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Total Hip Arthroplasty: A Comparison of Current Approaches

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Several approaches to the hip joint have been described. Five of them are regularly used for total hip arthroplasty (THA), others are seldom used for primary THA (e.g., Ganz trochanteric flip, medial Ludloff approach) or are only used for minimally-invasive surgery (2-incision approach) [1]. The fi ve approaches (Table 1) can be executed either mini-mally-invasively or conventionally, either supine or in lateral decubitus position.

The names for approaches are sometimes confusing. E.g. is the so called antero-lateral abductor split approach of Frndak et al. [8] or Mallory et al. [9] in the terminology used above a lateral approach?

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References

  1. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop 2003;417:232–241.

    PubMed  Google Scholar 

  2. Smith-Petersen, MN. A new supra-articular subperiosteal approach to the hip joint. Am J Orthop Surg 1917;15:592–595.

    Google Scholar 

  3. Watson-Jones R. Fracture of the neck of the femur. Br J Surg 1935;23:787–808.

    Article  Google Scholar 

  4. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br 1982;64-B:17–19.

    Google Scholar 

  5. Bauer R, Kerschbaumer F, Poisel S, Oberthaler W. The trans-gluteal approach to the hip joint. Arch Orthop Traumatol 1979;95:47–49.

    Article  CAS  Google Scholar 

  6. Charnley J. Low friction arthroplasty of the hip. Theory and practice. Berlin: Springer, 1979.

    Google Scholar 

  7. Moore AT. The self-locking metal hip prosthesis. J Bone Joint Surg Am 1957;39-A:811–827.

    PubMed  CAS  Google Scholar 

  8. Frndak PA, Mallory TH, Lombardi AV. Translateral surgical approach to the hip. The abductor muscle “split.” Clin Orthop Relat Res 1993;295:135–141.

    PubMed  Google Scholar 

  9. Mallory TH, Lombardi Jr AV, Fada RA, Herrington SM, Eberle RW. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res 1999;358:166–172.

    Article  PubMed  Google Scholar 

  10. Jolles BM, Bogoch ER. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev 2006;3:CD003828.

    Google Scholar 

  11. De Verteuil R, Imamura M, Zhu S, Glazener C, Frazer C, Munro N, Hutchinson J Grant A, Coyle D, Coyle K, Vale L. A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip. NIHR Health Technol Assess 2008;12:iii–iv, ix-223. DOI 10.3310/hta12260.

    Google Scholar 

  12. Hoppenfeld St, deBoer P. Surgical exposures in orthopaedics. The anatomic approach. Philadelphia: Lippincott, 1984.

    Google Scholar 

  13. Light TR, Keggi KJ. Anterior approach to hip arthroplasty. Clin Orthop Relat Res 1980;152:255–260.

    PubMed  Google Scholar 

  14. Kennon R, Keggi J, Zatorski LE, Keggi KJ. Anterior approach for total hip arthroplasty: Beyond the minimally invasive technique. J Bone Joint Surg Am 2004;86:91–97.

    PubMed  Google Scholar 

  15. Judet J, Judet H. Anterior approach in total hip arthroplasty. Presse Med 1985;14:1031–1033.

    PubMed  CAS  Google Scholar 

  16. Krismer M, Nogler M, Rachbauer F. Direct anterior single incision approach. In: Hozak WJ, Krismer M, Nogler M, Bonutti PM, Rachbauer F, Schaffer JL, Donnelly (eds.) Minimally invasive total joint arthroplasty. Heidelberg: Springer, 2004, pp 47–53.

    Google Scholar 

  17. Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 2005;441:115–124.

    Article  PubMed  Google Scholar 

  18. Rachbauer F. Minimal-invasive Hüftendoprothetik. Der vordere Zugang. Orthopäde 2006;35:723–724, 726–729.

    Article  PubMed  CAS  Google Scholar 

  19. Bertin KC, Röttinger H. Anterolateral mini-incision hip replacement surgery. A modifi ed Watson-Jones approach. Clin Orthop Relat Res 2004;428:248–255.

    Article  Google Scholar 

  20. Austin MS, Rothman RH. Acetabular orientation: Antero-lateral approach in the supine position. Clin Orthop Relat Res 2009;467:112–118.

    Article  PubMed  Google Scholar 

  21. De Beer J, Petruccelli D, Zalzal P, Winemaker MJ. Single-incision, minimally invasive total hip arthroplasty. Length doesn't matter. J Arthroplasty 2004;18:945–950.

