Posterior hip approach yields better functional results vis-à-vis anterolateral approach in total hip arthroplasty for patients with severe hip dysplasia: A prospective randomized controlled clinical study

Çatma, Faruk Mehmet; Öztürk, Alper; Ünlü, Serhan; Ersan, Önder; Altay, Murat

doi:10.1177/2309499017717179

Cited by 7 publications

(13 citation statements)

References 32 publications

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“…Little information is available in the literature on the role of bone geometry (fem-or al offset, acetabulum anteversion, neck-shaft angle) in the choice of surgical approach, even though some authors have highlighted the advantage of some approaches for specific pathologies, such as hip dysplasia. 43 Unfortunately, because of the sample size in our study, we were not able to conduct subgroup analyses looking at the impact of surgical approach with respect to specific patient characteristics such as sex, age or BMI. Finally, the ceiling effect common to the PROMs could conceal some improvements when patients score well at baseline, which makes it more difficult to measure the effect of the THR as a treatment for osteoarthritis in some cases.…”

Section: E185mentioning

confidence: 98%

Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches

Galmiche

Poitras

Dobransky

et al. 2020

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RESEARCH • RECHERCHEDoes surgical approach influence mid-to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches Background: The most effective surgical approach to total hip replacement (THR) remains controversial. Most studies that have compared approaches have reported only short-term outcome data. It is therefore unclear in the literature if a particular surgical approach offers long-term advantages. The aim of this study was to determine the effect of the 3 main surgical approaches to THR on patient-reported outcomes 5 years after surgery.Methods: All patients who underwent a THR for osteoarthritis or osteonecrosis between 2008 and 2012 by an anterior, posterior or lateral approach at The Ottawa Hospital in Ontario, Canada, were included in the study. All preoperative and postoperative scores for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) questionnaires were recorded. Analy sis of covariance was used to study the relationship between the amount of change in scores on the HOOS and WOMAC subscales (dependent variables) and the surgical approach. The confounding factors of age, sex, American Society of Anesthesiologists (ASA) class, Charnley classification and body mass index were included in the analysis.Results: There were 138 patients (37.6%) in the posterior approach group, 104 (28.3%) in the lateral approach group and 125 (34.1%) in the anterior approach group. There were no significant differences among the 3 groups in terms of Charnley classification, body mass index, sex, ASA class, surgical side and preoperative functional scores. We did not observe any sig nificant differences in the amount of change in the scores for HOOS and WOMAC subscales among the 3 groups. There were also no differences in the final postoperative scores. Conclusion:Our findings suggest that the choice of surgical approach in primary THR surgery without revision has no influence on functional outcomes and quality of life after 5 years. Further studies are needed to assess how patient age and sex may influence the functional outcome of individual surgical approaches.Contexte : L'approche chirurgicale la plus efficace pour l'arthroplastie totale de la hanche (ATH) n'a pas été déterminée. La plupart des études qui ont comparé les différentes approches n'ont fait état que de données à court terme. Donc, la littérature nous renseigne peu sur leurs bienfaits à long terme. Le but de cette étude est de vérifier l'effet des 3 principales approches chirurgicales pour l'ATH sur les paramètres rapportés par les patients 5 ans après la chirurgie. Méthodes : Tous les patients soumis à une ATH pour arthrose ou ostéonécrose entre 2008 et 2012 par approche antérieure, postérieure ou latérale à l'Hôpital d'Ottawa, en Ontario, au Canada, ont été inclus dans l'étude; et tous les scores préopératoires et postopératoires des questionnaires HOOS (Hip Disability and Osteoarthritis Outcome Score) e...

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Section: E185mentioning

confidence: 98%

Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches

Galmiche

Poitras

Dobransky

et al. 2020

cjs

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“…53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL 3,8–51 most of the authors were from European countries, but authors from north America were also present.…”

Section: Resultsmentioning

confidence: 99%

“…"We searched the Swedish Hip Arthroplasty to compare the posterior and anterolateral transgluteal approach" 13 Müller M et al 64 Arch Orthop Trauma Surg 2012. The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach.…”

mentioning

confidence: 99%

“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

et al. 2020

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Purpose: The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term “anterolateral” to describe different approaches; (2) which would be the correct description of the anterolateral approach? Methods: We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched. Results: 73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated. Conclusion: In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.

