Anterior vs Posterior Approach in THA

Montreal Sacred Heart Hospital

Status: Completed

Conditions: Total Hip Arthroplasty

Treatments: Procedure: Total hip arthroplasty

Study type: Interventional

Funder types: Other

Identifiers

NCT03673514

CÉR : 2009-09-67 2010-415;

Details and patient eligibility

About

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.

Full 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.

Enrollment: 50 patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• primary total hip replacement due to osteoarthrosis or osteonecrosis
• patients older than 50 years.

Exclusion criteria

• 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.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups

THA Posterior Approach

Active Comparator group

Description:

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.

Treatment:

Procedure: Total hip arthroplasty

THA Direct anterior approach

Active Comparator group

Description:

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.

Treatment:

Procedure: Total hip arthroplasty