburg gait), and resurgery. [15,16] Therefore, it is very important to evaluate the postoperative function of patients. Just as we thought, Foucher et al. [17] It is also considered that gait analysis is an effective method to evaluate the function after total hip arthroplasty, so as to provide a basis for surgical selection. Zomar et al. and Yoo et al. Concluded that the gait of THA patients undergoing DAA surgery had obvious advantages over PA surgery. [18][19] Compared with the two surgical methods, muscle injury was an important factor in the difference of postoperative gait recovery. According to the study of Ukai et al. [20] pre-operative and pre-operative nutritional status can impression the condition of lower limb muscle and fat after THA, thus affecting postoperative gait. Nankaku et al. [21] believed that the decreased muscle strength after THA would be maintained for about 1 year. Among them, lower limb muscle strength has been shown to be a contributing factor to functional performance (such as climbing stairs or chairs) in the elderly or in patients with hip fractures. [22] This is consistent with the significant decrease in hip flexion and extension in our study. Muscle mass is an important factor affecting postoperative gait. Among them, DAA surgery uses the anatomic space between muscles and nerves as the surgical entrance, which has a lower dislocation rate, earlier recovery of function and less muscle injury compared with other approaches. [19][23] Compared with the DAA, the PA surgical approach uses the traditional methods of severing the posterior joint capsule of the hip joint, the external rotation muscle group, and the fascia lata. [24] It has been reported that fascia lata has a strong relationship with the underlying muscle tissue. Intact fascia appears to be an important component of proper thigh muscle function and knee control in bipedal movement. From this analysis, the muscle injury under PA surgery was higher than that in DAA surgery group, resulting in worse postoperative gait recovery in PA surgery group than in DAA group. [25] At the same time, according to previous studies, the bone loss around the prosthesis was most obvious in Gruen1 and 7 regions [26] , Therefore, this study measured bone mass in GRUEN Zone 1 and Zone 7. However, we found that BMD values around Gruen1 region of prosthesis in the direct anterior approach group were more significantly improved than those in the posterior approach group, and the difference between the two groups was statistically significant, and BMD values in Gruen1 region and 7 region of patients in the two groups were positively correlated with gait. Umberto et al [27] show that bone loss is closely related to muscle tissue, and bone remodeling is affected by muscle morphology and dysfunction. When the strength generated by muscle changes, the anabolism of bone to musculogenic strain will also change. high Intensity Interval Training (HIIT) is a short period of high intensity exercise followed by a period of low intensity exercise. Halvarsson et al. believe that it is possible to exercise the muscle strength of lower limbs through balance and physical training, so that muscles can generate biomechanical stimulation to bones, delay muscle atrophy and bone loss, increase the fatigue resistance of lower limbs, and thus improve the gait of subjects and reduce the risk of falls. [28] Aboarrage et al. believe that HIIT plays an important role in bone and muscle crosstalk. Sitting too little will have many adverse effects on the human body, especially the health of the bones, sitting too little will lead to the speed of bone loss. [29] As mentioned above, patients with DAA surgery were more likely to move to the ground earlier than those in the PA group, so it was concluded that the bone mineral density loss of patients with DAA surgery was less than that in the PA group, which was consistent with our data. The loss of bone mass is also closely related to the stress shielding of the prosthesis. [26] Hellman et al. believed that the friction of prosthesis would produce ion debris harmful to bone tissue and lead to bone loss. [30] Some studies have found that abductor dysfunction may lead to secondary adverse local tissue reactions caused by prosthesis and osteolysis caused by bearing wear or infection, resulting in abnormal hip joint gait. [31] The PA surgical approach requires cutting off part of the external rotator muscle, destroying the original anatomical structure, resulting in postoperative muscle dysfunction, and worse postoperative bone loss and postoperative gait performance than DAA surgical approach. In this study, the gait index recovery and bone mineral density improvement of early patients after total hip replacement through DAA approach were better than those after total hip replacement through PA approach. In addition, there was a positive correlation between gait and BMD, and the correlation between gait and BMD was stronger in the direct forward approach group than in the posterior approach group. There are also shortcomings in this study. First, there was no significant statistical difference in BMD in Gruen7 area between the two groups of patients in this study before and after surgery, which may be related to the sample size. Second, this study is a retrospective study with a low level of evidence. Third, the postoperative follow-up time of this study was 3 months, and the long-term effect was not reflected, which can also be supplemented in future studies. In summary, total hip replacement under DAA approach has certain advantages for postoperative functional rehabilitation of patients, and can improve the bone density of patients while carrying out postoperative rehabilitation exercise, so as to improve the efficiency of gait and functional recovery of patients. Abbreviations bone mineral density (BMI); direct anterior approach(DAA); posterior approach(PA); Total Hip Arthroplasty (THA); bone mineral density(BMD) Declarations Funding/support statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflicts of interest statement: Xiulong Lou, Penglei Chen, Ruiqing Ji, Jing Shen, Jie Chen, Yuying Ge, Weifeng Ji declare that they have no conflict of interest. Acknowledgments: We thank all patients who participated and allowed their data to be anonymously used for the present study. Also, we would like to thank all staff from the participating departments and clinics. Authors’ Contributions: LXL, CPL and JRQ: Writing - Original Draft; SJ, CJ and GYY: Writing - Review & Editing; JWF: Supervision, Conceptualization. Ethics approval: This study was approved by The First Affiliated Hospital of Zhejiang Chinese Medical University institutional review board (approval number:2022-K-337-01).The location where the work was performed in The First Affiliated Hospital of Zhejiang Chinese Medical University. Availability of data and materials: All data and materials in this article are available. Consent for publication: This study was published with patient consent. References SEAH S, QUINN M, TIROSH O, et al. Postoperative Opioid Consumption After Total Hip Arthroplasty: A Comparison of Three Surgical Approaches[J/OL]. The Journal of Arthroplasty, 2019, 34(11): 2676-2680. DOI:10.1016/j.arth.2019.05.057. KAYANI B, KONAN S, CHANDRAMOHAN R, et al. The direct superior approach in total hip arthroplasty[J/OL]. British Journal of Hospital Medicine (London, England: 2005), 2019, 80(6): 320-324. DOI:10.12968/hmed.2019.80.6.320. PEETERS C M M, VISSER E, VAN DE REE C L P, et al. Quality of life after hip fracture in the elderly: A systematic literature review[J/OL]. Injury, 2016, 47(7): 1369-1382. DOI:10.1016/j.injury.2016.04.018. POST Z D, OROZCO F, DIAZ-LEDEZMA C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results[J/OL]. The Journal of the American Academy of Orthopaedic Surgeons, 2014, 22(9): 595-603. DOI:10.5435/JAAOS-22-09-595. AIT MOKHTAR M. Postero-posterolateral approach in total hip arthroplasty[J/OL]. International Orthopaedics, 2020, 44(12): 2577-2585. DOI:10.1007/s00264-020-04679-7. CHENG T E, WALLIS J A, TAYLOR N F, et al. