Outcomes of the Supine Anterior-based Muscle-sparing Approach for Primary and Revision Hip Arthroplasty

Abstract

Introduction: Risks and outcomes of total hip arthroplasty (THA) are believed to vary relative to the surgical approach. This study compares the supine anterior-based muscle-sparing (ABMS) approach with its modern-day counterparts. Methods: A retrospective review was done on 550 patients undergoing primary or revision THA from 2016 to 2018. Surgical modalities included direct anterior (DAA), ABMS, posterolateral, and Mu ¨ller modified Hardinge approaches. Surgical data were collected, and clinical outcomes were measured by the Hip Disability and Osteoarthritis Outcome Score, Modified Harris Hip Score, UCLA, and VR-12 Mental/Physical scores preoperatively and compared clinical outcomes among approaches. Results: A total of 550 patients were included (447 primaries, 103 revisions). The average age was 64 years (231 men, 319 women). Approaches included 79 DAA (14%), 212 ABMS (39%), 180 modified Mu ¨ller-Hardinge (33%), and 79 posterolateral (14%). The incidence of lateral femoral cutaneous nerve injury was more common with the DAA (P = 0.008), but no other clinically significant differences were noted among the groups. Conclusion:The results of this study showed no clinically notable differences between the supine ABMS and other approaches. The supine ABMS approach is an acceptable approach in modern day THA when used by an experienced surgeon well-versed in the approach.T otal hip arthroplasty (THA) is considered one of the most effective orthopaedic procedures for relieving pain, restoring function, and improving the quality of life in patients with hip osteoarthritis. Modern improvements in THA have yielded shorter hospital stays, better functional outcomes, and higher patient satisfaction scores. [1][2][3] Although some suggest that a surgical approach is an independent predictor of an early postoperative Tommy Pan, BA

Comparing the Anterior-Based Muscle-Sparing Approach with the Direct Anterior Approach in Hip Arthroplasty: A Systematic Review and Pairwise Meta-Analysis

“…Of the 10 studies, 7 studies [ 18 , 19 , 20 , 21 , 22 , 26 , 27 ] were retrospective cohort studies, 2 studies [ 23 , 24 ] used propensity score matching, and 1 study was a randomized controlled trial. Five studies [ 18 , 19 , 20 , 21 , 27 ] were conducted in the United States, three [ 23 , 24 , 26 ] in Europe, and two [ 22 , 25 ] in Asia. A total of 3716 hips were included with 1737 hips operated using the ABMS approach and the other 1979 hips operated using the DA approach.…”

“…All studies predominantly included women who underwent primary HA, with one study [ 24 ] exclusively focusing on patients who underwent bipolar hemiarthroplasty. For the ABMS approach, six studies [ 20 , 22 , 24 , 25 , 26 , 27 ] mentioned the position of the patients. Of these, two studies [ 20 , 24 ] employed the ABMS approach in the lateral decubitus position, while the remaining four studies [ 18 , 22 , 25 , 26 , 27 ] used the ABMS approach in the supine position.…”

“…For the ABMS approach, six studies [ 20 , 22 , 24 , 25 , 26 , 27 ] mentioned the position of the patients. Of these, two studies [ 20 , 24 ] employed the ABMS approach in the lateral decubitus position, while the remaining four studies [ 18 , 22 , 25 , 26 , 27 ] used the ABMS approach in the supine position. For the DA approach, four studies [ 23 , 24 , 25 , 27 ] performed the tabled DA approach, and three studies [ 20 , 22 , 26 ] performed the conventional DA approach.…”

“…Of these, two studies [ 20 , 24 ] employed the ABMS approach in the lateral decubitus position, while the remaining four studies [ 18 , 22 , 25 , 26 , 27 ] used the ABMS approach in the supine position. For the DA approach, four studies [ 23 , 24 , 25 , 27 ] performed the tabled DA approach, and three studies [ 20 , 22 , 26 ] performed the conventional DA approach. The other three studies [ 18 , 19 , 21 ] did not specify the type of DA approach used.…”

“…Regarding the prospective calculation of the study size (item 8: prospective calculation of the study size), all studies received point deductions. Points were deducted for three studies [ 19 , 20 , 27 ] for baseline group equivalence (item 11: baseline equivalence of groups). No deductions were made from the additional criteria domains (items 9,10,12: an adequate control group, contemporary groups, and adequate statistical analyses).…”