    Google Scholar 

  22. Laffosse JM, Chiron P, Tricoire JL, Giordano G, Molinier F, Puget J. Prospective and comparative study on minimally invasive posterior approach versus standard posterior approach in total hip replacement. Rev Chir Orthop 2007;93: 228–237.

    PubMed  Google Scholar 

  23. O'Brien DAL, Rorabeck, CH. The mini-incision direct lateral approach in primary total hip arthroplasty. Clin Orthop Relat Res 2005;441:99–103.

    Article  PubMed  Google Scholar 

  24. Moed BR, McMichael JC. Outcomes of posterior wall fractures of the acetabulum. Surgical technique. J Bone Joint Surg Am 2008;90-A(suppl 2):87–107.

    Article  Google Scholar 

  25. Goldstein WM, Branson JJ, Berland KA, Gordon AC. Minimal-incision total hip arthroplasty. J Bone Joint Surg Am 2003;85-A(suppl):33–38.

    PubMed  Google Scholar 

  26. Rommens PM. The Kocher-Langenbeck approach for the treatment of acetabular fractures. Operat Orthop Traumatol 2004;16:59–74.

    Article  Google Scholar 

  27. Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res 1998;355:224–228.

    Article  PubMed  Google Scholar 

  28. Pilot P, Kerens B, Draijter WF, Kort NP, ten Kate J, Buurman WA, Kuipers H. Is minimally invasive surgery less invasive in total hip replacement? A pilot study. Injury 2006; 37S:S17–S23.

    Google Scholar 

  29. Wohlrab D, Droege JW, Mendel T, Brehme K, Riedl K, Leuchte S. Minimal-invasiver vs. transglutealer Hüftgelenkersatz. Orthopäde 2008;37:1121–1126. DOI 10.1007/ s00132-008-1343-0 E-publication.

    Google Scholar 

  30. Horwitz BR, Rockowitz NL, Goll SR, Booth Jr RE, Balderston RA, Rothman RH, Cohn JC. A prospective randomized comparison of two surgical approaches to total hip arthroplasty. Clin Orthop Relat Res 1993;291:154–163.

    PubMed  Google Scholar 

  31. Weale AE, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study. J Bone Joint Surg Br 1996;78-B:899–902.

    Article  Google Scholar 

  32. Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005;87-A:2619–2625.

    Article  Google Scholar 

  33. Dellon AL, Mont M, Ducic I. Involvement of the lateral femoral cutaneous nerve as source of persistent pain after total hip arthroplasty. J Arthroplasty 2008;23:480–485.

    Article  PubMed  Google Scholar 

  34. Ince A, Kemper M, Waschke J, Hendrich Christian. Minimally invasive anterolateral approach to the hip. Risk to the superior gluteal nerve. Acta Orthop 2007;78:86–89.

    Google Scholar 

  35. Baker AS, Bitounis VC. Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Joint Surg 1989;71-B:47–50.

    Google Scholar 

  36. Ikeuchi M, Kawakami T, Yamanaka N, Okanoue Y, Tani T. Safe zone for the superior gluteal nerve in the transgluteal approach to the dysplastic hip. Intraoperative evaluation using a nerve stimulator. Acta Orthop 2006;77:603–606.

    Google Scholar 

  37. Eksioglu F, Uslu M, Gudemez E, Sahap Atik O, Tekdemir I. Reliability of the safe area for the superior gluteal nerve. Clin Orthop Relat Res 2003;412:111–116.

    Article  PubMed  Google Scholar 

  38. Ling ZX, Kumar VP. The course of the inferior gluteal nerve in the posterior approach to the hip. J Bone Joint Surg Br 2006;88-B:1580–1583.

    Article  Google Scholar 

  39. Picado CHF, Garcia FL, Marques W. Damage to the superior gluteal nerve after direct lateral approach to the hip. Clin Orthop Relat Res 2006;455:209–211.

    Article  Google Scholar 

  40. Stähelin T. Abduktorennahtversagen und Nervenschädigung beim transglutealen Zugang zur Hüfte. Gründe und Lösungsansätze für einen weniger invasiven Gelenksersatz. Orthopade 2006;35:1215–1224.

    Article  PubMed  Google Scholar 

  41. Dall D. Exposure of the hip by anterior osteotomy of the greater trochanter. A modifi ed anterolateral approach. J Bone Joint Surg Am 1962;44-A:1047–1460.