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach[J/OL]. The Journal of Arthroplasty, 2017, 32(3): 883-890. DOI:10.1016/j.arth.2016.08.027. CHECHIK O, KHASHAN M, LADOR R, et al. Surgical approach and prosthesis fixation in hip arthroplasty world wide[J/OL]. Archives of Orthopaedic and Trauma Surgery, 2013, 133(11): 1595-1600. DOI:10.1007/s00402-013-1828-0. PATEL N N, SHAH J A, ERENS G A. Current Trends in Clinical Practice for the Direct Anterior Approach Total Hip Arthroplasty[J/OL]. The Journal of Arthroplasty, 2019, 34(9): 1987-1993.e3. DOI:10.1016/j.arth.2019.04.025. YAN L, GE L, DONG S, et al. Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty[J/OL]. JAMA Network Open, 2023, 6(1): e2253942. DOI:10.1001/jamanetworkopen.2022.53942. TANABE H, BABA T, OZAKI Y, et al. Conventional versus lateral fasciotomy for prevention of lateral femoral cutaneous nerve injury in the non-fan-type nerve in total hip arthroplasty with direct anterior approach[J/OL]. The Bone & Joint Journal, 2023, 105-B(12): 1252-1258. DOI:10.1302/0301-620X.105B12.BJJ-2023-0375.R1. CHEN W, SUN J N, ZHANG Y, et al. Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis[J/OL]. Journal of Orthopaedic Surgery and Research, 2020, 15(1): 231. DOI:10.1186/s13018-020-01747-x. CHEN B, ZHANG J H, DUCKWORTH A D, et al. Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance.[J/OL]. The bone & joint journal, 2023, 105-B(11): 1149-1158. DOI:10.1302/0301-620X.105B11.BJJ-2023-0139.R1. SHEN J, JI R, YAO S, et al. Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty[J/OL]. Orthopaedic Surgery, 2023, 15(3): 679-686. DOI:10.1111/os.13640. MCGOLDRICK N P, ANTONIADES S, EL MENIAWY S, et al. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction[J/OL]. Archives of Orthopaedic and Trauma Surgery, 2022, 142(10): 2945-2955. DOI:10.1007/s00402-021-04179-2. JIN Z, WANG L, QIN J, et al. Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review[J/OL]. Annals of Medicine, 2023, 55(1): 1378-1392. DOI:10.1080/07853890.2023.2193424. HUANG X, LIU D, JIA B, et al. Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis [J/OL]. Orthopaedic Surgery, 2021, 13(6): 1707-1720. DOI:10.1111/os.13101. FOUCHER K C, FREELS S. Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty[J/OL]. Osteoarthritis and Cartilage, 2015, 23(10): 1685-1694. DOI:10.1016/j.joca.2015.05.005. ZOMAR B O, BRYANT D, HUNTER S, et al. A randomised trial comparing spatio-temporal gait parameters after total hip arthroplasty between the direct anterior and direct lateral surgical approaches[J/OL]. Hip International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy, 2018, 28(5): 478-484. DOI:10.1177/1120700018760262. YOO J I, CHA Y H, KIM K J, et al. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis[J/OL]. BMC musculoskeletal disorders, 2019, 20(1): 63. DOI:10.1186/s12891-019-2450-2. UKAI T, YOKOYAMA K, WATANABE M. Preoperative Body Composition Correlates with Postoperative Muscle Volume and Degeneration after Total Hip Arthroplasty[J/OL]. Nutrients, 2024, 16(3): 386. DOI:10.3390/nu16030386. NANKAKU M, AKIYAMA H, KAKINOKI R, et al. Factors associated with ambulatory status 6 months after total hip arthroplasty[J/OL]. Physiotherapy, 2014, 100(3): 263-267. DOI:10.1016/j.physio.2013.06.004. HASSELGREN L, OLSSON L L, NYBERG L. Is leg muscle strength correlated with functional balance and mobility among inpatients in geriatric rehabilitation?[J/OL]. Archives of Gerontology and Geriatrics, 2011, 52(3): e220-225. DOI:10.1016/j.archger.2010.11.016. TANABE H, BABA T, OZAKI Y, et al. Lateral versus conventional fasciotomy for prevention of lateral femoral cutaneous nerve injury in total hip arthroplasty with direct anterior approach: a study protocol for a dual-center, double-blind, randomized controlled trial[J/OL]. Trials, 2022, 23: 567. DOI:10.1186/s13063-022-06496-2. CHUNG Y Y, LEE S M, BAEK S N, et al. Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach[J/OL]. Clinics in Orthopedic Surgery, 2022, 14(1): 35-40. DOI:10.4055/cios21008. ULIVI M, ORLANDINI L, VITALE J A, et al. Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements[J/OL]. Acta Orthopaedica, 2021, 92(3): 274-279. DOI:10.1080/17453674.2020.1865633. SU R, FENG W, LIU X, et al. Early Rehabilitation and Periprosthetic Bone Environment after Primary Total Hip Arthroplasty: A Randomized Controlled Trial[J/OL]. Orthopaedic Surgery, 2021, 13(5): 1521-1531. DOI:10.1111/os.12984. TARANTINO U, BALDI J, SCIMECA M, et al. The role of sarcopenia with and without fracture[J/OL]. Injury, 2016, 47: S3-S10. DOI:10.1016/j.injury.2016.07.057. HALVARSSON A, FRANZÉN E, STÅHLE A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial[J/OL]. Clinical Rehabilitation, 2015, 29(4): 365-375. DOI:10.1177/0269215514544983. ABOARRAGE JUNIOR A M, TEIXEIRA C V L S, DOS SANTOS R N, et al. A High-Intensity Jump-Based Aquatic Exercise Program Improves Bone Mineral Density and Functional Fitness in Postmenopausal Women[J/OL]. Rejuvenation Research, 2018, 21(6): 535-540. DOI:10.1089/rej.2018.2069. HELLMAN M D, FORD M C, BARRACK R L. Is there evidence to support an indication for surface replacement arthroplasty?: a systematic review[J/OL]. The Bone & Joint Journal, 2019, 101-B(1_Supple_A): 32-40. DOI:10.1302/0301-620X.101B1.BJJ-2018-0508.R1. BETTIS T, KIM B J, HAMRICK M W. Impact of muscle atrophy on bone metabolism and bone strength: Implications for muscle-bone crosstalk with aging and disuse[J/OL]. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2018, 29(8): 1713-1720. DOI:10.1007/s00198-018-4570-1. Additional Declarations No competing interests reported. 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Chen","email":"","orcid":"","institution":"Zhejiang Chinese Medical University, The First Affiliated Hospital of Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Penglei","middleName":"","lastName":"Chen","suffix":""},{"id":325492327,"identity":"6ea69f79-088e-4fc1-8510-a5325dc06fa9","order_by":2,"name":"RuiQing Ji","email":"","orcid":"","institution":"Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"RuiQing","middleName":"","lastName":"Ji","suffix":""},{"id":325492328,"identity":"1176007b-828a-4879-a7cc-b16a5ae52b39","order_by":3,"name":"Jing Shen","email":"","orcid":"","institution":"The First Affiliated Hospital of Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Shen","suffix":""},{"id":325492329,"identity":"c204130a-1c8b-4f0a-9d93-d53f7f51fb0d","order_by":4,"name":"Jie Chen","email":"","orcid":"","institution":"The First Affiliated 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legend.\u003c/p\u003e","description":"","filename":"fig10.png","url":"https://assets-eu.researchsquare.com/files/rs-4673437/v1/57b7e7ece20c92328c4c09b9.png"},{"id":65969755,"identity":"22266fce-2bc8-4c17-a8cd-2e65641872b6","added_by":"auto","created_at":"2024-10-05 08:17:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8086876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4673437/v1/f9dbf3b6-f68c-48b9-8458-ec34a8491d23.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Compared with PA, DAA can improve bone mineral density and postoperative gait recovery：Retrospective study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eTotal Hip Arthroplasty (THA) is the most effective way to relieve pain, quickly restore function, improve walking ability and improve quality of life in end-stage hip patients, and its good therapeutic effect has been widely recognized in clinical practice.\u003csup\u003e[1,2]\u003c/sup\u003e With the intensification of the aging of the global population, the health problem of the elderly has become more and more a concern of today's society, among which, as the \"last fracture in life\" - hip fracture, not only greatly reduces the quality of life of the elderly, and even threatens their lives.\u003csup\u003e[3]\u003c/sup\u003e However, THA can effectively solve this problem, so more and more elderly patients are receiving it. Total hip replacement can be divided into posterior approach, lateral approach and direct anterior approach according to different surgical approaches, each of which is widely used in clinical practice.\u003csup\u003e[4\u0026ndash;6]\u003c/sup\u003e Total hip arthroplasty (DAA-THA) under direct anterior approach has gained momentum in recent years. Data show that the number of DAA-THAs in the United States has increased five to six times in seven years.\u003csup\u003e[7,8]\u003c/sup\u003e During the posterior approach, the gluteus medius muscle is damaged, leading to abductor weakness, and the lateral femoris muscle is also removed.