Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach

Rosenlund, Signe; Broeng, Leif; Holsgaard-Larsen, Anders; Jensen, Claus Hjorth; Overgaard, Søren

doi:10.1080/17453674.2017.1291100

Cited by 56 publications

(53 citation statements)

References 38 publications

(37 reference statements)

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“…Nine studies examined PA participation pre-/post-THA ( Table 1 ), in which four measured PA using an activity monitor, 11 – 14 two used a self-report questionnaire, 15 , 16 and three used both. 17 – 19 Jeldi et al 11 assessed changes in PA at 3 and 12 months post-THA in 30 subjects (average age 67 years) using an activity monitor worn on the anterior aspect of the thigh.…”

Section: Resultsmentioning

confidence: 99%

Physical activity after total joint arthroplasty: a narrative review

Almeida¹,

Khoja²,

Piva³

2018

OAJSM

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BackgroundTotal joint arthroplasty (TJA) is a common procedure to treat individuals with hip and knee osteoarthritis. While TJAs are successful in decreasing pain and improving quality of life, it is unclear whether individuals who undergo TJA become more physically active after surgery. It is possible that TJA, by itself, is not sufficient to affect the behavior of patients toward physical activity (PA) participation. To increase PA participation, individuals with TJA may need to be exposed to exercise/behavioral interventions specifically aimed to promote PA (ie, in addition to the surgery).ObjectivesThis narrative review aimed to assess the evidence on 1) whether TJAs change PA participation from pre- to postsurgery and 2) whether exercise/behavioral interventions delivered before or after TJA help to promote PA in these patients.ResultsFor aim 1, the studies that assessed PA from pre- to post-TJA reported that PA does not change in the first 3 months postsurgery. The results of follow-ups longer than 3 months but shorter than 12 months are contradictory, and the results of follow-ups longer than 12 months provide weak evidence of increased PA. Assessment of changes in PA due to TJA is challenged by the wide variability in demographics, methods used to assess PA, and different pathways of care used across studies. The results for aim 2 were limited by a scarcity of studies that used exercise/behavioral interventions to promote PA.ConclusionTJA relieves joint pain and offers a unique opportunity for patients to become more physically active. However, the current evidence is limited and unable to offer definitive results of whether TJA is effective to change PA from pre- to postsurgery. Future large studies in representative samples of patients with TJA are needed to adequately answer this question.

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Section: Resultsmentioning

confidence: 99%

Physical activity after total joint arthroplasty: a narrative review

Almeida¹,

Khoja²,

Piva³

2018

OAJSM

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“…However, data based on patient reported outcomes, which were the primary and secondary outcomes in the main trial [ 17 ], showed no significant difference between the groups except for self-reported limping [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Radiographic cup position following posterior and lateral approach to total hip arthroplasty. An explorative randomized controlled trial

et al. 2018

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The two most common surgical approaches to total hip arthroplasty are the posterior approach and lateral approach. The surgical approach may influence cup positioning and restoration of the offset, which may affect the biomechanical properties of the hip joint.The primary aim was to compare cup position between posterior approach and lateral approach. Secondary aims were to compare femoral offset, abductor moment arm and leg length discrepancy between the two approaches. Eighty patients with primary hip osteoarthritis were included in a randomized controlled trial and assigned to total hip arthroplasty using posterior approach or lateral approach. Postoperative radiographs from 38 patients in each group were included in this study for measurement of cup anteversion and inclination. Femoral offset, cup offset, total offset, abductor moment arm and leg length discrepancy were measured on preoperative and postoperative radiographs in 28 patients in each group. We found that mean anteversion was 5° larger in the posterior approach group (95% CI, -8.1 to -1.4; p = 0.006), while mean inclination was 5° less steep (95% CI, 2.7 to 7.2; p<0.001) compared with the lateral approach group. The posterior approach group had a larger mean femoral offset of 4.3mm (95% CI, -7.4 to -1.3, p = 0.006), mean total offset of 6.3mm (95% CI, -9.6 to -3; p<0.001) and mean abductor moment arm of 4.8mm (95% CI, -7.6 to -1.9; p = 0.001) compared with the lateral approach group. We found a larger cup anteversion but less steep cup inclination in the posterior approach group compared with the lateral approach group. Femoral offset and abductor moment arm were restored after total hip arthroplasty using lateral approach but significantly increased when using posterior approach.

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“…The most common approaches traditionally have been the lateral (or Hardinge) and posterior approaches. 2 More recently, the anterior and superior approaches (SuperPath) have been introduced. 3,4 Surgical innovation should occur in a way that improves outcomes whilst minimizing surgical and medical complications.…”

Section: Introductionmentioning

confidence: 99%

“…The lateral approach has the advantage of good exposure of the acetabulum and femur, joint stability 6,7 through preservation of the posterior capsule, but suffers from gluteal dysfunction 8 and post-operative limp. 2 The posterior approach overcomes the disadvantages of the trans-gluteal lateral approach, 8 provides excellent exposure to the femur and acetabulum but suffers from a risk of instability through posterior capsulotomy and detachment of the short external rotators. 6,7,9 The risk of instability has been partly mitigated through the advent of larger heads.…”

Section: Introductionmentioning

confidence: 99%

Early surgical complications of total hip arthroplasty related to surgical approach

Hoskins

Dowsey

Spelman

et al. 2020

ANZ Journal of Surgery

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Background: Total hip arthroplasty (THA) can be performed through a number of surgical approaches. The aim was to compare the incidence of early surgical complications in THA related to approach. Methods: A retrospective review of prospectively recorded data extracted from St. Vincent's Melbourne Arthroplasty Registry was performed between January 2006 and December 2016. Surgical approach was identified: lateral, posterior, anterior and superior. Primary outcome measure was return to theatre (RTT) for any cause within 1 year. Age, comorbidity, body mass index and femoral fixation were assessed for potential confounding. Secondary outcomes were RTT for revision procedure and for specific complications: intra or post-operative fracture, dislocation/instability, aseptic loosening and prosthetic joint injection (PJI). Variables were assessed for their association with outcome using unadjusted and adjusted quantile median regression for continuous outcomes and Cox proportional hazards regression for binary time-to-event outcomes. Results: There were a total of 2906 consecutive THA's recorded, 1413 lateral, 1188 posterior, 233 anterior and 72 superior. A total of 140 cases (4.5%) required RTT within 1 year. No approach was associated with RTT on unadjusted analyses or multivariate modelling. There was no association between approach and revision, PJI or periprosthetic fracture. The posterior approach was associated with 2.90 times the rate of dislocation relative to the lateral (P = 0.005). Conclusions: There was no difference in the RTT rate between surgical approaches for THA. There was no difference in revision rates, PJI or periprosthetic fracture. The posterior approach was associated with a higher rate of dislocation relative to the lateral, but not the anterior.

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Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach

Cited by 56 publications

References 38 publications

Physical activity after total joint arthroplasty: a narrative review

Physical activity after total joint arthroplasty: a narrative review

Radiographic cup position following posterior and lateral approach to total hip arthroplasty. An explorative randomized controlled trial

Early surgical complications of total hip arthroplasty related to surgical approach

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