    Google Scholar 

  42. Barber TC, Roger DJ, Goodman SB, Schurman DJ. Early outcome of total hip arthroplasty using the direct lateral vs. the posterior surgical approach. Orthopedics 1996;19:873–875.

    CAS  Google Scholar 

  43. Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res 2002;405:46–53.

    Article  PubMed  Google Scholar 

  44. Moskal JT, Mann III JW. A modifi ed direct lateral approach for primary and revision total hip arthroplasty. A prospective analysis of 453 cases. J Arthroplasty 1996;11:255–266.

    CAS  Google Scholar 

  45. Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB. A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res 2001;385: 95–99.

    Article  PubMed  Google Scholar 

  46. Madsen MS, Ritter MA, Morris HH, Meding JB, Berend ME, Faris PM, Vardaxis VG. The effect of total hip arthroplasty surgical approach on gait. J Orthop Res 2004;22:44–50.

    Article  PubMed  Google Scholar 

  47. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination fi ndings in patients with greater trochanteric pain syndrome. Arthritis Rheum 2001;44:2138–2145.

    Article  PubMed  CAS  Google Scholar 

  48. Iorio R, Healy WL, Warren PD, Appleby D. Lateral trochan-teric pain following primary total hip arthroplasty. J Arthroplasty 2006;21:233–236.

    Article  PubMed  Google Scholar 

  49. Weber M, Ganz R. Der vordere Zugang zu Becken und Hüftgelenk. Operat Orthop Traumotol 2002;10:245–257.

    Article  Google Scholar 

  50. Reinert CM, Bosse MJ, Poka A, Schacherer T, Brumback MJ, Burgess AR. A modifi ed extensile exposure for the treatment of complex or malunited acetabular fractures J. Bone Joint Surg Am 1988;70-A:329–337.

    Google Scholar 

  51. Swedish Hip Arthroplasty Register. Annual Report 2006. http://www.jru.orthop.gu.se.

  52. Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, Baron JA, Harris WH, Poss R, Katz JN. Incidence rates of dislocation, pulmonary embolism, and deep infection during the fi rst six months after elective total hip replacement. J Bone Joint Surg Am 2003;85-A:20–26.

    PubMed  Google Scholar 

  53. Berry DJ, von Knoch M, Schleck CD, Harmsen WC. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 2004;86-A:9–14.

    PubMed  Google Scholar 

  54. Von Knoch M, Berry DJ, Harmsen WS, Morrey BF. Late dislocation after total hip arthroplasty. J Bone Joint Surg Am 2002;84-A:1949–1953.

    Google Scholar 

  55. Arthursson AJ, Furnes O, Espehaug B, Havelin LI, Söreide JA. Prosthesis survival after total hip arthroplasty — does surgical approach matter? Analysis of 19,304 Charnley and 6,002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register. Acta Orthop 2007;78: 719–729.

    Article  PubMed  Google Scholar 

  56. Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D. The transverse acetabular ligament. An aid to orientation of the acetabular component during primary total hip replacement. A preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 2006;88-B:883–886.

    Google Scholar 

  57. Siguier T, Siguier M, Brumpt B. Mini-incision anterior approach does not increase dislocation rate. A study of 1037 total hip replacements. Clin Orthop Relat Res 2004;426: 164–173.

    Article  Google Scholar 

  58. Vicar AJ, Coleman CR. A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty. Clin Orthop Relat Res 1984;188: 152–159.

    PubMed  Google Scholar 

  59. Woo RYG, Morrey BF. Dislocations after total hip arthro-plasty. J Bone Joint Surg Am 1982;64-A:1295–1306.

    Google Scholar 

  60. Downing ND, Clark DI, Hutchinson JW, Colclough K, Howard PW. Hip abductor strength following total hip arthroplasty — A prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 2001;72:215–220.

    Article  PubMed  CAS  Google Scholar 

  61. Demos HA, Rorabeck CH, Bourne RB, MacDonald SJ, McCalden RW. Instability in primary total hip arthroplasty with the direct lateral approach. Clin Orthop Relat Res 2001; 393:168–180.

    Article  PubMed  Google Scholar 

  62. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after total hip arthroplasty. The effect of orientation of the acetabular component. J Bone Joint Surg Br 2005;87-B:762–769.

    Google Scholar 

  63. Peak EL, Parvizi J, Ciminiello M, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. J Bone Joint Surg Am 2005;87-A:247–253.

