With an increasing number of patients undergoing total hip replacement (THR), surgeons and healthcare systems alike are diligently studying the outcomes and complications associated with different surgical approaches. A recent observational study published in the Acta Orthopaedica journal has provided further insights into the incidence of reoperations due to dislocations in patients who have undergone THR using a contemporary posterior approach compared to a direct lateral approach.
Background and Purpose
Total hip replacement is a commonly performed orthopedic procedure that relieves pain and improves function in patients with hip osteoarthritis and other hip-related conditions. Among the various surgical approaches for THR, the posterior and direct lateral approaches are widely used. However, there is an ongoing debate regarding the risk of dislocation and need for reoperation associated with these approaches. The purpose of the observational study conducted by Skoogh et al. (2020) was to compare the incidence of reoperations due to dislocations between the contemporary posterior approach and the direct lateral approach for THR.
Patients and Methods
The observational study by Skoogh and colleagues leveraged the data from the Swedish Hip Arthroplasty Register. The study included 156,979 THR procedures where either the contemporary posterior or the direct lateral surgical approach was employed. The Kaplan-Meier method was used to estimate the cumulative incidence of reoperations, and the study analyzed various factors such as age, gender, femoral head size, and underlying diagnoses.
Results
Findings from the study indicated that the contemporary posterior approach had a higher incidence of reoperations due to dislocation when compared to the direct lateral approach. Dislocation is one of the most common complications after THR and often necessitates reoperation, which poses additional risks to patients and increases healthcare costs.
Interpretation
The study provided evidence that although the posterior approach is associated with benefits such as greater hip exposure and potentially quicker recovery times, it may also lead to an elevated risk of hip dislocation. These findings suggest that careful consideration should be given to the choice of surgical approach in THR, taking into account the patient’s specific risk profile for dislocation.
DOI: The Digital Object Identifier for the study is 10.1080/17453674.2019.1610269.
References
1. Berry, D. J., von Knoch, M., Schleck, C. D., & Harmsen, W. S. (2005). Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. Journal of Bone & Joint Surgery-America Volume, 87(11), 2456-2463. DOI: 10.2106/JBJS.D.02860
2. Enocson, A., Hedbeck, C. J., Tidermark, J., Pettersson, H., Ponzer, S., & Lapidus, L. J. (2009). Dislocation of total hip replacement in patients with fractures of the femoral neck. Acta Orthop, 80(2), 184-189. DOI: 10.1080/17453670902805020
3. Hailer, N. P., Weiss, R. J., Stark, A., & Kärrholm, J. (2012). The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis: an analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop, 83(5), 442-448. DOI: 10.3109/17453674.2012.733919
4. Jolles, B. M., & Bogoch, E. R. (2006). Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database of Systematic Reviews, (3), CD003828. DOI: 10.1002/14651858.CD003828.pub2
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Keywords
1. Total Hip Replacement Approaches
2. Hip Dislocation Risks
3. Posterior vs Lateral Approach THR
4. THR Reoperation Rates
5. Surgical Approach THR Outcomes