DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161945

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

Sukumaran Subbiah Subramanian, Mugundhan Moongilpatti Sengodan, Masoodh M. Basha

Abstract


Background: Various surgical approaches have been described for total hip arthroplasty with their own advantages and disadvantages. In the study it would like to know whether there is significant difference exists between the most widely used posterior and lateral approaches.

Methods: Study was a randomized prospective study in 108 hips. Out of 108 hips 52 were operated by posterior approach and the remaining 56 by lateral approach. The choice of approach was determined by random numbers. In the study functional outcome was compared with the Harris hip score, rate of complications and the effect of approach on the placement of acetabular cup with relation to its inclination and version in arthroplasty of the hip.

Results: Similar results in both approaches were found; there were no statistically significant difference in the outcome.

Conclusions: To conclude, the approach did not significantly affect the outcome in total hip replacement with respect to functional outcome or rates of complication. And it neither influences the acetabular cup placement. Proper operative technique seems to be more important than the choice of approach in total hip replacement. Studies with a bigger sample size need to be done to further throw light on the role of approach on cup placement.

 


Keywords


Total hip arthroplasty, Surgical approach, Functional outcome

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References


Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54(1):61-76.

Kelmanovich D, Parks ML, Sinha R. Surgical Approaches to Total Hip Arthroplasty. Journal of the Southern Orthopaedic Association. 2003;12(2):90-4.

Roberts JM, Fu FH, McClain EJ, Ferguson AB Jr. A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop Relat Res. 1984;187:205-10.

Robinson RP, Robinson HJ, Salvati EA. Comparison of the transtrochanteric and posterior approaches for total hip replacement. Clin Orthop. 1980;147:143-7.

Weiss APC, Jacobs MA. Posterior augmentation during closure following total hip arthroplasty. Orthopedics. 1990;13:577-9.

Hedley AK, Hendren DH, Mead LP. A posterior approach to the hip joint with complete posterior capsular and muscular repair. J Arthroplast. 1990;5(Suppl):S57–66.

Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop. 1998;355:224-8.

Bottner F, Pellicci PM. Review: Posterior Soft Tissue Repair in Primary Total Hip Arthroplasty. HSS Journal. 2006;2(1):7-11.

Ko CK, Law SW, Chiu KH. Enhanced soft tissue repair using locking loop stitch after posterior approach for hip hemiarthroplasty. J Arthroplasty. 2001;16(2):207-11.

Macaulay W, Colacchio ND, Fink LA. Modified enhanced posterior soft tissue repair results in a negligible dislocation rate after hip resurfacing. Operative Techniques in Orthopaedics. 2009;19(3):163-8.

Kao JT, Woolson ST. Priformis tendon repair after total hip replacement. Orthop Rev. 1992;21(2):171-4.

Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop. 2004;418:162-7.

White RE, Forness TJ, Allman JK, Junick DW. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop. 2001;393:163-7.

Dixon MC, Scott RD, Schai PA, Stamons V. A simple capsulorraphy in a posterior approach for total hip arthroplasty. J Arthroplast. 2004;19:373-6.

Nissen KI. The Judet Arthroplasty of the Hip via Gibson’s Lateral Approach. Postgraduate Medical Journal. 1952;28(321):412-23.

Baker AS, Bitounis VC. Abductor function after total hip replacement. An electromyographic and clinical review. Bone & Joint Journal. 1989;71(1):47-50

Morrey BF, Adams RA, Cabanela ME. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Cli Orthop Relat Res. 1984;160-7.

Saxler G. The accuracy of free-hand cup positioning-a CT based measurement of cup placement in 105 total hip arthroplasties. International Orthopaedics. 2004;28(4):198-201.

Pierchon F, Pasquier G, Cotten A, Fontaine C, Clarisse J, Duquennoy A. Causes of dislocation of total hip arthroplasty. CT study of component alignment Pierchon. Journal of Bone and Joint Surgery – British. 1994;76(1):45-8.

Linclau L, Dokter G, Peene P. Radiological aspects in preoperative planning and postoperative assessment of cementless total hip arthroplasty. Acta Orthop Belg. 1993;59:163-7.

Kalteis T, Handel M, Herold T, Perlick, Paetzel LC, Grifka J. Position of the acetabular cup-accuracy of radiographic calculation compared to CT-based measurement. European Journal of Radiology. 2006;58(2):294-300.

Haenle M, Heitner A, Mittelmeier W, Barbano R, Scholz R, Steinhauser E. Assessment of cup position from plain radiographs: impact of pelvic tilting., Surgical and Radiologic Anatomy. 2007;29(1):29-35.

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508-19.

Barber TC, Roger DJ, Goodman SB, Schurman DJ. Early outcome of total hip arthroplasty using the direct lateral vs the posterior surgical approach. Orthopedics. 1996;19:873-5.

Witzleb WC, Stephan L, Krummenauer F, Neuke A, Günther K-P. Short-term outcome after posterior versus lateral surgical approach for total hip arthro- plasty: a randomized clinical trial. Eur J Med Res. 2009;14:256-63.

Chechik O, Khashan M, Lador R, Salai M, Amar E. Surgical approach and prosthesis fixation in hip arthroplasty worldwide. Arch Orthop Trauma Surg. 2013;133:1595-600.

Petis S, Howard JL, Lanting BL, Vasarhelyi EM. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Canadian Journal of Surgery. 2015;58(2):128-39.

Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46-53.