\u003csup\u003e[9]\u003c/sup\u003e However, the direct anterior approach, which uses the anatomic space between muscles and nerves as the surgical entrance, has the advantages of lower dislocation rate, earlier recovery of function and less muscle injury than other approaches.\u003csup\u003e[10]\u003c/sup\u003e However, some studies have confirmed that posterior approach total hip replacement has certain advantages in terms of operation time, intraoperative blood loss and fracture incidence.\u003csup\u003e[11]\u003c/sup\u003e As mentioned above, with the progress of aging, osteoporosis has become a hot topic in the medical field, and patients with osteoporosis are prone to fractures, including hip fractures.\u003csup\u003e[12]\u003c/sup\u003e At present, there are few studies on the relationship between BMD and gait in early postoperative patients with different approaches. This study aims to review and compare the differences between gait and BMD in patients with total hip arthroplasty after direct anterior approach and posterior approach, and analyze the relationship between the two, as reported below.\u003c/p\u003e"},{"header":"2 Patients and Methods","content":"\u003cp\u003e This study was approved by our institutional review board (approval number:2022-K-337-01), and informed consent was obtained from all patients. For this retrospective comparative study, data on THA performed by a senior surgeon at a single center between 2021 and 2022 were reviewed. Inclusion criteria restricted the study to patients who are 50\u0026ndash;75 years old and diagnosed with femoral head necrosis underwent primary unilateral total hip replacement. And these patients\u0026rsquo; Body mass index\u0026thinsp;\u0026le;\u0026thinsp;25kg/m\u003csup\u003e2\u003c/sup\u003e with no dysfunction of the non-operative hip joint and no obvious abnormality of lower limb walking. Patients were excluded if the index procedure was bilateral THA, the contralateral hip had previously been replaced, history of prior trauma or surgery to the hips and developmental dysplasia of the hip and could not cooperate with the completion of postoperative follow-up and incomplete collection of clinical data. All THAs in this study were performed using DAAs with an uncemented hemispherical acetabular component (Triden\u0026reg;PSL, X3TM Polyethylene liners; Stryker, Kalamazoo, Michigan) and an unce- mented tapered wedge femoral component (Accolade TMZF\u0026reg; with Biolox\u0026reg; Delta ceramic head;Stryker, Kalama- zoo, Michigan).\u003c/p\u003e \u003cp\u003eAge, sex, body mass index (BMI), surgical procedure and preoperative diagnosis were recorded for each patient at admission. Patients were divided into two groups in a double-blind way, one group received THA with direct forward approach and the other group received THA with posterior approach. Gait analysis (Sweden Qualisys-Oqus700\u0026thinsp;+\u0026thinsp;system measurement) was performed for each patient before surgery. The stride length, stride speed, stride length, the percentage of the single supporting phase of the affected limb in the gait cycle, stride frequency and hip joint motion (hip joint flexion and extension, abduction and adduction, internal and external rotation) were recorded. The patient also underwent bone mineral density measurement (dual-energy X-ray measurement). The bone mineral density(BMD) measurement areas in this study were Gruen1 area (lesser trochanter of femur) and Gruen7 area (greater trochanter of femur).(Fig.\u0026nbsp;1) These indexes were remeasured at 1 week, 1 month and 3 months after surgery. The data was recorded by a researcher.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStatistical method\u003c/p\u003e \u003cp\u003eSPSS25.0 statistical software was used to process the data, which was in line with normal state. The measurement data with homogeneous variance were expressed in x\u0026thinsp;\u0026plusmn;\u0026thinsp;s format. The t test of two independent samples was used for comparison between groups. The Chi-square test or Fisher exact probability method was used for comparison of counting data. The correlation between BMD and gait was evaluated by Pearson rank correlation coefficient with α\u0026thinsp;=\u0026thinsp;0.05, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, the difference was statistically significant.\u003c/p\u003e"},{"header":"3 Result","content":"\u003cp\u003e3.1 Basic data comparison\u003c/p\u003e\n\u003cp\u003eAs shown in Table 1, a total of 80 patients included in this study were divided into two groups according to surgical methods, with 40 patients in each group. In the PA group, 4 people lost their weight during the study. There were 22 men and 18 women in the DAA group, and 17 men and 19 women in the PA group. The average age in the DAA group was (63.02\u0026plusmn;4.53) years, the average age in the PA group was (62.58\u0026plusmn;4.17) years, the average height of patients in the DAA group was (1.67\u0026plusmn;0.08) m, and the average height of patients in the PA group was (1.68\u0026plusmn;0.07) m. The mean weight of patients in the DAA group was (63.29\u0026plusmn;7.80) kg, and the mean height of patients in the PA group was (64.50\u0026plusmn;6.73) kg. The BMI of patients in the DAA group was (22.77\u0026plusmn;1.77) kg/m2, and the BMI of patients in the PA group was (22.91\u0026plusmn;1.21) kg/m2. In the DAA group, 19 patients underwent surgery on the left lower limb and 21 patients underwent surgery on the right lower limb. In the PA group, 20 patients underwent surgery on the left lower limb and 16 patients underwent surgery on the right lower limb. There was no statistical difference between the two groups.\u003c/p\u003e\n\u003cp\u003eTable 1 Preoperative demographic analysis of patients\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.966442953020135%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGroup(mean\u0026plusmn;standard deviation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.40268456375839%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.409395973154362%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.577181208053691%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.570469798657719%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.624161073825505%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOperative limb\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.462962962962962%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38888888888889%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.75925925925926%\" valign=\"top\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38888888888889%\" valign=\"top\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.932998324958124%\" valign=\"top\"\u003e\n \u003cp\u003eDAA(n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.385259631490788%\" valign=\"top\"\u003e\n \u003cp\u003e63.02\u0026plusmn;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.390284757118929%\" valign=\"top\"\u003e\n \u003cp\u003e1.67\u0026plusmn;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.557788944723619%\" valign=\"top\"\u003e\n \u003cp\u003e63.29\u0026plusmn;7.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.552763819095478%\" valign=\"top\"\u003e\n \u003cp\u003e22.77\u0026plusmn;1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.212730318257956%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.547738693467336%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.872696817420436%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.547738693467336%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.932998324958124%\" valign=\"top\"\u003e\n \u003cp\u003ePA(n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.385259631490788%\" valign=\"top\"\u003e\n \u003cp\u003e62.58\u0026plusmn;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.390284757118929%\" valign=\"top\"\u003e\n \u003cp\u003e1.68\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.557788944723619%\" valign=\"top\"\u003e\n \u003cp\u003e64.50\u0026plusmn;6.