Anterior or Posterior, It’s All the Same for THR?

An anterior or posterior approach to total hip replacement works equally well, says new research from Hospital for Special Surgery (HSS) in New York. The study (“No Effect of Surgical Approach Outcomes in Outpatient Total Hip Arthroplasty”), which examined time to walking, length of surgery, pain at discharge, and rates of complications and readmissions at 90 days after surgery, can be accessed online as part of the American Academy of Orthopaedic Surgeons AAOS 2020 Virtual Education Experience.

“Today’s advertising can be confusing, as it creates a mixed message about whether there are clinical benefits with a particular surgical approach. We wanted to find out what the evidence shows when the approaches are appropriately compared,” explains senior author Michael P. Ast, M.D., a hip and knee surgeon at HSS.

Asked about any prior work in this area, Dr. Ast commented to OTW, “There have been studies comparing approaches, however, prior studies have presented methodological concerns, including selection bias, poorly controlled peri-operative protocols, inappropriate comparison groups, or significant conflicts of interest. We carefully designed this study to focus on a matched group of the highest demand patients, ambulatory surgery patients, in a consistent and structured perioperative program, to determine if either approach provided clinically relevant early advantages or disadvantages.”

Dr. Ast and his team examined outcomes for 138 patients who underwent THR at HSS in 2019. Patients received the same care before, during and after surgery, and were grouped according to whether they had received an anterior or a posterior incision (69 in each group). Participants were matched for age, sex and body mass index.

The researhers found no statistically significant differences in outcomes between the two groups at any timepoint within the first 90 days after surgery. No one in either group had to undergo a reoperation and complications were low—two patients in the anterior group and three patients in the posterior group. For all patients, early ambulation was associated with earlier discharge and decreased use of pain medication while still in the hospital.

Specifying the need for appropriate protocols, Dr. Ast told OTW, “Surgeons should take comfort that whichever approach for surgery they prefer can provide high quality outcomes in an ambulatory surgery setting, while minimizing risks through an evidence-based, structured pre-operative and recovery program.”