Posterolateral Surgical Approach Compared With Modified Lateral Approach

Seoul National University

Status: Completed

Conditions: Arthroplasty, Replacement, Hip

Treatments: Procedure: surgical approach; Procedure: modified lateral approach

Study type: Interventional

Funder types: Other

Identifiers

NCT00936949

SNU 03-01

Details and patient eligibility

About

It has been reported that the operative approaches have an effect on clinical outcome in total hip arthroplasty. The purpose of this prospective study was to compare clinical and radiological outcomes between anterolateral approach and posterolateral approach in total hip arthroplasty.

Full description

Total hip arthroplasty is one of the most successful orthopaedic procedures for relieving pain and improving quality of life. But dislocation remains the leading early complication after total hip arthroplasty with a reported frequency between 0.4% and 11%. There are several risk factors of dislocation after total hip arthroplasty including patients, implants and surgical approaches. Among lots of risk factors, surgical approach has been debated as one of the important key factor influencing dislocation and abductor function. Direct lateral or posterolateral surgical approach is most commonly used in the total hip arthroplasty. The modified lateral approaches generally are thought to have lower dislocation rates and allow excellent acetabular exposure although limping is increased. The posterolateral approach may allow maintenance of abductor strength but it generally results in a higher dislocation rate. However, there are several reports that the posterolateral approach with capsular repair might be reduced dislocation rate.

We hypothesize the dislocation rate for the posterolateral approach with capsular repair is similar to modified lateral approaches for total hip arthroplasty. A prospective, randomized-controlled study was to examine the null hypothesis that the dislocation rate for the posterior approach with capsular repair was similar to modified lateral approaches for total hip arthroplasty at up to 2 year followup. We attempted to determine whether there was a difference in surgical parameters, component positioning, and clinical results of the modified lateral approach compared with the posterolateral approach.

Enrollment: 196 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• osteonecrosis
• primary or secondary osteoarthritis of the hips
• femoral neck fracture.

Exclusion criteria

• Patients with previous hemi- or total hip arthroplasty
• highly dislocated or severe ankylosed hip
• patients who are considered potentially unreliable or who may not reliably attend study visits

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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196 participants in 2 patient groups

posterolateral approach

Active Comparator group

Description:

The posterolateral approach was described by many authors, but all share a common muscular interval in reference to the gluteus medius tendon. Using a gluteus maximus split, the posterolateral approach remains posterior to the gluteus medius and minimus. Exposure of the hip and proximal femur requires division of the posterior hip capsule and the external rotators. The exposure and dislocation are completed with flexion and internal rotation of the femur. After arthroplasty, the external rotators and posterior capsule was routinely repaired using a heavy absorbable suture.

Treatment:

Procedure: surgical approach

modified lateral approach

Active Comparator group

Description:

The operative technique described modified lateral approach as described by Mulliken et al.

Treatment:

Procedure: modified lateral approach