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.552763819095478%\" valign=\"top\"\u003e\n \u003cp\u003e22.91\u0026plusmn;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.212730318257956%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.547738693467336%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.872696817420436%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.547738693467336%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.966442953020135%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.40268456375839%\" valign=\"top\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.409395973154362%\" valign=\"top\"\u003e\n \u003cp\u003e-0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.577181208053691%\" valign=\"top\"\u003e\n \u003cp\u003e-0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.570469798657719%\" valign=\"top\"\u003e\n \u003cp\u003e-0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.624161073825505%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.966442953020135%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.40268456375839%\" valign=\"top\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.409395973154362%\" valign=\"top\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.577181208053691%\" valign=\"top\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.570469798657719%\" valign=\"top\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.624161073825505%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e* p\u0026lt;0.05 ** p\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e3.2 Comparison of preoperative bone mineral density and gait analysis indexes\u003c/p\u003e\n\u003cp\u003eThe patients in this study underwent gait analysis and bone mineral density examination after admission, and their data were analyzed. The analysis results are shown in Table 2. step, stride, Percentage of gait cycle with single support phase of affected limb, pace, step frequency, hip in two groups extension, adduction degree of hip joint abduction, internal and external rotation of the hip joint, bone density in gruen1 There was no significant difference in bone density in gruen7 region (P\u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eTable 2 Comparison of preoperative gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement (x\u0026plusmn;s)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.043715846994534%\" valign=\"top\"\u003e\n \u003cp\u003eGroup(mean \u0026plusmn; standard deviation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.94353369763206%\" valign=\"top\"\u003e\n \u003cp\u003eDAA(n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.482695810564662%\" valign=\"top\"\u003e\n \u003cp\u003ePA(n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.2040072859745%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.1183970856102%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.207650273224044%\" rowspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003e* p\u0026lt;0.05\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e** p\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative step\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e35.38\u0026plusmn;2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e35.83\u0026plusmn;2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e-0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative stride\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e69.28\u0026plusmn;2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e68.48\u0026plusmn;2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e1.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage of gait cycle with single support phase of affected limb before operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e22.59\u0026plusmn;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e22.31\u0026plusmn;2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative pace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e54.63\u0026plusmn;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e54.44\u0026plusmn;3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative step frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e42.34\u0026plusmn;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e42.28\u0026plusmn;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative hip extension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e30.45\u0026plusmn;2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e29.53\u0026plusmn;2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e1.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative adduction degree of hip joint abduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e7.15\u0026plusmn;0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e7.17\u0026plusmn;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e-0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative internal and external rotation of the hip joint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e10.03\u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e9.71\u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e1.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative bone density in gruen1 region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.68\u0026plusmn;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.67\u0026plusmn;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e1.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative bone density in gruen7 region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.59\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.59\u0026plusmn;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e-0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e3.3 Comparison of bone mineral density and gait analysis indexes 1 week after operation\u003c/p\u003e\n\u003cp\u003eThe gait analysis indexes and bone mineral density of the patients were reviewed one week after surgery. The average Step of the patients in the DAA group was (39.95\u0026plusmn;2.22) cm, and that of the PA group was (37.96\u0026plusmn;2.10) cm, with statistical difference between the two groups (P\u0026lt;0.05). The mean Stride of DAA group was (78.17\u0026plusmn;2.13) cm and that of PA group was (75.04\u0026plusmn;2.63) cm, and there was a statistical difference between the two groups (P\u0026lt;0.05). The mean value of Percentage of gait cycle with single brace phase in affected limb was 26.07\u0026plusmn;1.97% in DAA group and 24.42\u0026plusmn;2.38% in PA group, and there was statistical difference between the two groups (P\u0026lt; 0.05). The average Pace of the DAA group was 62.58\u0026plusmn;3.15cm/s, and the average pace of the PA group was 58.94\u0026plusmn; 2.94cm /s, and there were statistical differences between the two groups (P\u0026lt; 0.05). The mean hip extension of the DAA group was (35.83\u0026plusmn;1.72) degrees, and that of the PA group was (31.19\u0026plusmn;2.07) degrees, and there were statistically significant differences between the two groups (P\u0026amp;lt; 0.05). The mean value of hip internal and external rotation was (12.41\u0026plusmn;0.41) degrees in the DAA group and (11.27\u0026plusmn;0.74) degrees in the PA group. There was no significant difference in hip internal and external rotation values between the two groups (P=0.160). The mean BMD in Gruen1 area was (0.67\u0026plusmn;0.04) g\u0026middot;cm-2 in DAA group and (0.66\u0026plusmn;0.04) g\u0026middot;cm-2 in PA group one week after\u0026nbsp;\u003c/p\u003e\n\u003cp\u003esurgery, with no statistical difference between the two groups (P=0.422). The mean BMD in\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGruen7 area 1 week after surgery was (0.56\u0026plusmn;0.24) g\u0026middot;cm-2 in DAA group and (0.56\u0026plusmn;0.24)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eg\u0026middot;cm-2 in PA group, with no statistical difference between the two groups (P=0.945). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Comparison of gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement 1week after surgery (x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.043715846994534%\" valign=\"top\"\u003e\n \u003cp\u003eGroup(mean \u0026plusmn; standard deviation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.94353369763206%\" valign=\"top\"\u003e\n \u003cp\u003eDAA(n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.482695810564662%\" valign=\"top\"\u003e\n \u003cp\u003ePA(n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.2040072859745%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.1183970856102%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.207650273224044%\" rowspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003e* p\u0026lt;0.05\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e** p\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStep 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e39.95\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e37.96\u0026plusmn;2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e4.