{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T10:01:01Z","timestamp":1792749661695,"version":"4.5.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to compare the clinical outcomes of total hip arthroplasty (THA) using the lateral decubitus direct anterior approach (DAA) vs. the traditional posterior lateral approach (PLA), and to explore the risk factors and predictive models for lateral femoral cutaneous nerve (LFCN) injury following DAA-THA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred patients undergoing primary unilateral THA were randomly assigned to the DAA group and the PLA group, with 100 cases in each group. Clinical data, surgical parameters, postoperative pain scores, and other relevant data were recorded, and the differences between the two groups in terms of treatment outcomes and postoperative recovery were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to the PLA group, patients in the DAA group had shorter incisions, reduced blood loss and drainage, shorter hospital stays, decreased postoperative inflammatory markers, and lower pain scores. However, the incidence of postoperative LFCN injury was higher in the DAA (DAA:24patients, 24%, PLA:2patients, 2%) group, although most cases resolved within one year. Univariate analysis showed that diabetes, preoperative serum CK levels, serum IL-6, and TNF-\u03b1 levels at postoperative day 3 were associated with early LFCN injury, while diabetes, BMI, and postoperative inflammation were significantly associated with persistent LFCN injury. Binary logistic regression analysis identified serum IL-6 and TNF-\u03b1 levels at postoperative day 3 as independent risk factors for persistent LFCN injury. The established predictive model demonstrated good discrimination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite slightly longer surgical duration, DAA demonstrated significant advantages in reducing early pain, blood loss, and hospital stay. However, postoperative LFCN injury warrants attention, especially in patients with diabetes and postoperative inflammatory reactions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1482731","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T05:53:26Z","timestamp":1743486806000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical comparison between direct anterior approach and posterior lateral approach in total hip arthroplasty and risk factors for lateral femoral cutaneous nerve injury"],"prefix":"10.3389","volume":"12","author":[{"given":"Jian-feng","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"38","DOI":"10.5312\/wjo.v7.i1.38","article-title":"Direct anterior total hip arthroplasty: literature review of variations in surgical technique","volume":"7","author":"Connolly","year":"2016","journal-title":"World J Orthop"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.2106\/JBJS.ST.17.00060","article-title":"The pararectus approach: a new concept","volume":"8","author":"Keel","year":"2018","journal-title":"JBJS Essent Surg Tech"},{"key":"B3","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s00132-016-3366-2","article-title":"Surgical access routes to the hip joint in the elderly","volume":"46","author":"Nogler","year":"2017","journal-title":"Orthopade"},{"key":"B4","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1177\/1120700018820652","article-title":"A comparison of clinical, radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis","volume":"29","author":"Jia","year":"2019","journal-title":"Hip Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1007\/s00402-024-05314-5","article-title":"Factors influencing patient selection of orthopaedic surgeons for total hip (THA) and total knee arthroplasty (TKA)","volume":"144","author":"Fabrizio","year":"2024","journal-title":"Arch Orthop Trauma Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"103214","DOI":"10.1016\/j.otsr.2022.103214","article-title":"Quantitative gait analysis after total hip arthroplasty through a minimally invasive direct anterior approach: a case control study","volume":"108","author":"Martinez","year":"2022","journal-title":"Orthop Traumatol Surg Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s13018-023-03641-8","article-title":"Treatment of irreducible intertrochanteric femoral fracture with a minimally invasive clamp reduction technique via the anterior approach","volume":"18","author":"Qiu","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3248","DOI":"10.1016\/j.arth.2021.05.009","article-title":"MRI Assessment of muscle damage after the posterolateral versus direct anterior approach for THA (polada trial). 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