Short-term outcome after posterior versus lateral surgical approach for total hip arthroplasty - a randomized clinical trial*

Abstract

PurposeCurrently, total hip replacement (THR) is most commonly performed via a posterior or a direct lateral approach, but the impact of the latter on the invention's outcome has yet not been quantified.MethodsWe compared the short-term outcome of cementless THR using the both approaches in a prospective, randomized controlled trial. 60 patients with unilateral osteoarthritis were included. Outcome assessment was performed one day before surgery and one week, four weeks, six weeks and 12 weeks after surgery, respectively, using the Harris Hip score as primary objective.ResultsWe found no significant difference in the intraindividual Harris Hip Score improvement at the pre-and three months post-operative assessments between both treatment groups (p = 0.115). However, Harris Hip scores and most functional and psychometric secondary endpoints showed a consistent tendency of a slightly better three months result in patients implanted via the posterior approach. In contrast a significant shorter operating time of the direct lateral approach was recorded (67 minutes versus 76 minutes, p < 0.001).ConclusionIn our opinion this slightly better short-term functional outcome after posterior approach is not clinical relevant. However, to make definitive conclusions all clinical relevant factors (i.e. mid- to long-term function, satisfaction, complication rates and long-term survival) have to be taken into account. Level of evidence: I - therapeutic

The choice of approach in total hip arthroplasty, does it really matters?

“…The rate of dislocation and fracture did not differ significantly between the groups. [25][26][27] Harris hip score in our study also favors that there is no significant difference with either approach. A common comparator between the posterior and lateral approach is the incidence of abductor insufficiency.…”

Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach

“…Historically, the posterior and direct lateral approaches have been the most commonly used techniques, both with advantages and disadvantages [1][2][3]. The direct lateral approach has often been associated with persistent postoperative abductor dysfunction and limp.…”

Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

“…Several studies have suggested the direct lateral approach has an increased incidence of abductor insufficiency following THA. 15,24,30,56 The reported incidence varies from 0% to 16% for the posterior approach and from 4% to 20% for the direct lateral approach. 15 However, there is tremendous heterogeneity in the methods used to diagnose abductor insufficiency in many of these studies.…”

“…A more recent prospective study 56 randomly assigned 60 patients to undergo THA through either a posterior or lateral approach. The primary end point was the HHS at the 12-week follow-up.…”