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStride length 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e78.17\u0026plusmn;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e75.04\u0026plusmn;2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e5.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage of gait cycle with single brace phase in affected limb 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e26.07\u0026plusmn;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e24.42\u0026plusmn;2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e3.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePace 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e62.58\u0026plusmn;3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e58.94\u0026plusmn;2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e5.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStep frequency 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e48.51\u0026plusmn;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e45.52\u0026plusmn;1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e11.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eHip extension 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e35.83\u0026plusmn;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e31.19\u0026plusmn;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e10.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eInternal and external rotation of the hip 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e12.41\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e11.27\u0026plusmn;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e8.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eHip adduction and abduction degree 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e7.45\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e7.35\u0026plusmn;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e1.420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eBone density in gruen1 zone 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.68\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.64\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e4.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eBone density in gruen7 zone 1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.56\u0026plusmn;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.56\u0026plusmn;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e3.4 Comparison of bone mineral density and gait analysis indexes 1 month after operation\u003c/p\u003e\n\u003cp\u003eThe patient\u0026rsquo;s gait indexes and bone mineral density were reviewed one month after surgery. After data analysis, as shown in Table 4, step, stride, Percentage of gait cycle with single support phase of affected limb, pace, step frequency, hip of DAA group extension, internal and external rotation of the hip joint, bone density in gruen1 region, bone density in gruen7 region values were all higher than those in PA group, except bone density in gruen7 region (P=0.581), which had statistical significance (P\u0026lt;0.05). The adduction degree of hip joint abduction in the DAA group was lower than that in the PA group, and the values of the two groups were statistically significant (P\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement 1 month after surgery (x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.043715846994534%\" valign=\"top\"\u003e\n \u003cp\u003eGroup(mean \u0026plusmn; standard deviation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.94353369763206%\" valign=\"top\"\u003e\n \u003cp\u003eDAA(n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.482695810564662%\" valign=\"top\"\u003e\n \u003cp\u003ePA(n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.2040072859745%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.1183970856102%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.207650273224044%\" rowspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003e* p\u0026lt;0.05\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e** p\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStep 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e46.67\u0026plusmn;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e42.28\u0026plusmn;2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e7.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStride length 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e87.42\u0026plusmn;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e83.56\u0026plusmn;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e7.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage of gait cycle with single brace phase in affected limb 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e33.33\u0026plusmn;2.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e30.72\u0026plusmn;2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e4.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePace 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e71.92\u0026plusmn;4.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e65.78\u0026plusmn;3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e6.943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStep frequency 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e58.41\u0026plusmn;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e47.33\u0026plusmn;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e51.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eHip extension 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e39.80\u0026plusmn;2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e34.44\u0026plusmn;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e9.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eInternal and external rotation of the hip 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e15.17\u0026plusmn;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e13.63\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e9.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eHip adduction and abduction degree 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e9.60\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e10.62\u0026plusmn;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e-8.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eBone density in gruen1 zone 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.75\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.73\u0026plusmn;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e2.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.006**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eBone density in gruen7 zone 1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.63\u0026plusmn;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.60\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e3.5\u0026nbsp;Comparison of bone mineral density and gait analysis indexes 3 months after operation\u003c/p\u003e\n\u003cp\u003eThe patient\u0026rsquo;s gait indexes and bone mineral density were reviewed 3 months after surgery. After data analysis, as shown in Table 5, step, stride, Percentage of gait cycle with single support phase of affected limb, pace, step frequency, hip of DAA group extension, internal and external rotation of the hip joint, bone density in gruen1 region, bone density in gruen7 region values were better than those in PA group one month after operation, and were all higher than those in PA group(P\u0026lt; 0.05), with statistical significance except bone density in gruen7 region (P=0.259). The adduction degree of hip joint abduction in the DAA group was lower than that in the PA group, and the values of the two groups were statistically significant (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eTable 5 Comparison of gait indexes and bone mineral density between direct anterior approach group and posterior approach group in total hip replacement 3 month after surgery (x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.043715846994534%\" valign=\"top\"\u003e\n \u003cp\u003eGroup(mean \u0026plusmn; standard deviation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.94353369763206%\" valign=\"top\"\u003e\n \u003cp\u003eDAA(n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.482695810564662%\" valign=\"top\"\u003e\n \u003cp\u003ePA(n=36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.2040072859745%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.1183970856102%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.207650273224044%\" rowspan=\"11\" valign=\"top\"\u003e\n \u003cp\u003e* p\u0026lt;0.05\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e** p\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStep 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e54.46\u0026plusmn;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e51.23\u0026plusmn;2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e5.