Total Hip Arthroplasty: Anterolateral Approach Versus Posterior Approach

Azad Ahmad  Ismael; Ali Abdalnabi Alwan  Al-Tamimi

doi:10.56056/amj.2018.51

Authors

Azad Ahmad Ismael MBChB, KBMS (Orthopedics) trainee, Sulaymaniyah Teaching Hospital
Ali Abdalnabi Alwan Al-Tamimi MBChB, FICMS, Ass. Prof. Orthopedic Surgeon, School of Medicine/Sulaimani University

DOI:

https://doi.org/10.56056/amj.2018.51

Keywords:

Anterolateral approach, Posterior approach, Hip arthroplasty, Dislocation

Abstract

Background and objectives:Total hip arthroplasty is a popular successful surgical procedure for end stage hip pathologies. Since the introduction of total hip arthroplasty, many surgical approaches have been used; each has its own advantages and disadvantages. The aim of this study was to compare the intraoperative and post- operative complications of anterolateral (Watson-Jones) versus posterior (Moore) approaches for primary to-tal hip arthroplasty.

Methods: forty-one patients were selected and enrolled into two groups; 22 patients had total hip arthroplasty through posterior approach and 19 patients had anterolateral approach. The patients were followed-up for an average of six months, and each patient was assessed through observation of intraoperative neurovascular injury and femoral fracture, and postoperative pain, dislocation, limping and heterotopic ossification.

Results: The main complications of the posterior approach were intraoperative sciatic nerve injury (4.9%) and post- operative dislocation (4.9%), while the anterolateral approach associated with higher rates of intraoperative femo- ral fracture (2.4%) and postoperative abductor weakness and limping (4.9%).

Conclusions:Current study does not demonstrate any superiority of either approach. Therefore, we think the choice of surgical approach for total hip arthroplasty would be better if based on patient characteristics, surgeon experience and patient preference

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References

Vicente JRN, Pires AF, Lee BT, Leonhardt MC, Ejnisman L, Croci AT. The influence of the surgical approach concerning dislocation in total hip arthroplasty. Rev Bras Ortop. 2009;44(6);504-507.

Kwon M., Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates?. Clin Orthop Relat Res. 2006; 447; 34–38. DOI: 10.1097/01.blo.0000218746.84494.df

Mallory TH, lambordi AV, Fada RA, Herrington SM, Eberle RW. Disloca- tion after total hip arthroplasty using the anterolateral and abductor split approach. Clin Orthop Relat Res. 1999; 358; 166-172

Masonis JL, Bourne RB. Surgical approach, abductor function, and to- tal hip arthroplasty dislocation. Clin Orthop Relat Res. 2002; 405; 46–53. DOI: 10.1097/01.blo.0000038476.05771.6c

Palan J, Beard DJ, Murray DW, Andrew JG, Nolan J. Which approach for total hip arthroplasty, anterolateral or posterior?. Clin Orthop Relat Res. 2009; 467; 473–477. DOI 10.1007/s11999-008-0560-5

Petis S, Howard JL, Lanting BL, Vasarhelyi EM. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical out- comes. Can J Surg,. 2015; 58(2); 128-139. DOI:10.1503/cjs.007214

Donald R, Gore M, Murray P, Sepic SB, Gardner GM. Anterolateral ap- proach compared to posterior approach in total hip arthroplasty: dif- ferences in component positioning, hip strength, and hip motion. J. B. Lippincott Co. 1982; 165; 180-187.

Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB. A clinical com- parison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res. 2001; 385; 95–99.

Lindgren V, Garellick G, Kärrholm J, Wretenberg P. The type of surgical approach influences the risk of revision in total hip arthroplasty.Acta Ortho- paedica 2012; 83 (6); 559–565. DOI: 10.3109/17453674.2012.742394.

Gang W, Gui-shan G, Dan L, Da-hui S, Wei Z, Jun WT. Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly pa- tients. Chin. J. Traumatol. 2010; 13(4); 234-239. DOI: 10.3760/cma.j.is sn.1008-1275.2010.04.008

Kelmanovich D, Parks ML, Sinha R, Macaulay W. Surgical approach- es to total hip arthroplasty. J South Orthop Assoc. 2003; 12(2); 90-94

Downing ND, Clark DI, Hutchinson JW, Colclough K, Howard PW. Hip abductor strength following total hip arthroplasty. Acta Orthop Scand 2001; 72 (3); 215–220.

Innmann MM, Streit MR, Kolb J et al. Influence of surgical approach on component positioning in primary total hip arthroplasty. BMC Muscu- loskelet Disord. 2015; 16. DOI: 10.1186/s12891-015-0623-1

Hailer NP, Weiss RJ, Stark A, Kärrholm J. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. Acta Orthopaedica 2012; 83 (5); 442–448. DOI: 10.3109/17453674.2012.733919

Miller LE, Gondusky JS, Bhattacharyya S, Kamath AF, 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; 1-7. https://doi.org/10.1016/j.arth.2017.11.011

Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-anal-ysis. J Arthroplasty. 2015; 30 (3); 419-434. http://dx.doi.org/10.1016/j. arth.2014.10.020

Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop. 2004; 418; 162–167.

Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthro- plasty. J Am Acad Orthop Surg. 2004; 12(5); 314–321.

Yang IH. Neurovascular injury in hip arthroplasty. Hip Pelvis. 2014; 26(2); 74-78. http://dx.doi.org/10.5371/hp.2014.26.2.74.

Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987; 2018:136-41

Weber ER, Daube JR, Coventry MB. Peripheral neuropathies associ- ated with total hip arthroplasty. J Bone Joint Surg Am. 1976; 58; 66-69.

Simmons C Jr, Izant TH, Rothman RH, Booth RE Jr, Balderston RA. Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review. J Arthroplasty. 1991; 6 Suppl.; S57- 66.

Fleming RE Jr, Michelsen CB, Stinchfield FE. Sciatic paralysis. A complication of bleeding following hip surgery. J Bone Joint Surg Am. 1979; 61(1); 37-39.

Zhao R, Cai H, Liu Y, Tian H, Zhang K, Liu Z. Risk factors for intraoper- ative proximal femoral fracture during primary cementless THA. Ortho- pedics. 2017; 40(2); e281-e287. DOI: 10.3928/01477447-20161116- 06.

Erlenwein J, Müller M, Falla D et al. Clinical relevance of persistent postoperative pain after total hip replacement – a prospective obser- vational cohort study. J Pain Res. 2017; 10; 2183–2193. http://dx.doi. org/10.2147/JPR.S137892.

Putananon C, Tuchinda H, Arirachakaran A, Wongsak S, Narinsora- sak T, Kongtharvonskul J. Comparison of direct anterior, lateral, poste- rior and posterior-2 approaches in total hip arthroplasty: network me- ta-analysis. Eur J Orthop Surg Traumatol. 2018; 28(2); 255-267. DOI: 10.1007/s00590-017-2046-1.

Den Hartog YM, Hannink G, Van Dasselaar NT, Mathijssen NM, Veh- meijer SB. Which patient-specific and surgical characteristics influence postoperative pain after THA in a fast-track setting? BMC Musculoskel- et Disord. 2017; 18; 363. DOI: 10.1186/s12891-017-1725-8.

T. Woolson, Zulfiquar O. Rahimtoola. Risk Factors for Dislocation During the First 3 Months After Primary Total Hip Replacement. J Ar- throplasty. 1999; 14(6); 662-68.

Bouchet R, Mercier N, Saragaglia D. Posterior approach and dis- location rate: A 213 total hip replacements case-control study com- paring the dual mobility cup with a conventional 28-mm metal head/ polyethylene prosthesis. Orthop Traumatol Surg Res. 2011; 97; 2-7. DOI:10.1016/j.otsr.2010.07.008

Sioen W, Simon JP, Labey L, Van Audekercke R. Posterior transosse-ous capsulotendinous repair in total hip arthroplasty: a cadaver study. J Bone Joint Surg Am. 2002; 84(10);1793–1798.

Madsen MS, Ritter MA, Morris HH et al. The effect of total hip arthro- plasty surgical approach on gait. J Orthop Res.2004; 22; 44-50. DOI: lO. 10l6/S0736-0266(03)00l5l-7.

Iorio R, Healy WL, Warren PD, Appleby D. Lateral trochanteric pain follow¬ing primary total hip arthroplasty. J Arthroplasty. 2006; 21(2); 233-236. DOI:10.1016/j.arth.2005.03.041.

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

Berend KR, Lombardi AV Jr. Intraopera¬tive femur fracture is as- sociated with stem and instrument design in primary total hip arthro- plasty. Clin Orthop Relat Res. 2010; 468(9); 2377-2381. DOI: 10.1007/ s11999-010-1314-8.

Sawaia RN, Galvão AFM, Oliveira FM, Secunho GR, Filho GV. Mini- mally invasive anterolateral access route for total hip arthroplasty. Rev Bras Ortop. 2011; 46(2); 183-188.

Bertin KC, Ro¨ttinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res. 2004; 429; 248–255. DOI: 10.1097/01.blo.0000150294.81825.8c.

Back DL, Smith JD, Dalziel RE, Young AD, Shimmin A. Incidence of heterotopic ossification after hip resurfacing. ANZ J surg. 2007; 77(8); 642-647. DOI: 10.1111/j.1445-2179.2007.04178.x.

Regis D., Sandri A, Sambugaro E. Incidence of heterotopic ossi- fication after surface and conventional total hip arthroplasty: a com- parative study using anterolateral approach and indomethacin prophy- laxis. Biomed Res Int. 2013, Article ID 293528; 4 pages. http://dx.doi. org/10.1155/2013/293528.

Neal B, Gray H, Macmahon S, Dunn L. Incidence of heterotopic bone formation after major hip surgery. ANZ J. Surg. 2002; 72(11); 808–821.

Bischoff R, Dunlap J, Carpenter L, DeMouy E, Barrack R. Heterotopic ossification following uncemented total hip arthroplasty: effect of the operative approach. J Arthroplasty. 1994; 9(6); 641–644.

Eggli S, Woo A. Risk factors for heterotopic ossification in total hip arthroplasty. Arch Orthop Trauma Surg. 2001 Oct.; 121(9); 531–535.

Pavlou G, Salhab M, Murugesan L et al. Risk factors for hetero- topic ossification in primary total hip arthroplasty. Hip Int. 2012; 22(1); 50–55. DOI: 10.5301/HIP.2012.9057.

Zeckey C, Hildebrand F, Frink M, Krettek C. Heterotopic ossifications following implant surgery—epidemiology, therapeutical approaches and current concepts. Semin Immunopathol 2011; 33(3); 273–286. DOI: 10.1007/s00281-011-0240-5.