OPTIONS FOR TOTAL HIP ARTHROPLASTY SURGICAL APPROACHES
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Abstract
Total hip arthroplasty (THA) is a highly successful surgical technique that greatly reduces pain and improves general well-being in people with hip osteoarthritis. Total hip arthroplasty can be performed using one of several surgical approaches. The most common approaches are the Direct Anterior Approach (DAA), Lateral Approach (LA), and Posterior Approach (PA). Each approach has its own set of advantages and disadvantages. Even though the Posterior Approach is the most commonly used, it is crucial to highlight that other techniques have drawbacks in terms of infection rates, bone loss, and ease of access. This article highlights the methodology for each surgical approach and provides a full examination of outcomes and associated complications.
References
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2. Kelmanovich D, Parks ML, Sinha R, Macaulay W. Surgical approaches to total hip arthroplasty. J South Orthop Assoc. 2003 Jan 1;12(2):90-4.
3. Vaishya R, Vijay V, Demesugh DM, Agarwal AK. Surgical approaches for total knee arthroplasty. Journal of clinical orthopaedics and trauma. 2016 Apr;7(2):71.
4. Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of two surgical approaches for total hip arthroplasty. The Journal of arthroplasty. 2010 Aug 1;25(5):671-9.
5. Levine BR, Klein GR, Di Cesare PE. Surgical approaches in total hip arthroplasty. Bull NYU Hosp Jt Dis. 2007 Apr 1;65:5-18.
6. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates?. Clinical Orthopaedics and Related Research (1976-2007). 2006 Jun 1;447:34-8.
7. SaNNa M, SaNNa C, CaPutO F, PIu G, SalVI M. Surgical approaches in total knee arthroplasty. Joints. 2013 Apr;1(2):34.
8. Insall JN. Surgical techniques in total knee arthroplasty. Springer Science & Business Media; 2006 Apr 28.
9. HORWITZ BR, ROCKOWITZ NL, GOLL SR, BOOTH JR RE, BALDERSTON RA, ROTHMAN RH, COHN JC. A prospective randomized comparison of two surgical approaches to total hip arthroplasty. Clinical Orthopaedics and Related Research (1976-2007). 1993 Jun 1;291:154-63.
10. Berstock JR, Blom AW, Beswick AD. A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty. The Annals of The Royal College of Surgeons of England. 2015 Jan;97(1):11-6.
11. Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 472 (2014): 455-463.
12. Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty. Bone Joint J 99-B(2017): 732-740.
13. Moerenhout K, Derome P, Laflamme GY, et al. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Canadian Journal of Surgery 63 (2020):E412-417.
14. Bhaskar D, Rajpura A, Board T. Current Concepts in Acetabular Positioning in Total Hip Arthroplasty. Indian J Orthop 51 (2017): 386-396.
15. Bartlett JD, Lawrence JE, Khanduja V. What Is the Risk Posed to the Lateral Femoral Cutaneous Nerve During the Use of the Anterior Portal of Supine Hip Arthroscopy and the Minimally Invasive Anterior Approach for Total Hip Arthroplasty? Arthroscopy: The Journal of Arthroscopic and Related Surgery 34 (2018): 1833-1840.
16. Coffey R, Gupta V. Meralgia Paresthetica. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2023(2022).
17. Abe H, Sakai I, Takao M, et al. Difference in Stem Alignment Between the Direct Anterior Approach and the Posterolateral Approach in Total Hip Arthroplasty. J Arthroplasty 30 (2015): 1761-1766.
18. Meneghini RM, Elston AS, Chen AF, et al. Direct Anterior Approach: Risk Factor for Early Femoral Failure of Cementless Total Hip Arthroplasty. Journal of Bone and Joint Surgery 99 (2017): 99-105.
19. Kahhaleh E, Charles T, Collard X, et al. A low dislocation rate after revision total hip arthroplasty performed through the anterior approach. Arthroplasty 5 (2023): 4.
20. Zhou Y, Cao S, Li L, et al. Is soft tissue repair a right choice to avoid early dislocation after THA in posterior approach? BMC Surg 17 (2017): 60.
