Which Approach for Total Hip Arthroplasty: Anterolateral or Posterior?

Beard, David; Murray, David; Andrew, JG; Nolan, John

doi:10.1007/s11999-008-0560-5

Cited by 90 publications

(54 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Few studies have investigated the influence of surgical approach on revision rate [2,32,39]. In our study, there were no differences in aseptic revision rates across the various approaches.…”

Section: Discussionmentioning

confidence: 44%

“…Our results are comparable to a prospective, nonrandomized, multicenter study of 1089 THAs comparing anterolateral with posterior approaches. At 5 years they observed no differences in revision rates between the groups [32,39]. The Swedish Hip Register reported a complex relationship among surgical approach, implant used, and revision rate.…”

Section: Discussionmentioning

confidence: 99%

“…The learning curve associated with newer approaches may also have negative implications on the results [10,28,50]. Only a few studies have specifically evaluated the impact of surgical approach on surgical outcomes including complications and short-and medium-term survivorship [2,34,39]. Finally, because most reported studies have been conducted either by single surgeons at a single center or performed in a controlled fashion [1-4, 6, 7], the generalizability of these results to the greater orthopaedic community and patients is limited.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

199

View full text Add to dashboard Cite

Background Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. Questions/purposes (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? Methods The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011. Endpoints were septic revisions, aseptic revisions, and dislocations. The exposure of interest was surgical approach (posterior, anterolateral, direct lateral, direct anterior). Patient, implant, surgeon, and hospital factors were evaluated as possible confounders. Survival analysis was performed with marginal multivariate Cox models. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. A total of 42,438 primary THAs were available for analysis of revision outcomes and 22,237 for dislocation. Median followup was 3 years (interquartile range, 1-5 years). The registry's voluntary participation is 95%. The most commonly used approach was posterior (75%, N = 31,747) followed by anterolateral (10%, N = 4226), direct anterior (4%, N = 1851), and direct lateral (2%, N = 667). Results During the study period 785 hips (2%) were revised for aseptic reasons, 213 (0.5%) for septic reasons, and 276 (1%) experienced a dislocation. The revision rate per 100 years of observation was 0.54 for aseptic revisions, 0.15 for septic revisions, and 0.58 for dislocations. There were no differences in adjusted risk of revision (either septic or aseptic) across the different THA approaches. However, the anterolateral approach (adjusted HR, 0.29; 95% CI, 0.13-0.63, p = 0.002) and direct anterior approach (adjusted HR, 0.44; 95% CI, 0.22-0.87, p = 0.017) had a lower risk of dislocation relative to the posterior approach. There were no differences in any of the outcomes when comparing the direct anterior approach with the anterolateral approach. Conclusions Anterior and anterolateral surgical approaches had the advantage of a lower risk of dislocation without increasing the risk of early revision. Level of Evidence Level III, therapeutic study.

show abstract

Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

199

View full text Add to dashboard Cite

show abstract

“…Concluíram que, numa fase inicial, definida pelos autores entre os três meses e um ano pós-cirurgia, os doentes operados pela via posterior apresentam melhores resultados na dor e na funcionalidade do que os doentes operados pela via ântero-lateral. 13 Verificaram também que, ao fim de dois anos e cinco anos, não havia diferenças nas duas vias de abordagem. Estes resultados são semelhantes aos encontrados neste estudo, que demonstrou haver doentes com maiores pontuações no HOOS aos seis meses do pós-operatório para a via posterior.…”

Section: Resultsunclassified

Avaliação da Função e Qualidade de Vida após Artroplastia Total da Anca por Diferentes Vias de Abordagem

et al. 2017

View full text Add to dashboard Cite

Material and Methods:Retrospective study of 94 patients subject to unilateral hip replacement surgery, using the 'Hip Osteoarthritis Outcome Score' (HOOS LK 2.0) questionnaire, the Trendelenburg test and evaluation of muscle strength of the hip abductor muscles with dynamometer. Patients were evaluated at six months, 12 months, 18 months and 24 months after surgery. Results:The study revealed that 97.9% patients completed the rehabilitation program. The postoperative evolution (six to 24 months) does not appear to have any differences in results when comparing both approaches. At six months the patient operated by the anterolateral approach showed worse results when compared with the posterior approach, in particular in Hip Osteoarthritis Outcome Score pain, in Hip Osteoarthritis Outcome Score symptoms and Hip Osteoarthritis Outcome Score activities of daily living. After 24 months, no differences between the two surgical approaches were found. Of the 94 patients evaluated, the Trendelenburg test was positive in 31% of patients of which 81.9% corresponds to patients operated by the anterolateral approach. Muscle strength of the abductors of the operated hip was clearly lower in the anterolateral approach at six months, 12 months, and 24 months. Discussion: This study showed that, in the first six months after total hip arthroplasty, the patients operated by the posterior approach were, according to the HOOS questionnaire, less symptomatic, and presented with better quality of life and less impact on activities of daily living and in sport and leisure when compared with the patients operated by the anterolateral approach. However, these differences were matched over the 24 months. Moreover, the results of muscle strength of the abductor muscles of the hip were clearly superior in patients operated by the posterior approach at six months, at 12 months and at 24 months compared to the patients operated by the anterolateral approach. Conclusion: After 24 months post total hip arthroplasty there are no differences between the two approaches with regard to function or quality of life. However, the patients operated by the anterolateral approach had greater muscle strength deficits and higher percentage of positive Trendelenburg test.

show abstract

“…. Similarly, a large study of 1089 patients did not find significant differences in OHS between anterolateral and PA THA at five year follow up 48 . This is significant as the study considered medium-to-long term outcomes of THA and thus suggests that any early functional differences may dissipate beyond the short-term.…”

Section: Perioperative Outcomesmentioning

confidence: 89%

The influence of surgical approach on outcomes of total hip arthroplasty

Tadross¹,

Lunn²,

Redmond³

et al. 2016

Orthopaedics and Trauma

View full text Add to dashboard Cite

The vast majority of total hip arthroplasties performed in the UK are undertaken using either a posterior or direct lateral approach. This review describes the functional outcomes of these approaches. Functional outcome can be assessed through motion capture of function, strength testing of muscle groups around the hip and imaging of anatomical structures. Regardless of surgical approach, total hip arthroplasty patients rarely -matched controls. The direct lateral approach is associated with abductor deficiencies whilst the posterior approach may introduce extension and rotation deficits. How long functional differences persist between surgical approaches is unclear. The emergence of improved imaging technologies as well as isokinetic dynamometry (muscle strength testing) and 3D biomechanical modelling provide more comprehensive evaluations than traditional post-operative assessments such as radiology or couch examination. Targeted physiotherapy has been suggested as a possible intervention to counter lasting functional deficits. This review provides a foundation to inform surgeons of the impact of each approach to justify their surgical practice and may inform physical rehabilitation regimens postsurgery.

show abstract

Which Approach for Total Hip Arthroplasty: Anterolateral or Posterior?

Abstract: The best approach to use when performing THA is controversial. We did a prospective, nonrandom-

Cited by 90 publications

References 36 publications

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Avaliação da Função e Qualidade de Vida após Artroplastia Total da Anca por Diferentes Vias de Abordagem

The influence of surgical approach on outcomes of total hip arthroplasty

Contact Info

Product

Resources

About