Anterior vs Posterior Approach in THA
- Conditions
- Total Hip Arthroplasty
- Interventions
- Procedure: Total hip arthroplasty
- Registration Number
- NCT03673514
- Lead Sponsor
- Hopital du Sacre-Coeur de Montreal
- Brief Summary
Determining the best approach for a total hip arthroplasty (THA) implies that the procedure is kind on soft tissues, with the lowest complication rates, and easily reproducible. Although there have been several attempts to resolve this issue in the last decade, a definitive answer has not been found. Therefore, the investigators performed a prospective study to compare direct anterior versus posterior approach based on (1) hospital stay, (2) functional outcome, (3) pain, (4) implant position (5) complications and (6) surgical time.
- Detailed Description
In this multicentric, prospective, randomized clinical trial, 55 total hip arthroplasties were performed on 50 patients between February 2011 and July 2013. Patients meeting the inclusion criteria underwent surgical treatment using the DAA or PA, according to a randomization process. Radiological analysis assessed implant position, limb lengthening, and potential implant related complications. X-rays were performed at subsequent follow-up visits and consisted of an antero-posterior (AP) pelvic X-ray and a lateral projection of the hip. Two independent observers, not involved with patients or surgeries, reviewed all postoperative radiographs independently.Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study.
Patients underwent either the posterior or direct anterior approach.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 50
- primary total hip replacement due to osteoarthrosis or osteonecrosis
- patients older than 50 years.
- inflammatory arthritis,
- any previous ipsilateral hip surgery
- suffering from proximal femoral deformity
- BMI over 40
- active infection
- severe contralateral hip disease, muscle contractures or neuromuscular pathology
- requiring structural bone grafts.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description THA Posterior Approach Total hip arthroplasty The posterior approach to the hip has been described by many authors and yields good results. Implants used were Quadra®-H stem and Versacup® hip system, Medacta, Switzerland, with metal on polyethylene bearing. All implants were non-cemented. THA Direct anterior approach Total hip arthroplasty The modified Hueter approach, based on the Smith-Peterson approach, was performed for the direct anterior minimally invasive surgery. This approach could have some advantages as it is a muscle sparing approach, hence yielding a faster recovery. A traction table was used for DAA as surgeons were trained to use this method. No intra-operative fluoroscopy was used for implant confirmation.Implants used were Quadra®-H stem and Versacup® hip system, Medacta, Switzerland, with metal on polyethylene bearing. All implants were non-cemented.
- Primary Outcome Measures
Name Time Method Hospital stay Between 0 days and 1 month, average of 4 days Length in days of hospital stay
- Secondary Outcome Measures
Name Time Method surgical time Up to 240 minutes Surgical time in minutes
implant position 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively Radiological assessment
functional recovery 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively The Harris Hip Score (HHS) was used to measure pain and function.Grading for the Harris Hip Score is interpreted on a scale of 0 to 100 as follows: results \<70 are Poor; 70 - 79 are Fair; 80-89 are Good; 90 -100 are Excellent
pain assessment: VAS 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively Visual Analog Scale (VAS) was used. The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations, including those with rheumatic diseases. The pain VAS is a continuous scale comprised of a horizontal (HVAS) or vertical (VVAS) line, usually 10 centimeters (100 mm) in length, anchored by 2 verbal descriptors, one for each symptom extreme. The pain VAS is a single-item scale, anchored by "no pain" (score of 0) and "pain as bad as it could be" or "worst imaginable pain" (score of 100 \[100-mm scale\]) . It is one total score, without subscale. As the lowest score of zero means no pain, it is the best possible outcome. As the highest score of 100 means the worst imaginable pain, it is the worst possible outcome.
number of patients with per/post surgical complications. 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively Possible complications are: peroperative fracture, hip dislocation, infection, neurologic complication, vascular complication or hematoma.