Direct Anterior Versus Direct Lateral Hip Approach in Total Hip Arthroplasty with the Same Perioperative Protocols One Year Post Fellowship Training

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2023 Mar 20

PMID 36935481

Authors

Asim M Makhdom

William J Hozack

Affiliations

Soon will be listed here.

Abstract

Background: Variable results have been reported regarding the clinical outcomes in Total hip arthroplasty (THA) based on the surgical approach. The aim of this study is to compare the clinical outcomes between Direct anterior (DA) and direct lateral (DL) approaches in THA when performed immediately after fellowship training.

Methods: During the 1st year of practice, all consecutive patients who underwent THA via DA and DL hip approaches were retrospectively investigated. Patients'demographics, diagnosis, American society of Anesthesiology (ASA) score, route of anesthesia, length of hospital stay (LOS), leg length discrepancy (LLD), radiographic parameters, operative time, number of opioids refills postoperatively, and complications were collected and compared between the two groups. The short form of Hip Disability and Osteoarthritis Outcome score, Joint Replacement (HOOS, JR) was prospectively collected pre and postoperatively. The minimum follow-up period was 2 years.

Results: Forty patients in DA group and 38 patients in DL group were included. No statistically significant difference was found between the two groups in terms of demographics, diagnosis, ASA scores, route of anesthesia at the time of THA, postoperative radiographic parameters, LOS, LLD, opioid refills and HOOS scores (p > 0.05). Patients in the DA group had shorter operative time (83 ± 17 min) when compared to the DL group (93 ± 24 min) (p = 0.03). No major complications were found except for one early deep infection patient in DL group.

Conclusion: Both DA and DL approaches resulted in satisfactory outcomes in THA when performed by a fellowship trained surgeon.

References

Macheras G, Lepetsos P, Galanakos S, Papadakis S, Poultsides L, Karachalios T . Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach. Hip Int. 2020; 32(2):166-173. DOI: 10.1177/1120700020940671. View

de Steiger R, Lorimer M, Solomon M . What is the learning curve for the anterior approach for total hip arthroplasty?. Clin Orthop Relat Res. 2015; 473(12):3860-6. PMC: 4626490. DOI: 10.1007/s11999-015-4565-6. View

Coulomb R, Laborde A, Haignere V, Bauzou F, Marchand P, Kouyoumdjian P . Varus stem positioning does not affect long-term functional outcome in cementless anatomical total hip arthroplasty. Arch Orthop Trauma Surg. 2022; 143(1):511-518. DOI: 10.1007/s00402-021-04320-1. View

Post Z, Orozco F, Diaz-Ledezma C, Hozack W, Ong A . Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014; 22(9):595-603. DOI: 10.5435/JAAOS-22-09-595. View

Tischler E, Orozco F, Aggarwal V, Pacheco H, Post Z, Ong A . Does intraoperative fluoroscopy improve component positioning in total hip arthroplasty?. Orthopedics. 2015; 38(1):e1-6. DOI: 10.3928/01477447-20150105-52. View

Wang Z, Bao H, Hou J . Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 2019; 14(1):63. PMC: 6390312. DOI: 10.1186/s13018-019-1095-z. View

Kurtz S, Ong K, Lau E, Mowat F, Halpern M . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-5. DOI: 10.2106/JBJS.F.00222. View

Widmer K . A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty. 2004; 19(3):387-90. DOI: 10.1016/j.arth.2003.10.016. View

Miller L, Gondusky J, Bhattacharyya S, Kamath A, Boettner F, Wright J . Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review With Meta-Analysis. J Arthroplasty. 2017; 33(4):1296-1302. DOI: 10.1016/j.arth.2017.11.011. View

10.

Petis S, Howard J, Lanting B, Vasarhelyi E . Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg. 2015; 58(2):128-39. PMC: 4373995. DOI: 10.1503/cjs.007214. View

11.

Mahure S, Feng J, Schwarzkopf R, Long W . The Impact of Arthroplasty Fellowship Training on Total Joint Arthroplasty: Comparison of Peri-Operative Metrics between Fellowship-Trained Surgeons and Non-Fellowship-Trained Surgeons. J Arthroplasty. 2020; 35(10):2820-2824. DOI: 10.1016/j.arth.2020.05.027. View

12.

Aggarwal V, Elbuluk A, Dundon J, Herrero C, Hernandez C, Vigdorchik J . Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J. 2019; 101-B(6):646-651. DOI: 10.1302/0301-620X.101B6.BJJ-2018-1474.R1. View

13.

Alecci V, Valente M, Crucil M, Minerva M, Pellegrino C, Sabbadini D . Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol. 2011; 12(3):123-9. PMC: 3163771. DOI: 10.1007/s10195-011-0144-0. View

14.

Meneghini R, Pagnano M, Trousdale R, Hozack W . Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006; 453:293-8. DOI: 10.1097/01.blo.0000238859.46615.34. View

15.

Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J . Longer Operative Time Results in a Higher Rate of Subsequent Periprosthetic Joint Infection in Patients Undergoing Primary Joint Arthroplasty. J Arthroplasty. 2019; 34(5):947-953. DOI: 10.1016/j.arth.2019.01.027. View

16.

Parvizi J, Restrepo C, Maltenfort M . Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study. Orthop Clin North Am. 2016; 47(3):497-504. DOI: 10.1016/j.ocl.2016.03.003. View

17.

Matar H, Jenkinson R, Pincus D, Satkunasivam R, Paterson J, Ravi B . The Association Between Surgeon Age and Early Surgical Complications of Elective Total Hip Arthroplasty: Propensity-Matched Cohort Study (122,043 Patients). J Arthroplasty. 2020; 36(2):579-585. DOI: 10.1016/j.arth.2020.08.040. View

18.

Watts C, Houdek M, Wagner E, Sculco P, Chalmers B, Taunton M . High Risk of Wound Complications Following Direct Anterior Total Hip Arthroplasty in Obese Patients. J Arthroplasty. 2015; 30(12):2296-8. DOI: 10.1016/j.arth.2015.06.016. View

19.

Meermans G, Konan S, Das R, Volpin A, Haddad F . The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2017; 99-B(6):732-740. DOI: 10.1302/0301-620X.99B6.38053. View

20.

Lyman S, Lee Y, Franklin P, Li W, Mayman D, Padgett D . Validation of the HOOS, JR: A Short-form Hip Replacement Survey. Clin Orthop Relat Res. 2016; 474(6):1472-82. PMC: 4868170. DOI: 10.1007/s11999-016-4718-2. View