A Comparison of Anterolateral and Posterolateral Approaches in Primary Total Hip Arthroplasty

Abstract

Several approaches have been defined for applying THA (3). The most commonly used of these are the anterolateral (modified Watson-Jones) and the posterior (Southern, Moore, Gibson, or posterolateral) approaches (4, 5). The anterolateral approach was first defined by Sprengel and Bardenhauer, and then later modified by Watson-Jones (6). In this approach, entry is made from the gluteus medius cleavage and the tensor fascia lata stimulated by the superior gluteal nerve (7). Trochanteric osteotomy or separation of a section from the adhesion point of the gluteus medius or minimus to the trochanter is necessary for sufficient acetabulum exposure (7,8). In the posterior approach, the external rotator muscles of the hip are separated from the capsule after cutting from the adhesion point without touching the gluteus medius and minimus tissue by separating the split gluteus maximus muscle (9).As different approaches have advantages and disadvantages, the debate is still ongoing as to which approach is superior to the others. Despite insufficient information on the long-term results of different approaches, some studies have reported on short-term results such as blood loss (10), perioperative pain (11), duration of hospitalization (12), and cosmetic results (12). ABSTRACTThe aim of this study was to compare the short-term clinical and radiological results of anterolateral and posterolateral approaches in total hip arthroplasty.The study included patients who were operated on for hip osteoarthritis. The patients were allocated to one of two groups for applying uncemented total hip prosthesis with the anterolateral or posterolateral approach. They were operated on by one surgical team composed of two senior surgeons. They were clinically evaluated using the Harris Hip Score and radiologically using direct radiographs. Various parameters were recorded in both the groups, including amount of blood loss, surgical time, and duration of hospitalization.A total of 70 patients were followed up for a mean duration of 18 months (range 6-36 months), 34 in the anterolateral group and 36 in the posterolateral group. No statistically significant differences were observed between the anterolateral and posterolateral approaches for a total hip prosthesis in terms of the clinical and radiological results.The most successful results can be obtained using the technique that the surgeon performs better according to his experience of total hip arthroplasty.

Post-operative clinical outcomes and complications of posterior versus lateral approach for primary total hip arthroplasty: A retrospective cohort study

“…The length of hospital stay was found to be similar between PA and LA by Buglak et al (2.7 days vs. 3.1 days), which is inconsistent to the original findings of our study. [15][16][17][18] The longer duration of hospital stay in LA reported in our study could be attributed to the higher median age and higher comorbidity rate for patients who received THA through LA. In addition, the other non-balanced factors such as type of anesthesia, implant brand, bearing surface, and femoral head size might have influenced the length of hospital stay as well.…”