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStride length 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e99.44\u0026plusmn;2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e91.64\u0026plusmn;2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e12.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage of gait cycle with single brace phase in affected limb 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e37.48\u0026plusmn;3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e35.31\u0026plusmn;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e3.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.003**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003ePace 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e101.63\u0026plusmn;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e94.08\u0026plusmn;3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e9.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eStep frequency 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e60.65\u0026plusmn;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e59.77\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e3.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eHip extension 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e44.63\u0026plusmn;2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e37.72\u0026plusmn;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e12.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eInternal and external rotation of the hip 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e15.33\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e14.09\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e10.476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eHip adduction and abduction degree 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e10.65\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e12.59\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e-21.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eBone density in gruen1 zone 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.76\u0026plusmn;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.74\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e2.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.02547770700637%\" valign=\"top\"\u003e\n \u003cp\u003eBone density in gruen7 zone 3 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.08067940552017%\" valign=\"top\"\u003e\n \u003cp\u003e0.78\u0026plusmn;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.046709129511676%\" valign=\"top\"\u003e\n \u003cp\u003e0.71\u0026plusmn;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.225053078556263%\" valign=\"top\"\u003e\n \u003cp\u003e1.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.62208067940552%\" valign=\"top\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e3.6\u0026nbsp;Correlation analysis between gait data and bone mineral density\u003c/p\u003e\n\u003cp\u003eThere was a positive correlation between gait indexes and BMD at 1 month and 3 months in the direct anterior approach group and the posterior approach group (R\u0026gt; 0 ,P\u0026lt; 0.05), as shown in FIG. 3-10. Bone mineral density in gruen1 area was significantly correlated with hip flexion and extension in the PA group one month after surgery (R\u003csup\u003e2\u003c/sup\u003e=0.1506, P=0.0531).\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIn this study, we found that there was no statistically significant difference in bone mineral density in Gruen1 zone and Gruen7 zone 1 week after surgery between the DAA surgery group and the PA surgery group. At 1 month after surgery, the difference of bone mineral density in Gruen1 region between the two groups was most obvious. In our study, there was no statistical difference in bone mineral density in Gruen7 region between the two groups during the 3-month follow-up, indicating that there was no significant difference in the change of femoral lesser trochanter bone mass between the two groups. One week after surgery, there was no significant difference in the adduction degree of hip joint between the two groups, and other gait indexes were statistically different. The gait data 1 month and 3 months after operation were statistically different, and the mean value of DAA group was more optimistic than that of PA group.\u003c/p\u003e \u003cp\u003eFor patients with end-stage hip disease, total hip replacement is the most effective treatment in clinical practice. There are three classic approaches to total hip replacement: direct anterior approach, posterior approach, and lateral approach. Posterior approach is still the mainstream of hip replacement in the world today, and direct anterior approach is rarely used by clinicians.\u003csup\u003e[7]\u003c/sup\u003e Many studies have been conducted on the prognostic effect and sequelae of the surgical method. Many studies believe that the accuracy of prosthetic position, length of stay, postoperative functional recovery, leg length difference, postoperative pain, proprioceptive recovery and postoperative prosthetic dislocation of patients under DAA surgery have positive effects compared with PA surgery \u003csup\u003e[13,14]\u003c/sup\u003e, however, little research attention has been paid to the correlation analysis of bone mineral density and gait analysis under two different surgical methods. After THA, patients experience surgical site infection, prosthesis related complications (dislocation, fracture, loosening, and dislocation), surgical trauma related complications (nerve damage and ectopic ossification), dysfunction (leg length difference and Trendelenburg gait), and resurgery.\u003csup\u003e[15,16]\u003c/sup\u003e Therefore, it is very important to evaluate the postoperative function of patients. Just as we thought, Foucher et al. \u003csup\u003e[17]\u003c/sup\u003e It is also considered that gait analysis is an effective method to evaluate the function after total hip arthroplasty, so as to provide a basis for surgical selection. Zomar et al. and Yoo et al. Concluded that the gait of THA patients undergoing DAA surgery had obvious advantages over PA surgery.\u003csup\u003e[18][19]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCompared with the two surgical methods, muscle injury was an important factor in the difference of postoperative gait recovery. According to the study of Ukai et al. \u003csup\u003e[20]\u003c/sup\u003e pre-operative and pre-operative nutritional status can impression the condition of lower limb muscle and fat after THA, thus affecting postoperative gait. Nankaku et al. \u003csup\u003e[21]\u003c/sup\u003e believed that the decreased muscle strength after THA would be maintained for about 1 year. Among them, lower limb muscle strength has been shown to be a contributing factor to functional performance (such as climbing stairs or chairs) in the elderly or in patients with hip fractures. \u003csup\u003e[22]\u003c/sup\u003e This is consistent with the significant decrease in hip flexion and extension in our study. Muscle mass is an important factor affecting postoperative gait. Among them, DAA surgery uses the anatomic space between muscles and nerves as the surgical entrance, which has a lower dislocation rate, earlier recovery of function and less muscle injury compared with other approaches.