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“…While abductor mechanism dysfunction has most commonly been attributed to the direct incision or detachment of muscles in the lateral approach, other reasons like blunt trauma, retraction, denervation injury, and less common factors like thermal injury from polymethyl methacrylate can lead to damage to other muscles around the hip, including during modified or minimally invasive approaches 109,[115][116][117] . Despite this, our systematic review found a poor representation of muscle groups other than hip abductors in the comparative studies assessing strength changes following THA approaches 69,[71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][96][97][98][99][100][101][102][103][104][105][106][107][108][109] . It shows that despite persisting strength and functional abnormalities being reported following THA, not enough muscle strength data was found to compare different approaches or establish the superiority of one approach.…”

Section: Discussionmentioning

confidence: 99%

“…However, variations in measurement tools, methodology, and test positions used in THA research make the extrapolation of results and comparison of muscle strength outcomes complex. A variety of methods, including the Medical Research Council scale rating, manual muscle testing, handheld or isokinetic dynamometry, or other customized devices, has been used to quantify muscle strength in literature [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85] . Substantial variability is also seen in the reporting of strength outcomes with the results expressed as raw numbers, values normalized to limb-length or the contralateral side, and strength or torque ratios to the non-operated side [51][52][53][54][55][56][57][58][59][60][61]…”

Section: Introductionmentioning

confidence: 99%

Muscle strength changes following different surgical approaches used in primary total hip arthroplasty: A Systematic Review and Meta-analysis

Varma¹,

Ganderton²,

El-Ansary³

et al. 2022

J Orthop Rehabil Res

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Background: Persistent functional abnormalities and strength deficits are commonly reported despite the advances in surgical approaches for primary total hip arthroplasty (THA). Understanding the influence of different approaches on hip muscle strength changes following THA may play a crucial role in optimizing post-operative recovery. Aim: Systematic review and meta-analysis of between-approach comparison of directly measured hip muscle strength following primaryTHA. Method: A comprehensive online database search was performed, identifying studies that compare muscle strength between at least two different THA approaches. Based on Cochrane guidelines, a qualitative and quantitative analysis was completed along with a meta-analysis of the eligible studies. ROBINS-i and ROB-2 were used to analyse the risk of bias, and the Pedro tool was used for quality appraisal. Results: 881 publications were appraised, yielding 23 eligible publications. Sufficient data for analysis was found only between posterior and lateral approaches for hip abduction strength in all categories. No statistically significant difference was found between the two approaches at 12 months and over time-period following THA (Z=1.51, P=0.13, Std Mean diff = 0.24, 95% CI [-.07,.56]). However, the results slightly favoured posterior approach. Additionally, no statistically significant difference found in the strength ratio of the operated side to the unoperated side (U = 15, z = -0.52, p = 0.69) or in the percentage change in muscle strength at 3 months (U=10, z=-.577, p=0.686) and 12 months (U = 10, z=-.577, p = 0.686) from pre-operative baseline. Conclusion: This systematic review and meta-analysis found no statistically significant difference between posterior and lateral approaches for directly measured hip muscle strength measured. Despite the increasing popularity of AA, ALA, and other minimally invasive or modified approaches, and the relationship between muscle strength and function, a sparsity was identified in published studies that performed a comparison between approaches of hip muscle strength.

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Posterior hip approach yields better functional results vis-à-vis anterolateral approach in total hip arthroplasty for patients with severe hip dysplasia: A prospective randomized controlled clinical study

Abstract: THR surgery for patients with severe developmental dysplasia of hip is a challenging procedure, and posterior approach provides better functional outcomes regarding gait and AMSs.

Cited by 7 publications

References 32 publications

Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches

Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches

“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

Muscle strength changes following different surgical approaches used in primary total hip arthroplasty: A Systematic Review and Meta-analysis

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