From the Guidelines
The direct anterior surgical approach is recommended for hip replacement surgery due to its association with less postoperative pain compared to the posterolateral approach, as shown in a meta-analysis by Wang et al. 1. When considering the method of hip dislocation for hip replacement, several factors come into play, including the surgical approach, patient anatomy, and surgeon experience.
- The direct anterior approach has been shown to result in lower pain scores on the first postoperative day, with a difference of less than 10-mm on the VAS, compared to the posterolateral approach 1.
- However, it is also associated with a longer duration of surgery and potentially higher surgical complications, as seen in the study by Putananon et al. 1.
- The minimally invasive operative approach has been supported by some studies to improve postoperative pain outcomes, but it also carries a higher risk of iatrogenic nerve damage, as shown in a meta-analysis of 2849 patients 1.
- Ultimately, the choice of dislocation method should depend on a balance of these factors, prioritizing the patient's quality of life and minimizing morbidity and mortality.
- Proper soft tissue repair during closure is essential to minimize dislocation risk, regardless of the approach used, and surgeons should position the leg in specific ways during the procedure to facilitate dislocation while protecting surrounding neurovascular structures.
From the Research
Methods of Hip Dislocation for Hip Replacement
- The posterior approach, direct lateral approach, and direct anterior approach are the most common surgical approaches used for total hip arthroplasty (THA) 2.
- Each approach has its own unique advantages and disadvantages, but all can be safely and successfully utilized for THA 2.
- The direct anterior approach (DAA) has been associated with a lower risk of dislocation and revision for instability compared to the posterior approach 3.
- However, the DAA has also been associated with a higher risk of revision for aseptic loosening compared to the posterior approach 3.
- The posterolateral approach has been shown to be a safe and effective method for THA, with a lower incidence of perioperative complications compared to other mini-incision approaches 4.
- A retrospective study comparing the prognosis of patients with primary THA receiving the DAA or posterior approach found similar long-term rates of success for both approaches 5.
- A survey of orthopedic surgeons from 57 countries found that the posterior approach was the most commonly used approach, followed by the direct lateral approach and the anterior approach 6.
Comparison of Surgical Approaches
- The posterior approach and direct anterior approach have been compared in several studies, with mixed results 3, 5.
- The direct anterior approach has been associated with a lower risk of dislocation and revision for instability, but a higher risk of revision for aseptic loosening 3.
- The posterolateral approach has been shown to be a safe and effective method for THA, with a lower incidence of perioperative complications compared to other mini-incision approaches 4.
- The choice of surgical approach ultimately depends on the surgeon's preference and experience, as well as the individual patient's needs and circumstances 2, 4, 6.
Outcomes and Complications
- The outcomes and complications of THA can vary depending on the surgical approach used 3, 4, 5.
- The direct anterior approach has been associated with a lower risk of dislocation and revision for instability, but a higher risk of revision for aseptic loosening 3.
- The posterolateral approach has been shown to be a safe and effective method for THA, with a lower incidence of perioperative complications compared to other mini-incision approaches 4.
- The posterior approach has been associated with an increased risk of postoperative dislocations, but this risk can be mitigated with routine repair of the external rotators and capsule 4.