Similar Improvement in Gait Parameters Following Direct Anterior &amp; Posterior Approach Total Hip Arthroplasty

Rathod, Parthiv; Orishimo, Karl F.; Kremenic, Ian J.; Deshmukh, Ajit; Rodríguez, José A.

doi:10.1016/j.arth.2013.11.021

Cited by 75 publications

(53 citation statements)

References 21 publications

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“…These findings suggest that the direct anterior approach results in a faster recovery. However, these promising results are contradicted in other studies [59, 60]. …”

Section: Discussioncontrasting

confidence: 58%

The design of a randomised controlled trial to evaluate the (cost-) effectiveness of the posterolateral versus the direct anterior approach for THA (POLADA – trial)

Rykov

Reininga

Knobben

et al. 2016

BMC Musculoskelet Disord

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BackgroundTotal hip arthroplasty (THA) is one of the most successful orthopaedic procedures. Because of the increasing number of THAs, a growing demand for faster recovery and a greater emphasis on cost-effectiveness, minimally invasive THAs have been introduced in the last decades. The direct anterior approach is a minimally invasive, tissue-sparing approach in which intermuscular planes are used. Theoretically, this approach should result in a faster recovery of physical functioning and higher health-related quality of life.Methods/designA randomised controlled trial will be performed. Patients will be randomly allocated to undergo THA by means of the anterior or posterolateral approach. Both the intervention and control group will consist of two subgroups: 1) patients with a good bone stock who will receive an uncemented femoral stem, and 2) patients with a poor bone stock who will receive a cemented femoral stem. Patients between 18 and 90 years with primary or secondary osteoarthritis will be included. Physical functioning and health-related quality of life will be assessed by means of questionnaires. Additionally, performance based tests will be performed to objectively assess the physical functioning. Cost-effectiveness will be assessed by obtaining data on medical costs in and outside the hospital and other nonmedical costs. Measurements will take place preoperatively, two and six weeks, three months and one year postoperatively.DiscussionThere is some evidence that the anterior approach results in reduced tissue damage and faster recovery in the direct postoperative period, compared to the posterolateral approach. However, there is still a lack of well-designed studies that have confirmed the better outcomes and cost-effectiveness of the anterior approach. Therefore, the purpose of this study is to assess the physical functioning, health related quality of life and the cost-effectiveness of the anterior approach, compared to the conventional posterolateral approach.Trial registrationNetherlands Trial Registry, number 5343 (registration date April 12, 2015)Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1322-2) contains supplementary material, which is available to authorized users.

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“…These findings suggest that the direct anterior approach results in a faster recovery. However, these promising results are contradicted in other studies [59, 60]. …”

Section: Discussioncontrasting

confidence: 58%

The design of a randomised controlled trial to evaluate the (cost-) effectiveness of the posterolateral versus the direct anterior approach for THA (POLADA – trial)

Rykov

Reininga

Knobben

et al. 2016

BMC Musculoskelet Disord

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“…The association between preoperative transverse plane kinetics and THA response may also have implications for determining which surgical approach may be appropriate for a given patient. Transverse plane kinematic and kinetic differences have been observed among THA patients who underwent THA using different surgical approaches . If, based on the present findings, patients with preoperative gait deficits in the transverse plane are more vulnerable to having less improvement in clinical scores, it may follow that these patients would be better served by THA approaches that do not further traumatize the anterior portion of the gluteus medius.…”

Section: Discussionmentioning

confidence: 58%

Preoperative gait mechanics predict clinical response to total hip arthroplasty

Foucher

2016

Journal Orthopaedic Research

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Some patients do not have an adequate clinical response to total hip arthroplasty (THA) for reasons that are not fully understood. Identifying modifiable factors that are associated with nonresponse could lead to new ways to identify and treat potential nonresponders. This study investigated whether any preoperative gait characteristics were associated with THA clinical response, and whether or not there were corresponding postoperative gait differences in THA nonresponders compared to responders. A secondary analysis was conducted of 124 subjects (age 61 ± 10 years; 64 female/60 male), evaluated before and 1 year after primary unilateral THA, using quantitative gait analysis and Harris Hip Scores (HHS). Responders and nonresponders were identified using the OMERACT-OARSI responder criteria, modified for use with the HHS. Pre- and postoperative dynamic sagittal plane range of motion (ROM) and 3D peak external moments were compared, for responders and nonresponders, using t-tests and logistic regression. 11.3% of subjects were nonresponders. Before surgery, the ROM was 26% higher for nonresponders than responders, but the peak external rotation moment was 30% lower (p = 0.003-0.043). Preoperative gait and HHS predicted response with a sensitivity of 71.4% and a specificity of 99.1%. There were persistent postoperative deficits in the peak external rotation moment in nonresponders compared to responders (p = 0.028). This study showed that gait analysis, where available, can augment clinical scores in predicting THA response. Moreover, it suggests that further analysis of the subtle role of transverse plane hip mechanics could lead to interventions to promote better THA response. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:366-376, 2017.

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“…In addition, we have presented data on early recovery of muscle strength, showing DAA patients may have early flexion weakness, and posterior approach patients may have external rotation weakness, most of which resolves by 6 months [9]. Finally, gait analysis at 6 months follow-up from our center failed to demonstrate a difference [10].…”

mentioning

confidence: 99%