    Article  Google Scholar 

  64. Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty: A multivari-ate analysis. J Arthroplasty 2002;17:282–288.

    Article  PubMed  CAS  Google Scholar 

  65. Iagulli ND, Mallory TH, Berend KR, Lombardi AV Jr, Russell JH, Adams JB, Groseth KL. A simple and accurate method for determining leg length in primary total hip arthroplasty. Am J Orthop 2006;35:455–457.

    PubMed  Google Scholar 

  66. Maloney WJ, Keeney JA. Leg length discrepancy after total hip arthroplasty. J Arthroplasty 2004;19:108–110.

    Article  PubMed  Google Scholar 

  67. Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Patients preferred a mini-posterior THA to a contralateral two-incision THA. Clin Orthop Relat Res 2006;453:156–159.

    Article  PubMed  Google Scholar 

  68. Charles MN, Fejbel RJ, Kim P. Minimally invasive surgery of the hip — a randomized pilot study. Annual Meeting of the Canadian Orthopaedic Association, Toronto, June 2006. Poster 88. (Citation and data from De Verteuil R et al. NIHR Health Technol Assess 2008).

    Google Scholar 

  69. Asayama I, Kinsey TL, Mahoney OM. Two-year experience using a limited-incision direct lateral approach in total hip arthroplasty. J Arthroplasty 2006;429:232–238.

    Google Scholar 

  70. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O'Brien S, Beverland D. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am 2005;87-A:701–710.

    Article  Google Scholar 

  71. Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP. Minimally invasive total hip arthroplasty: A prospective randomized study. J Arthroplasty 2005;20:139–144.

    Article  PubMed  Google Scholar 

  72. Chung WK, Liu D, Foo LS. Mini-incision total hip replacement — surgical technique and early results. J Orthop Surgery 2004;12:19–24.

    CAS  Google Scholar 

  73. Kim YH. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique. A prospective and randomized study. J Arthroplasty 2006;21:1092–1098.

    Google Scholar 

  74. Ciminello M, Parvizi J, Sharkey PF, Eslampour A, Rothman RH. Total hip arthroplasty: Is small incision better? J Arthroplasty 2006;21:484–488.

    Article  Google Scholar 

  75. Di Gioia AM III, Plakseychuk AY, Levison TJ, Jaramaz B. Mini-incision technique for total hip arthroplasty with navigation. J Arthroplasty 2003;18:945–950.

    Google Scholar 

  76. Mow CS, Woolson ST, Ngarmukos SG, Park EH, Lorenz HP. Comparison of scars from total hip replacements done with a standard or a mini-incision. Clin Orthop Relat Res 2005;441:80–85.

    Article  PubMed  Google Scholar 

  77. Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE. Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. J Bone Joint Surg Am 2007;89-A:1153–1160.

    Article  Google Scholar 

  78. Wright JM, Crockett HC, Delgado S, Lyman S, Madsen M, Sculco TP. Mini-incision for total hip arthroplasty: A prospective controlled investigation with 5-year follow-up evaluation. J Arthroplasty 2004;19:538–545.

    Article  PubMed  Google Scholar 

  79. Zhang XL, Wang Q, Jiang Y, Zeng BF. Minimally invasive total hip arthroplasty with anterior incision. Chung Hua Ko Tsa Chih 2006;44:512–515.

    Google Scholar 

  80. Duwelius PJ, Burkhart RL, Hayhurst JO, Moller H, Butler JB. Comparison of the 2-incision and mini-posterior total hip arthroplasty technique. J Arthroplasty 2007:22:48–56.

    Article  PubMed  Google Scholar 

  81. Tanavalee A, Jaruwannapong S, Yuktanandana P, Itiravivong P. Early outcomes following minimally invasive total hip arthroplasty using a two-incision approach versus mini-posterior approach. Hip Int 2006;16:S17–S22.

    Google Scholar 

  82. Wennberg JE. Dealing with medical practise variations: A proposal for action. Health Aff 1984;3:6–32.

    Article  CAS  Google Scholar 

  83. Norwegian Arthroplasty Register 2006. http://info.hauke-land.no/nrl/

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Krismer, M. (2009). Total Hip Arthroplasty: A Comparison of Current Approaches. In: Bentley, G. (eds) European Instructional Lectures. European Federation of National Associations of Orthopaedics and Traumatology, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-00966-2_17

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