Internet Promotion of Direct Anterior Approach Total Hip Arthroplasty by Members of the American Association of Hip and Knee Surgeons

Shofoluwe, Ademola; Naveen, Neal B.; Inabathula, Avinash; Ziemba-Davis, Mary; Meneghini, R. Michael; Callaghan, John J.; Warth, Lucian C.

doi:10.1016/j.arth.2017.08.015

Cited by 33 publications

(17 citation statements)

References 36 publications

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“…Nonetheless the early outcomes are making the approach increasingly attractive and popular to both surgeons and patients, especially in light of the tendency to underplay the potential risks in favour of the benefits that was observed in a recent survey amongst US surgeons. 88 As with most minimally invasive surgical techniques, a great deal of training and skill is required in order to be able to enjoy the advantages and avoid the potentially catastrophic complications. The learning curve is inevitable, as with any new skill or technique, and the early results appear to be surgeon-dependent.…”

Section: Resultsmentioning

confidence: 99%

Total hip arthroplasty through an anterior approach

2018

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Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients.Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay.No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches.Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes.Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

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Section: Resultsmentioning

confidence: 99%

Total hip arthroplasty through an anterior approach

2018

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“…9 Systematic reviews of this limited evidence base found no differences in patient function or complication rates between approaches. [5][6][7][8] Nevertheless, media reports 10 and surgeon promotion 11 of better outcomes with the anterior approach have been widespread and performance of anterior THAs in the United States was estimated to have increased from 12% in 2009 to 40% in 2018. 4 Reflecting technical evolution in the anterior approach and public interest in the procedure, in 2015 the Canadian Institute for Health Information began identifying the surgical approach used to conduct each THA in the country.…”

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confidence: 99%

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty

Pincus

Jenkinson

Paterson

et al. 2020

JAMA

142

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IMPORTANCE Controversy exists about the preferred surgical approach for total hip arthroplasty (THA).OBJECTIVE To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019). EXPOSURES Surgical approach (anterior vs lateral/posterior) for THA. MAIN OUTCOMES AND MEASURES Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression. RESULTS Of the 30 098 patients (mean [SD] age, 67 years [10.7 years]; 16 079 women [53.4%]) who underwent THA, 2995 ( 10%) underwent the anterior approach; 21 248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88).CONCLUSIONS AND RELEVANCE Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.

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“…Over 70% of patients who have heard of the direct anterior approach believe it is the best approach for THA because they perceive that it causes less pain and less muscle damage [8]. Surgeons also promote anterior approach THA, as a review of American Association of Hip and Knee Surgeons members found that 22.8% have websites touting the benefits of anterior approach hip replacements [9].…”

Section: Discussionmentioning

confidence: 99%

Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications

et al. 2020

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Background: Anterior-based approaches to primary total hip arthroplasty (THA) are being used more frequently, and several variations have been described. The supine direct anterior (DA) approach has been widely studied, but few studies have compared it with the mini-anterolateral (mini-AL) approach (abductor-sparing, Watson-Jones approach) in the lateral decubitus position. This study aims to compare early perioperative complications and outcomes between these 2 approaches. Methods: This study retrospectively reviewed 340 consecutive THAs (n ¼ 170 DA, n ¼ 170 mini-AL) performed by 3 arthroplasty surgeons at a single institution between January 2017 and May 2018. The primary outcome was reoperation for any reason within 1 year. Secondary outcomes included woundhealing complications and several perioperative factors. A Student's t-test was used for continuous variables, and a chi-squared test was used for categorical variables. Results: In this cohort, 6 patients (4%) from the mini-AL group required reoperation within 1 year, compared with 2 patients (1%) from the DA group (P ¼ .024). However, the DA group had 13 patients (8%) with wound-healing complications compared with 6 patients (4%) in the mini-AL group 4% (P ¼ .036). Perioperative outcomes were similar for operative time, distance walked with physical therapy, morphine milligram equivalent consumed, length of stay, and discharge disposition. Pain scores during index hospitalization were also similar. Conclusions: Patients who underwent THA using the supine DA approach had fewer reoperations within 1 year, but more wound-healing complications compared with the mini-AL approach in the lateral decubitus position. For surgeons performing primary THA using an anterior-based approach, relative risks and benefits of these approaches must be understood.

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Internet Promotion of Direct Anterior Approach Total Hip Arthroplasty by Members of the American Association of Hip and Knee Surgeons

Cited by 33 publications

References 36 publications

Total hip arthroplasty through an anterior approach

Total hip arthroplasty through an anterior approach

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty

Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications

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