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. When considering the method of hip dislocation for hip replacement, several factors come into play, including surgical technique, postoperative pain management, and patient outcomes. According to a systematic review and meta-analysis published in 2021 1, the direct anterior surgical approach was found to be associated with less postoperative pain than the posterolateral approach, although it was also associated with a longer duration of surgery. Some key points to consider when evaluating the different approaches include:
- The direct anterior surgical 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 1.
- The posterolateral approach, on the other hand, may be associated with higher pain scores and a higher risk of dislocation 1.
- Minimally invasive operative approaches have also been studied, but the evidence is inconclusive, with some studies showing improved postoperative pain outcomes and others showing no difference or increased risk of surgical complications 1.
- Ultimately, the choice of approach depends on surgeon and patient preference, as well as individual patient anatomy and specific surgical goals. However, based on the most recent and highest quality evidence, the direct anterior surgical approach is the recommended method for hip dislocation during total hip replacement surgery.
From the Research
Methods of Hip Dislocation for Hip Replacement
- The direct anterior approach (DAA) and posterior approach are two common methods used in total hip arthroplasty (THA) 2, 3, 4, 5, 6.
- A study published in 2020 found that the DAA had a lower risk of dislocation and revision for instability compared to the posterior approach, but a higher risk of revision for aseptic loosening 2.
- Another study published in 2016 found that the transition from a posterior approach to a DAA can be achieved without harming patient safety, with no significant differences in 30-day readmission rates, 90-day readmission rates, complication rate, or revision rate 3.
- A systematic review and meta-analysis published in 2021 found that the posterior approach was associated with shorter operative time, while the anterior approach was associated with shorter length of hospital stay and greater earlier improvement in functional outcomes up to six months from the procedure 6.
- A survey of orthopedic surgeons published in 2013 found that the posterior approach was the most commonly used approach, followed by the direct lateral approach, and then the anterior approach 5.
Comparison of Surgical Approaches
- The DAA has been shown to have a lower risk of dislocation and revision for instability compared to the posterior approach 2.
- The posterior approach has been shown to have a shorter operative time compared to the DAA 6.
- The DAA has been shown to have a shorter length of hospital stay and greater earlier improvement in functional outcomes up to six months from the procedure compared to the posterior approach 6.
Outcomes and Complications
- The risk of dislocation and revision for instability is lower with the DAA compared to the posterior approach 2.
- The risk of revision for aseptic loosening is higher with the DAA compared to the posterior approach 2.
- The posterior approach has been shown to have a shorter operative time, but the DAA has been shown to have a shorter length of hospital stay and greater earlier improvement in functional outcomes up to six months from the procedure 6.