Elsevier

The Journal of Arthroplasty

Volume 25, Issue 5, August 2010, Pages 671-679.e1
The Journal of Arthroplasty

Prospective Randomized Study of Two Surgical Approaches for Total Hip Arthroplasty

https://doi.org/10.1016/j.arth.2010.02.002Get rights and content

Abstract

The benefits of different surgical approaches for total hip arthroplasty continue to be debated. One hundred patients were prospectively enrolled and randomized into 2 groups. One group underwent total hip arthroplasty through a single-incision modified Smith-Peterson approach, whereas the other group underwent total hip arthroplasty through a direct lateral approach. All patients received the same postoperative protocol. Evaluation included operative time, estimated blood loss, analgesia requirement, transfusions, and length of stay. Functional outcome was assessed preoperatively and postoperatively. Up to 1-year follow-up, the direct anterior group demonstrated significantly better improvement in both the mental and physical health dimensions of Short Form-36 and Western Ontario McMaster Osteoarthritis Index compared with direct lateral approach group. At 2 years, the results in both groups were the same.

Section snippets

Demographics

After institutional review board approval, during a 2-year period from 2005 to 2007, consecutive patients undergoing unilateral total hip arthroplasty by a single surgeon at our institution were approached and evaluated for inclusion in this study. The patients were recruited on an individual basis by the clinical research department. The surgeon involved agreed to participate in the study but was not involved in patient recruitment.

The inclusion criteria were as follows: patients between 18

Functional Outcome

There was a significant improvement in function as measured by the Harris Hip Score, the Lower Extremity Functional Score, the Western Ontario McMaster Osteoarthritis Index, the Linear Analog Scale Assessment, and the Short Form-36 test after total hip arthroplasty in both groups (Table 4, Table 5, Table 6; Table 5, Table 6 available online at www.arthroplastyjournal.org). The functional outcome was the same for both groups at the latest follow-up at 2 years (Table 7). However, there was a

Discussion

Although both groups of patients in this prospective randomized study have excellent clinical results, there seem to be subtle advantages to the direct anterior approach as measured by outcome measurement such as the Western Ontario McMaster Osteoarthritis Index, Short Form-36, and Linear Analog Scale Assessment scores.

This study has demonstrated that the direct anterior approach has specific early outcome benefits for patients as compared with a direct lateral approach for total hip

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    Supplementary material available at www.arthroplastyjournal.org.

    Benefits or funds were received in partial or total support of the research material described in this article. These benefits or support were received from the following sources: J.P., Consultant for Stryker Orthopaedics (Mahwah, NJ), Intellectual Properties of SmarTech (Philadelphia, Pa).

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