Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches

Abstract

BackgroundTotal hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches.MethodsThe study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches.ResultsFor the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094).ConclusionOur study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.

Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis

“…However, it is still controversial whether there is a difference in leg length discrepancy between patients after THA using the DAA and LA approaches. Although the study of Debi et al 54 . showed a good outcome in LLD values in patients who underwent THA by the DAA compared to the anterolateral approach (ALA), most authors stated that both DAA and ALA showed similar results in postoperative leg length control 55, 56 .…”

Radiographic Results on Acetabular Cup Placement with the SuperPath Technique: A Retrospective Study of 756 Cases

“…Malposition of the acetabular cup is associated with complications such as impingement, recurrent dislocation, increased ischial osteolysis and wear of prosthetic components [36][37][38]. Few studies have evaluated acetabular cup placement depending on the surgical approach [29,[39][40][41]. MIS techniques arose with the simultaneous effort to reduce periarticular tissue damage and achieve good clinicalradiographic results, the latter at least overlapping with those obtained with traditional surgical approaches [42][43][44].…”

A Crossover Cohort of Direct Anterior vs Posterolateral Approach in Primary Total Hip Arthroplasty: What Does the Patient Prefer?

“…Both the PLA and DAA to THA have been used successfully, but the surgical approach remains a topic of contention among arthroplasty surgeons. Literature has suggested that the DAA provides better outcomes of postoperative pain, LOS, functional recovery, and patient-reported outcome measures [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ]. However, there are studies suggesting that this approach offers no benefit compared with other approaches for THA and potential increased risk of periprosthetic fracture or early reoperation [ 3 , [20] , [21] , [22] , [23] , [24] , [25] , [26] ].…”

“…The proposed benefits of DAA THA have been described extensively including the following: decreased visual analog scale (VAS) pain scores in the immediate postoperative period, reduced hospital length of stay (LOS), greater likelihood of home discharge, improved acute patient-reported outcome scores, lower creatine kinase levels postoperatively, and more accurate acetabular cup placement [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. Furthermore, more rapid functional recovery after the DAA is perhaps the most cited advantage of the DAA.…”