Abstract：
BACKGROUND: The purpose of this study was to evaluate the impact of direct anterior approach (DAA) or posterior approach (PA) on step and stair counts after total hip arthroplasty using a remotely monitored mobile application with a smartwatch while controlling for baseline characteristics.
METHODS: This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year. Step and stair counts were available for 1,501 and 847 patients, respectively. Longitudinal regression models were created to control for baseline characteristics.
RESULTS: Patients in the DAA group had significantly lower body mass index (P = .049) and comorbidities (P = .028), but there were no significant differences in age (P = .225) or sex (P = .315). The DAA patients had a higher average and improvement from baseline in step count at 2 and 3 weeks postoperatively after controlling for patient characteristics (P = .028 and P = .044, respectively). The average stair counts were higher for DAA patients at one month postoperatively (P = .035), but this difference was not significant after controlling for patient demographics. Average stair ascending speeds and changes from baseline were not different between DAA and PA patients. Descending stair speed was higher at 2 weeks postoperatively for DAA patients, but was no longer higher after controlling for baseline demographics.
CONCLUSIONS: After controlling for baseline characteristics, DAA patients demonstrate earlier improvement in step count than PA patients after total hip arthroplasty. However, patient selection and surgeon training may continue to influence outcomes through a surgical approach.
METHODS: This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year. Step and stair counts were available for 1,501 and 847 patients, respectively. Longitudinal regression models were created to control for baseline characteristics.
RESULTS: Patients in the DAA group had significantly lower body mass index (P = .049) and comorbidities (P = .028), but there were no significant differences in age (P = .225) or sex (P = .315). The DAA patients had a higher average and improvement from baseline in step count at 2 and 3 weeks postoperatively after controlling for patient characteristics (P = .028 and P = .044, respectively). The average stair counts were higher for DAA patients at one month postoperatively (P = .035), but this difference was not significant after controlling for patient demographics. Average stair ascending speeds and changes from baseline were not different between DAA and PA patients. Descending stair speed was higher at 2 weeks postoperatively for DAA patients, but was no longer higher after controlling for baseline demographics.
CONCLUSIONS: After controlling for baseline characteristics, DAA patients demonstrate earlier improvement in step count than PA patients after total hip arthroplasty. However, patient selection and surgeon training may continue to influence outcomes through a surgical approach.
摘要：
背景：这项研究的目的是评估直接前（DAA）或后（PA）入路对全髋关节置换术（THA）后步数和楼梯数的影响，使用带有智能手表的远程监控移动应用程序，同时控制基线特征。
方法：这是一项利用基于智能手机的护理管理平台对患者进行的前瞻性队列研究的次要数据分析。主要结果是步数和阶梯数以及从基线到一年的变化。1,501和847名患者可获得台阶和楼梯计数，分别。建立纵向回归模型以控制基线特征。
结果：DAA组患者的BMI（P=0.049）和合并症（P=0.028）明显降低，但年龄(P=0.225)和性别(P=0.315)差异无统计学意义。在控制患者特征后，DAA患者在术后2周和3周的步数比基线有更高的平均值和改善（分别为P=0.028和P=0.044）。DAA患者术后1个月的平均阶梯数较高(P=0.035),但在控制患者的人口统计学指标后,这种差异并不显著.DAA和PA患者的平均楼梯上升速度和从基线的变化没有差异。DAA患者术后两周下降楼梯速度较高，但在控制基线人口统计学后不再更高。
结论：在控制基线特征后，在THA之后,DAA患者表现出比PA患者更早的步数改善。然而,患者选择和外科医生培训可能会继续影响手术方法的结局.
方法：这是一项利用基于智能手机的护理管理平台对患者进行的前瞻性队列研究的次要数据分析。主要结果是步数和阶梯数以及从基线到一年的变化。1,501和847名患者可获得台阶和楼梯计数，分别。建立纵向回归模型以控制基线特征。
结果：DAA组患者的BMI（P=0.049）和合并症（P=0.028）明显降低，但年龄(P=0.225)和性别(P=0.315)差异无统计学意义。在控制患者特征后，DAA患者在术后2周和3周的步数比基线有更高的平均值和改善（分别为P=0.028和P=0.044）。DAA患者术后1个月的平均阶梯数较高(P=0.035),但在控制患者的人口统计学指标后,这种差异并不显著.DAA和PA患者的平均楼梯上升速度和从基线的变化没有差异。DAA患者术后两周下降楼梯速度较高，但在控制基线人口统计学后不再更高。
结论：在控制基线特征后，在THA之后,DAA患者表现出比PA患者更早的步数改善。然而,患者选择和外科医生培训可能会继续影响手术方法的结局.
