Clinicoradiological outcomes and patient satisfaction following total hip arthroplasty via direct anterior approach vs posterior approach (a prospective randomized controlled trial)

Total hip arthroplasty (THA) is one of the commonly performedsurgeries in orthopedics. THA is performed for various indications likeend-stage degenerative hip osteoarthritis (OA), hip osteonecrosis (ON),congenital hip disorders, post-traumatic arthritis of hip, inflammatoryarthropathies of hip. It is done for pain relief, functional restoration andoverall improvement in quality of life. Hip osteoarthritis (OA) is the mostprevalent and disabling conditions affecting the elderly. There is an estimated25% lifetime risk of symptomatic hip OA in people who live to age 85 years.

There are 3 classic approaches forTHA, each with advantages and disadvantages: the Direct Anterior Approach, the PosteriorApproach and the Lateral Approach.

Thedirect anterior approach to the hip was originally described by Carl Heuter in1881. Smith-Peterson had frequently used this approach and modified over theyears and popularized this approach in 1920s-1930s. The anterior-based incisionutilizes the interval between the tensor fascia lata and the sartorius muscles. The main advantageof the approach to be the muscle-sparing nature, earlier restoration of gait kinematicsand low dislocation rates. The direct anterior approach can beperformed with or without the use of a specialized table. Mainchallenges in anterior approach is limited exposure, difficulty in obesepatient, and duration of surgery increases due to limited exposure, also it hassteep learning curve.

The posterior approach to the hip waspopularized by Moore in the 1950s. The posterior approach is the most commonsurgical approach used globally for THAs. It providesadequate visualization of both the acetabulum and femur during bothreconstructive procedures. The approach spares the abductor muscles duringsurgical exposure of the acetabulum and femur. Main drawback ofposterior approach was dislocation due to cutting of short external rotators ofhip. However, dislocation became less common with the PA because of enhanced capsularclosure and larger heads.

The direct lateral approach tothe hip was described by Hardinge in 1982. This approach provides adequateexposure of both the proximal femur and acetabulum. It has the benefit ofproviding an extensive exposure to the femur as required. A very lowdislocation rate has also been reported in clinical follow-up. However main drawback of this approach is abductor weakness as wesplit abductors of hip.