In recent years there has been considerable debate in the international literature about the relationship between the surgical approach and major complications in total hip arthroplasty. Many views have been put forward in favour of each of the surgical approaches to the hip, namely the anterior, the posterior and the lateral.
In the classic texts of the literature each approach is associated, to a greater or lesser degree, with particular complications. It does not, however, appear to be settled whether an ideal approach for total replacement of the joint exists, or which it is.
A new study in the highly authoritative and internationally recognised journal JAMA (Journal of American Medical Association) set out to answer this question. The article sought to determine whether the anterior approach is associated with a lower risk of complications than the more traditional approaches, that is, the lateral and the posterior.
A population-based prospective cohort study was carried out of all adults in Ontario, Canada, who underwent primary total hip arthroplasty for osteoarthritis between April 2015 and March 2018. All patients were followed up for one year. The study compared the patients, specifically correlating the anterior approach against the posterior and the lateral for total hip arthroplasty.
Major complications of the operation occurred within one year (deep infection, dislocation requiring closed or open reduction, and revision surgery). All the results were assessed by statistical methods.
Of the 30,098 patients, whose mean age was 67 years, 16,079 were women who underwent total hip arthroplasty; 2,995 had an anterior approach, 21,248 a lateral approach and 5,855 a posterior approach. The operations were carried out in one of 73 hospitals and by one of 298 surgeons. All patients were followed up for one year. Compared with those in whom a lateral or posterior approach was used, the patients with an anterior approach were younger (mean age 65 versus 67 years) and had a lower rate of comorbidity. The patients with an anterior approach were also operated on by higher-volume surgeons. The comparison between the anterior approach and the lateral or posterior approach showed that the anterior approach group had a significantly higher risk of major surgical complications (61 patients versus 29 patients).
The authors concluded that, among patients who underwent total hip arthroplasty, the anterior approach, compared with the posterior or lateral approach, was associated with a small but statistically significantly increased risk of major surgical complications. The authors' recommendation is that the findings may help the surgeon decide on the approach for total arthroplasty; they advised, however, that further study is needed to understand these results.
Source: “JAMA (Journal of American Medical Association )”, March 2020