21. Kwon MS, Kuskowski M, Mulhall KJ, et al. Does Surgical Approach Affect Total Hip Arthroplasty Dislocation Rates? Clin Orthop Relat Res 447 (2006): 34-38.
22. Fessy MH, Putman S, Viste A, et al. What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips. Orthopedics and Traumatology: Surgery and Research 103 (2017): 663-668.
23. Noor, S. S., Keerio, N. H., Valecha, N. K., & Qureshi, M. A. (2020). Total Hip Arthroplasty Outcome (Hospital Results). Journal of Biochemical Technology, 11 (3), 92-96.
24. Peracha MA, Tago IA, Zaur ZA, Jatoi ZA, Maher IK, Khawaja K, Keerio NH. Outcomes of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation in Patients with Basicervical Femoral Neck Fractures: A Randomized Controlled Trial. Annals of the Romanian Society for Cell Biology. 2022 Apr 5;26(01):748-53.
25. Carta S, Fortina M. ALDI (Anterior Lateral Decubitus Intermuscular) approach to the hip: Comprehensive description of the surgical technique with operative video.Orthopedics and Traumatology: Surgery and Research 105 (2019): 923-930.
26. Carro LP, Hernando MF, Cerezal L, et al. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J 6 (2016): 384-396.
27. Goyal P, Lau A, McCalden R, et al. Accuracy of the modified Hardinge approach in acetabular positioning. Canadian Journal of Surgery 59 (2016): 247-253.
28. : Niaz Hussain Keerio, Nasrullah Aamer, Raheel Akbar Baloch, Nouman Memon, Arslan Abro, Syed Shahid Noor. Vitamin D Insufficiency Among the Adult Women of Remote Areas of Pakistan. JPUMHS . 2020 Jun; 10(2):04-8.
29. Lepri AC, Villano M, Matassi F, et al. "Anterolateral" approach to the hip: a systematic review of the correct definition of terms. HIP International 30(2 _suppl) (2020):13-19.
30. Streck LE, Boettner F. Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. Medicina (Kaunas) 59 (2023).
31. Gänsslen A, Grechenig S, Nerlich M, et al. Standard Approaches to the Acetabulum Part 1: Kocher-Langenbeck Approach. Acta Chir Orthop Traumatol Cech 83 (2016): 141-146.
32. Gerard R, Savéan J, Lefèvre C. Minimally invasive posterolateral hip approach with SPARTAQUUS (Spare the Piriformis And Respect The Active QUadratus femoris and gluteus mediUS) technique. Orthopedics and Traumatology: Surgery and Research 106 (2020):1523-1526.
33. Haddad FS, Thakrar RR, Hart AJ, Skinner JA, Nargol AVF, Nolan JF, et al. Metal-on-metal bearings. J Bone Joint Surg Br. 2011 May;93-B (5):572-9.
34. Hoshino C, Koga D, Koyano G, et al. Femoral nerve palsy following primary total hip arthroplasty with the direct anterior approach. PLoS One 14 (2019): e0217068.
35. Yucuma D, Riquelme I, Avellanal M. Painful Total Hip Arthroplasty: A Systematic Review and Proposal for an Algorithmic Management Approach. Pain Physician 24 (2021): 193-201.
36. Deng Y, Kieser D, Wyatt M, et al. Risk factors for periprosthetic femoral fractures around total hip arthroplasty: a systematic review and meta-analysis. ANZ J Surg 90 (2020): 441-447.
37. SS Noor, N Hussain, I Javed, Outcome of AUSTIN-MOORE Hemiarthroplasty in elderly patients with fracture neck of femur. JPOA 2010 Feb; 22(1): 14-19.
38. Morita A, Kobayashi N, Choe H, et al. Effect of switching administration of alendronate after teriparatide for the prevention of BMD loss around the implant after total hip arthroplasty, 2-year follow-up: a randomized controlled trial. J Orthop Surg Res 15 (2020): 17.
2. Kelmanovich D, Parks ML, Sinha R, Macaulay W. Surgical approaches to total hip arthroplasty. J South Orthop Assoc. 2003 Jan 1;12(2):90-4.
3. Vaishya R, Vijay V, Demesugh DM, Agarwal AK. Surgical approaches for total knee arthroplasty. Journal of clinical orthopaedics and trauma. 2016 Apr;7(2):71.
4. Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of two surgical approaches for total hip arthroplasty. The Journal of arthroplasty. 2010 Aug 1;25(5):671-9.
5. Levine BR, Klein GR, Di Cesare PE. Surgical approaches in total hip arthroplasty. Bull NYU Hosp Jt Dis. 2007 Apr 1;65:5-18.
6. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates?. Clinical Orthopaedics and Related Research (1976-2007). 2006 Jun 1;447:34-8.
7. SaNNa M, SaNNa C, CaPutO F, PIu G, SalVI M. Surgical approaches in total knee arthroplasty. Joints. 2013 Apr;1(2):34.
8. Insall JN. Surgical techniques in total knee arthroplasty. Springer Science & Business Media; 2006 Apr 28.
9. HORWITZ BR, ROCKOWITZ NL, GOLL SR, BOOTH JR RE, BALDERSTON RA, ROTHMAN RH, COHN JC. A prospective randomized comparison of two surgical approaches to total hip arthroplasty. Clinical Orthopaedics and Related Research (1976-2007). 1993 Jun 1;291:154-63.
10. Berstock JR, Blom AW, Beswick AD. A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty. The Annals of The Royal College of Surgeons of England. 2015 Jan;97(1):11-6.
11. Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 472 (2014): 455-463.
12. Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty. Bone Joint J 99-B(2017): 732-740.
13. Moerenhout K, Derome P, Laflamme GY, et al. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Canadian Journal of Surgery 63 (2020):E412-417.
14. Bhaskar D, Rajpura A, Board T. Current Concepts in Acetabular Positioning in Total Hip Arthroplasty. Indian J Orthop 51 (2017): 386-396.
15. Bartlett JD, Lawrence JE, Khanduja V. What Is the Risk Posed to the Lateral Femoral Cutaneous Nerve During the Use of the Anterior Portal of Supine Hip Arthroscopy and the Minimally Invasive Anterior Approach for Total Hip Arthroplasty? Arthroscopy: The Journal of Arthroscopic and Related Surgery 34 (2018): 1833-1840.
16. Coffey R, Gupta V. Meralgia Paresthetica. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2023(2022).
17. Abe H, Sakai I, Takao M, et al. Difference in Stem Alignment Between the Direct Anterior Approach and the Posterolateral Approach in Total Hip Arthroplasty. J Arthroplasty 30 (2015): 1761-1766.
18. Meneghini RM, Elston AS, Chen AF, et al. Direct Anterior Approach: Risk Factor for Early Femoral Failure of Cementless Total Hip Arthroplasty. Journal of Bone and Joint Surgery 99 (2017): 99-105.
19. Kahhaleh E, Charles T, Collard X, et al. A low dislocation rate after revision total hip arthroplasty performed through the anterior approach. Arthroplasty 5 (2023): 4.
20. Zhou Y, Cao S, Li L, et al. Is soft tissue repair a right choice to avoid early dislocation after THA in posterior approach? BMC Surg 17 (2017): 60.
21. Kwon MS, Kuskowski M, Mulhall KJ, et al. Does Surgical Approach Affect Total Hip Arthroplasty Dislocation Rates? Clin Orthop Relat Res 447 (2006): 34-38.
22. Fessy MH, Putman S, Viste A, et al. What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips. Orthopedics and Traumatology: Surgery and Research 103 (2017): 663-668.
23. Noor, S. S., Keerio, N. H., Valecha, N. K., & Qureshi, M. A. (2020). Total Hip Arthroplasty Outcome (Hospital Results). Journal of Biochemical Technology, 11 (3), 92-96.
24. Peracha MA, Tago IA, Zaur ZA, Jatoi ZA, Maher IK, Khawaja K, Keerio NH. Outcomes of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation in Patients with Basicervical Femoral Neck Fractures: A Randomized Controlled Trial. Annals of the Romanian Society for Cell Biology. 2022 Apr 5;26(01):748-53.
25. Carta S, Fortina M. ALDI (Anterior Lateral Decubitus Intermuscular) approach to the hip: Comprehensive description of the surgical technique with operative video.Orthopedics and Traumatology: Surgery and Research 105 (2019): 923-930.
