In recent years there has been intense scientific debate about the type of approach used in total hip arthroplasty. Many new views have appeared on the superiority of the anterior approach over the posterior with regard to the rate of possible dislocation, postoperative pain and rapid mobilisation of the patient. In the international literature, however, there are very few papers confirming the superiority of the anterior approach over the posterior.
A study was recently published in the internationally respected journal “Journal of Arthroplasty”, a prospective randomised trial of early clinical results comparing patients who underwent total hip arthroplasty through an anterior approach with those in whom the posterior approach was used.
The operations in all patients were performed by two experienced total hip arthroplasty surgeons. The study included 72 patients, assessed preoperatively and then at two, six and 12 weeks postoperatively. Clinical results were assessed with the Western Ontario McMasters Arthritis Index and Oxford Hip Scores. Secondary outcomes included the EuroQoL, the 10-metre walk test and other clinical and radiographic factors.
The data showed no difference between the two groups when the primary outcomes were compared. There were no significant differences in the 10-metre walk test, in the EuroQoL or in the analysis of the radiographs. Subgroup analysis for the first surgeon showed that the first group had a shorter hospital stay, less need for opioids postoperatively and a smaller surgical incision. This was offset, however, by a longer operative time, higher blood loss intraoperatively and weaker hip flexion at two and six weeks. An incidence of the order of 83% of neurapraxia of the lateral femoral cutaneous nerve was also seen at 12 weeks in the first group. No neurapraxia, on the other hand, was seen in the posterior approach group. A dislocation occurred in both groups of patients. One patient in the anterior approach group required a reoperation for leg-length discrepancy.
The authors concluded that total hip arthroplasty through an anterior approach gives results comparable with those of the posterior approach. The choice of surgical approach for total hip arthroplasty should be based on patient factors, on the surgeon's preferences and on the surgeon's experience.
Source: Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, Armstrong MS, Singh PJ. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach. J Arthroplasty. 2017 Mar;32(3):883-890.
