Comparative study on differences in acetabular position during total hip arthroplasty between by direct anterior approach and by posterolateral approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yu , SANG Weilin , JIANG Yafei ,  MA Jinzhong

Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, P.R.China;

Corresponding author：

MA Jinzhong, Email: majinzhong007@sina.com

Keywords：

Total hip arthroplasty; direct anterior approach; posterolateral approach; acetabular position

DOI：

10.7507/1002-1892.201701036

Video：

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Objective To compare the differences in acetabular position during total hip arthroplasty (THA) between by direct anterior approach and by posterolateral approach. Methods Between December 2008 and December 2015, 102 patients undergoing THA were included in the study. THA was performed by anterior approach in 51 cases (anterior group) and by posterolateral approach in 51 cases (posterolateral group). There was no significant difference in gender, age, body mass index, side, and cause of illness between 2 groups (P>0.05), with comparability. The acetabular abduction angle and anteversion angel were measured on the X-ray film at 1 day after operation to evaluate whether the acetabular prosthesis was displaced in the safe zone. Results The acetabular abduction angle was (42.28±5.77)° in the anterior group and was (43.93±7.44)° in the posterolateral group, showing no significant difference (t=1.30, P=0.19). The acetabular anteversion angle was (21.14±5.17)° in the anterior group and was (21.05±4.10)° in the posterolateral group, showing no significant difference (t=0.05, P=0.96). The ratio in the target safe zone of the acetabular abduction angle in the anterior group and the posterolateral group were 88.2% (45/51) and 84.3% (43/51) respectively, showing no significant difference (χ²=0.33, P=0.56). The ratio in the target safe zone of the acetabular anteversion was 80.4% (41/51) in the anterior group and was 82.4% (42/51) in the posterolateral group, showing no significant difference between 2 groups (χ²=0.06, P=0.79). The ratio in the target safe zone of both the abduction and anteversion angel was 70.6% (36/51) in the anterior group and was 68.6% (35/51) in the posterolateral group, showing no significant difference (χ²=0.05, P=0.82). Conclusion There is no differences in the acetabulum position during THA between by direct anterior approach and posterolateral approach.

Citation： LIU Yu, SANG Weilin, JIANG Yafei, MA Jinzhong. Comparative study on differences in acetabular position during total hip arthroplasty between by direct anterior approach and by posterolateral approach. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 790-793. doi: 10.7507/1002-1892.201701036 Copy

1.	Restrepo C, Parvizi J, Pour AE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty, 2010, 25(5): 671-9.e1.
2.	Bertin KC, Röttinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res, 2004, (429): 248-255.
3.	Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach. Clin Orthop Relat Res, 2014, 472(2): 455-463.
4.	Agten CA, Sutter R, Dora C, et al. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol, 2017, 27(3): 1312-1321.
5.	Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg (Am), 2011, 93(15): 1392-1398.
6.	York PJ, Smarck CT, Judet T, et al. Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop, 2016, 40(10): 2041-2048.
7.	Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. J Arthroplasty, 2015, 30(9 Suppl): 94-97.
8.	de Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res, 2015, 473(12): 3860-3866.
9.	Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop, 2012, 83(4): 342-346.
10.	Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res, 2011, 469(2): 319-329.
11.	Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg, 2004, 12(5): 314-321.
12.	Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty, 2004, 19(3): 387-390.
13.	Lewinnek GE, Lewis JL, Tarr R, Compere CL, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
14.	张江涛, 尚延春, 吴富源, 等. 髋关节假体置换中股骨头直径及髋臼前倾角的作用. 中国组织工程研究, 2013, 17(30): 5427-5433.
15.	Nam D, Sculco PK, Su EP, et al. Acetabular component positioning in primary THA via an anterior, posterolateral, or posterolateral-navigated surgical technique. Orthopedics, 2013, 36(12): e1482-e1487.
16.	Bremer AK, Kalberer F, Pfirrmann CW, et al. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg (Br), 2011, 93(7): 886-889.
17.	Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.

1. Restrepo C, Parvizi J, Pour AE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty, 2010, 25(5): 671-9.e1.
2. Bertin KC, Röttinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res, 2004, (429): 248-255.
3. Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach. Clin Orthop Relat Res, 2014, 472(2): 455-463.
4. Agten CA, Sutter R, Dora C, et al. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol, 2017, 27(3): 1312-1321.
5. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg (Am), 2011, 93(15): 1392-1398.
6. York PJ, Smarck CT, Judet T, et al. Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop, 2016, 40(10): 2041-2048.
7. Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. J Arthroplasty, 2015, 30(9 Suppl): 94-97.
8. de Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res, 2015, 473(12): 3860-3866.
9. Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop, 2012, 83(4): 342-346.
10. Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res, 2011, 469(2): 319-329.
11. Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg, 2004, 12(5): 314-321.
12. Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty, 2004, 19(3): 387-390.
13. Lewinnek GE, Lewis JL, Tarr R, Compere CL, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
14. 张江涛, 尚延春, 吴富源, 等. 髋关节假体置换中股骨头直径及髋臼前倾角的作用. 中国组织工程研究, 2013, 17(30): 5427-5433.
15. Nam D, Sculco PK, Su EP, et al. Acetabular component positioning in primary THA via an anterior, posterolateral, or posterolateral-navigated surgical technique. Orthopedics, 2013, 36(12): e1482-e1487.
16. Bremer AK, Kalberer F, Pfirrmann CW, et al. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg (Br), 2011, 93(7): 886-889.
17. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on differences in acetabular position during total hip arthroplasty between by direct anterior approach and by posterolateral approach

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