\u003csup\u003e[19][23]\u003c/sup\u003e Compared with the DAA, the PA surgical approach uses the traditional methods of severing the posterior joint capsule of the hip joint, the external rotation muscle group, and the fascia lata. \u003csup\u003e[24]\u003c/sup\u003e It has been reported that fascia lata has a strong relationship with the underlying muscle tissue. Intact fascia appears to be an important component of proper thigh muscle function and knee control in bipedal movement. From this analysis, the muscle injury under PA surgery was higher than that in DAA surgery group, resulting in worse postoperative gait recovery in PA surgery group than in DAA group. \u003csup\u003e[25]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt the same time, according to previous studies, the bone loss around the prosthesis was most obvious in Gruen1 and 7 regions \u003csup\u003e[26]\u003c/sup\u003e, Therefore, this study measured bone mass in GRUEN Zone 1 and Zone 7. However, we found that BMD values around Gruen1 region of prosthesis in the direct anterior approach group were more significantly improved than those in the posterior approach group, and the difference between the two groups was statistically significant, and BMD values in Gruen1 region and 7 region of patients in the two groups were positively correlated with gait. Umberto et al \u003csup\u003e[27]\u003c/sup\u003e show that bone loss is closely related to muscle tissue, and bone remodeling is affected by muscle morphology and dysfunction. When the strength generated by muscle changes, the anabolism of bone to musculogenic strain will also change. high Intensity Interval Training (HIIT) is a short period of high intensity exercise followed by a period of low intensity exercise. Halvarsson et al. believe that it is possible to exercise the muscle strength of lower limbs through balance and physical training, so that muscles can generate biomechanical stimulation to bones, delay muscle atrophy and bone loss, increase the fatigue resistance of lower limbs, and thus improve the gait of subjects and reduce the risk of falls.\u003csup\u003e[28]\u003c/sup\u003e Aboarrage et al. believe that HIIT plays an important role in bone and muscle crosstalk. Sitting too little will have many adverse effects on the human body, especially the health of the bones, sitting too little will lead to the speed of bone loss.\u003csup\u003e[29]\u003c/sup\u003e As mentioned above, patients with DAA surgery were more likely to move to the ground earlier than those in the PA group, so it was concluded that the bone mineral density loss of patients with DAA surgery was less than that in the PA group, which was consistent with our data. The loss of bone mass is also closely related to the stress shielding of the prosthesis.\u003csup\u003e[26]\u003c/sup\u003e Hellman et al. believed that the friction of prosthesis would produce ion debris harmful to bone tissue and lead to bone loss.\u003csup\u003e[30]\u003c/sup\u003e Some studies have found that abductor dysfunction may lead to secondary adverse local tissue reactions caused by prosthesis and osteolysis caused by bearing wear or infection, resulting in abnormal hip joint gait.\u003csup\u003e[31]\u003c/sup\u003e The PA surgical approach requires cutting off part of the external rotator muscle, destroying the original anatomical structure, resulting in postoperative muscle dysfunction, and worse postoperative bone loss and postoperative gait performance than DAA surgical approach.\u003c/p\u003e \u003cp\u003eIn this study, the gait index recovery and bone mineral density improvement of early patients after total hip replacement through DAA approach were better than those after total hip replacement through PA approach. In addition, there was a positive correlation between gait and BMD, and the correlation between gait and BMD was stronger in the direct forward approach group than in the posterior approach group. There are also shortcomings in this study. First, there was no significant statistical difference in BMD in Gruen7 area between the two groups of patients in this study before and after surgery, which may be related to the sample size. Second, this study is a retrospective study with a low level of evidence. Third, the postoperative follow-up time of this study was 3 months, and the long-term effect was not reflected, which can also be supplemented in future studies.\u003c/p\u003e \u003cp\u003eIn summary, total hip replacement under DAA approach has certain advantages for postoperative functional rehabilitation of patients, and can improve the bone density of patients while carrying out postoperative rehabilitation exercise, so as to improve the efficiency of gait and functional recovery of patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ebone mineral density (BMI); direct anterior approach(DAA); posterior approach(PA); Total Hip Arthroplasty (THA); bone mineral density(BMD)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding/support statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest statement:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXiulong Lou, Penglei Chen, Ruiqing Ji, Jing Shen, Jie Chen, Yuying Ge, Weifeng Ji declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all patients who participated and allowed their data to be anonymously used for the present study. Also, we would like to thank all staff from the participating departments and clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLXL, CPL and JRQ: Writing - Original Draft; SJ, CJ and GYY: Writing - Review \u0026amp; Editing; JWF: Supervision, Conceptualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis study was approved by\u0026nbsp;The First Affiliated Hospital of Zhejiang Chinese Medical University\u0026nbsp;institutional review board (approval number:2022-K-337-01).The location where the work was performed in\u0026nbsp;The First Affiliated Hospital of Zhejiang Chinese Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All data and materials in this article are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e This study was published with patient consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSEAH S, QUINN M, TIROSH O, et al. Postoperative Opioid Consumption After Total Hip Arthroplasty: A Comparison of Three Surgical Approaches[J/OL]. The Journal of Arthroplasty, 2019, 34(11): 2676-2680. DOI:10.1016/j.arth.2019.05.057.\u003c/li\u003e\n\u003cli\u003eKAYANI B, KONAN S, CHANDRAMOHAN R, et al. The direct superior approach in total hip arthroplasty[J/OL]. British Journal of Hospital Medicine (London, England: 2005), 2019, 80(6): 320-324. DOI:10.12968/hmed.2019.80.6.320.\u003c/li\u003e\n\u003cli\u003ePEETERS C M M, VISSER E, VAN DE REE C L P, et al. Quality of life after hip fracture in the elderly: A systematic literature review[J/OL]. Injury, 2016, 47(7): 1369-1382. DOI:10.1016/j.injury.2016.04.018.\u003c/li\u003e\n\u003cli\u003ePOST Z D, OROZCO F, DIAZ-LEDEZMA C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results[J/OL]. The Journal of the American Academy of Orthopaedic Surgeons, 2014, 22(9): 595-603. DOI:10.5435/JAAOS-22-09-595.\u003c/li\u003e\n\u003cli\u003eAIT MOKHTAR M. Postero-posterolateral approach in total hip arthroplasty[J/OL]. International Orthopaedics, 2020, 44(12): 2577-2585. DOI:10.1007/s00264-020-04679-7.\u003c/li\u003e\n\u003cli\u003eCHENG T E, WALLIS J A, TAYLOR N F, et al. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach[J/OL]. The Journal of Arthroplasty, 2017, 32(3): 883-890. DOI:10.1016/j.arth.2016.08.027.\u003c/li\u003e\n\u003cli\u003eCHECHIK O, KHASHAN M, LADOR R, et al. Surgical approach and prosthesis fixation in hip arthroplasty world wide[J/OL]. Archives of Orthopaedic and Trauma Surgery, 2013, 133(11): 1595-1600. DOI:10.1007/s00402-013-1828-0.\u003c/li\u003e\n\u003cli\u003ePATEL N N, SHAH J A, ERENS G A. Current Trends in Clinical Practice for the Direct Anterior Approach Total Hip Arthroplasty[J/OL]. The Journal of Arthroplasty, 2019, 34(9): 1987-1993.e3. DOI:10.1016/j.arth.2019.04.025.\u003c/li\u003e\n\u003cli\u003eYAN L, GE L, DONG S, et al. Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty[J/OL]. JAMA Network Open, 2023, 6(1): e2253942. DOI:10.1001/jamanetworkopen.2022.53942.\u003c/li\u003e\n\u003cli\u003eTANABE H, BABA T, OZAKI Y, et al. Conventional versus lateral fasciotomy for prevention of lateral femoral cutaneous nerve injury in the non-fan-type nerve in total hip arthroplasty with direct anterior approach[J/OL]. The Bone \u0026amp; Joint Journal, 2023, 105-B(12): 1252-1258. DOI:10.1302/0301-620X.105B12.BJJ-2023-0375.R1.\u003c/li\u003e\n\u003cli\u003eCHEN W, SUN J N, ZHANG Y, et al. Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis[J/OL]. Journal of Orthopaedic Surgery and Research, 2020, 15(1): 231. DOI:10.1186/s13018-020-01747-x.\u003c/li\u003e\n\u003cli\u003eCHEN B, ZHANG J H, DUCKWORTH A D, et al. Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance.[J/OL]. The bone \u0026amp; joint journal, 2023, 105-B(11): 1149-1158. DOI:10.1302/0301-620X.105B11.BJJ-2023-0139.R1.\u003c/li\u003e\n\u003cli\u003eSHEN J, JI R, YAO S, et al. Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty[J/OL]. Orthopaedic Surgery, 2023, 15(3): 679-686. DOI:10.1111/os.13640.\u003c/li\u003e\n\u003cli\u003eMCGOLDRICK N P, ANTONIADES S, EL MENIAWY S, et al. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction[J/OL]. Archives of Orthopaedic and Trauma Surgery, 2022, 142(10): 2945-2955. DOI:10.1007/s00402-021-04179-2.\u003c/li\u003e\n\u003cli\u003eJIN Z, WANG L, QIN J, et al. Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review[J/OL]. Annals of Medicine, 2023, 55(1): 1378-1392. DOI:10.1080/07853890.2023.2193424.\u003c/li\u003e\n\u003cli\u003eHUANG X, LIU D, JIA B, et al. Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: \u003cem\u003eA Systematic Review and Meta‐Analysis\u003c/em\u003e[J/OL]. Orthopaedic Surgery, 2021, 13(6): 1707-1720. DOI:10.1111/os.13101.\u003c/li\u003e\n\u003cli\u003eFOUCHER K C, FREELS S. Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty[J/OL]. Osteoarthritis and Cartilage, 2015, 23(10): 1685-1694. DOI:10.1016/j.joca.2015.05.005.\u003c/li\u003e\n\u003cli\u003eZOMAR B O, BRYANT D, HUNTER S, et al. A randomised trial comparing spatio-temporal gait parameters after total hip arthroplasty between the direct anterior and direct lateral surgical approaches[J/OL]. Hip International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy, 2018, 28(5): 478-484. DOI:10.1177/1120700018760262.\u003c/li\u003e\n\u003cli\u003eYOO J I, CHA Y H, KIM K J, et al. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis[J/OL]. BMC musculoskeletal disorders, 2019, 20(1): 63. DOI:10.1186/s12891-019-2450-2.\u003c/li\u003e\n\u003cli\u003eUKAI T, YOKOYAMA K, WATANABE M. Preoperative Body Composition Correlates with Postoperative Muscle Volume and Degeneration after Total Hip Arthroplasty[J/OL]. Nutrients, 2024, 16(3): 386. DOI:10.3390/nu16030386.\u003c/li\u003e\n\u003cli\u003eNANKAKU M, AKIYAMA H, KAKINOKI R, et al. Factors associated with ambulatory status 6 months after total hip arthroplasty[J/OL]. Physiotherapy, 2014, 100(3): 263-267. DOI:10.1016/j.physio.2013.06.004.\u003c/li\u003e\n\u003cli\u003eHASSELGREN L, OLSSON L L, NYBERG L. Is leg muscle strength correlated with functional balance and mobility among inpatients in geriatric rehabilitation?[J/OL]. Archives of Gerontology and Geriatrics, 2011, 52(3): e220-225. DOI:10.1016/j.archger.2010.11.016.\u003c/li\u003e\n\u003cli\u003eTANABE H, BABA T, OZAKI Y, et al. Lateral versus conventional fasciotomy for prevention of lateral femoral cutaneous nerve injury in total hip arthroplasty with direct anterior approach: a study protocol for a dual-center, double-blind, randomized controlled trial[J/OL]. Trials, 2022, 23: 567. DOI:10.1186/s13063-022-06496-2.\u003c/li\u003e\n\u003cli\u003eCHUNG Y Y, LEE S M, BAEK S N, et al. Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach[J/OL]. Clinics in Orthopedic Surgery, 2022, 14(1): 35-40. DOI:10.4055/cios21008.\u003c/li\u003e\n\u003cli\u003eULIVI M, ORLANDINI L, VITALE J A, et al. Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements[J/OL]. Acta Orthopaedica, 2021, 92(3): 274-279. DOI:10.1080/17453674.2020.1865633.\u003c/li\u003e\n\u003cli\u003eSU R, FENG W, LIU X, et al. Early Rehabilitation and Periprosthetic Bone Environment after Primary Total Hip Arthroplasty: A Randomized Controlled Trial[J/OL]. Orthopaedic Surgery, 2021, 13(5): 1521-1531. DOI:10.1111/os.12984.\u003c/li\u003e\n\u003cli\u003eTARANTINO U, BALDI J, SCIMECA M, et al. The role of sarcopenia with and without fracture[J/OL]. Injury, 2016, 47: S3-S10. DOI:10.1016/j.injury.2016.07.057.\u003c/li\u003e\n\u003cli\u003eHALVARSSON A, FRANZ\u0026Eacute;N E, ST\u0026Aring;HLE A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial[J/OL]. Clinical Rehabilitation, 2015, 29(4): 365-375. DOI:10.1177/0269215514544983.\u003c/li\u003e\n\u003cli\u003eABOARRAGE JUNIOR A M, TEIXEIRA C V L S, DOS SANTOS R N, et al. A High-Intensity Jump-Based Aquatic Exercise Program Improves Bone Mineral Density and Functional Fitness in Postmenopausal Women[J/OL]. Rejuvenation Research, 2018, 21(6): 535-540. DOI:10.1089/rej.2018.2069.\u003c/li\u003e\n\u003cli\u003eHELLMAN M D, FORD M C, BARRACK R L. Is there evidence to support an indication for surface replacement arthroplasty?: a systematic review[J/OL]. The Bone \u0026amp; Joint Journal, 2019, 101-B(1_Supple_A): 32-40. DOI:10.1302/0301-620X.101B1.BJJ-2018-0508.R1.\u003c/li\u003e\n\u003cli\u003eBETTIS T, KIM B J, HAMRICK M W. Impact of muscle atrophy on bone metabolism and bone strength: Implications for muscle-bone crosstalk with aging and disuse[J/OL]. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2018, 29(8): 1713-1720. DOI:10.1007/s00198-018-4570-1.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total Hip Arthroplasty, direct anterior approach, posterior approach, bone mineral density, gait","lastPublishedDoi":"10.21203/rs.3.rs-4673437/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4673437/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo investigate the difference of bone mineral density and gait in patients with direct anterior approach and posterior approach after total hip arthroplasty was compared, and the correlation between bone density and gait was observed.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 76 patients diagnosed with femoral head necrosis and completed the first unilateral total hip arthroplasty from October 2021 to March 2022 were enrolled as the study subjects, and were divided into two groups according to different surgical methods. The gait indexes and bone density in Gruen1 and 7 regions were analyzed retrospectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eGait indexes of DAA group and PA group were significantly improvedmafter surgery compared with those before surgery; bone mineral density (BMI) at 1 month and 3 months after surgery in Gruen1 area was significantly improved compared with that in 1 week after surgery. Stride length, stride speed, stride frequency, percentage of single support phase of affected limb to gait cycle, hip motion and BMI at 1 month and 3 months after surgery in DAA group were all better than those in posterior approach group, and the differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); there was a positive correlation between the gait indexes and BMI at 1 month and 3 months after operation in both the anterior and posterior approach groups (r\u0026thinsp;\u0026gt;\u0026thinsp;0 ,P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTotal Hip Arthroplasty(THA) with DAA has certain advantages in the postoperative functional rehabilitation of patients, which can improve the bone density of patients and improve the postoperative gait recovery of patients.\u003c/p\u003e","manuscriptTitle":"Compared with PA, DAA can improve bone mineral density and postoperative gait recovery：Retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 16:01:43","doi":"10.21203/rs.3.rs-4673437/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1aee56e7-47ac-4899-aa0b-e453c717c378","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-05T08:08:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-26 16:01:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4673437","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4673437","identity":"rs-4673437","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}