26. Carro LP, Hernando MF, Cerezal L, et al. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J 6 (2016): 384-396.
27. Goyal P, Lau A, McCalden R, et al. Accuracy of the modified Hardinge approach in acetabular positioning. Canadian Journal of Surgery 59 (2016): 247-253.
28. : Niaz Hussain Keerio, Nasrullah Aamer, Raheel Akbar Baloch, Nouman Memon, Arslan Abro, Syed Shahid Noor. Vitamin D Insufficiency Among the Adult Women of Remote Areas of Pakistan. JPUMHS . 2020 Jun; 10(2):04-8.
29. Lepri AC, Villano M, Matassi F, et al. "Anterolateral" approach to the hip: a systematic review of the correct definition of terms. HIP International 30(2 _suppl) (2020):13-19.
30. Streck LE, Boettner F. Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. Medicina (Kaunas) 59 (2023).
31. Gänsslen A, Grechenig S, Nerlich M, et al. Standard Approaches to the Acetabulum Part 1: Kocher-Langenbeck Approach. Acta Chir Orthop Traumatol Cech 83 (2016): 141-146.
32. Gerard R, Savéan J, Lefèvre C. Minimally invasive posterolateral hip approach with SPARTAQUUS (Spare the Piriformis And Respect The Active QUadratus femoris and gluteus mediUS) technique. Orthopedics and Traumatology: Surgery and Research 106 (2020):1523-1526.
33. Haddad FS, Thakrar RR, Hart AJ, Skinner JA, Nargol AVF, Nolan JF, et al. Metal-on-metal bearings. J Bone Joint Surg Br. 2011 May;93-B (5):572-9.
34. Hoshino C, Koga D, Koyano G, et al. Femoral nerve palsy following primary total hip arthroplasty with the direct anterior approach. PLoS One 14 (2019): e0217068.
35. Yucuma D, Riquelme I, Avellanal M. Painful Total Hip Arthroplasty: A Systematic Review and Proposal for an Algorithmic Management Approach. Pain Physician 24 (2021): 193-201.
36. Deng Y, Kieser D, Wyatt M, et al. Risk factors for periprosthetic femoral fractures around total hip arthroplasty: a systematic review and meta-analysis. ANZ J Surg 90 (2020): 441-447.
37. SS Noor, N Hussain, I Javed, Outcome of AUSTIN-MOORE Hemiarthroplasty in elderly patients with fracture neck of femur. JPOA 2010 Feb; 22(1): 14-19.
38. Morita A, Kobayashi N, Choe H, et al. Effect of switching administration of alendronate after teriparatide for the prevention of BMD loss around the implant after total hip arthroplasty, 2-year follow-up: a randomized controlled trial. J Orthop Surg Res 15 (2020): 17.
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Published
Oct 26, 2023
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Mahantesh Magadum, Zulfiqar Haider Kerawala, Mohammed Asif Peracha, Ahmed Abdelaziz Abdelkader Elgohary, Eslam Mohammed Shalaby, & Niaz Hussain Keerio. (2023). OPTIONS FOR TOTAL HIP ARTHROPLASTY SURGICAL APPROACHES. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1092–1099. https://doi.org/10.53555/jptcp.v30i18.3241
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Author Biographies
Mahantesh Magadum
Specialist Orthopedic Surgeon, SaudiGerman Hospital Dubai and Sharjah United Arab Emirates.
Zulfiqar Haider Kerawala
Specialist Orthopedic Surgeon, Al Qassimi Hospital Sharjah United Arab Emirates.
Mohammed Asif Peracha
Consultant Orthopedic Surgeon, Liaquat National Hospital and Medical college, Karachi, Pakistan.
Ahmed Abdelaziz Abdelkader Elgohary
Ortho-trauma Specialist, Rashid hospital Dubai United Arab Emirates.
Eslam Mohammed Shalaby
Senior Specialist Orthopedic Trauma, Hatta Hospital Dubai Academic Health Corporation United Arab Emirates.
Niaz Hussain Keerio
Assistant Professor, Ibn-e-Sina University, Mohammed Medical College Hospital Mirpurkhas Pakistan.