The direct anterior versus postero-lateral approach in total hip arthroplasty: Clinical and radiological outcomes

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Published Feb 1, 2025
https://doi.org/10.62438/tunismed.v103i2.5416
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Vol. 103 No. 2 (2025): Tunis Med Feb 2025

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Khalil Fendri
Department of Orthopaedic Surgery and Traumatology, Trauma Centre, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia
Mohamed Amine Selmene
Department of Orthopaedic Surgery and Traumatology, Trauma Centre, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia
Houssem Eddine Kraiem
Department of Orthopaedic Surgery and Traumatology, Trauma Centre, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia
Malek Bachar
Department of Orthopaedic Surgery and Traumatology, Trauma Centre, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia
Mourad Zaraa
Department of Orthopaedic Surgery and Traumatology, Trauma Centre, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia
Wael Chebbi
Department of Orthopaedic Surgery and Traumatology, Trauma Centre, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia

Abstract

Introduction: Total hip arthroplasty (THA)  is an  effective surgical procedure.  Several surgical approaches have been described.


Aim: To compare postero-lateral and anterior approaches in terms of postoperative care, functional and radiological outcomes in patients undergoing primary THA surgery.


Methods: Patients undergoing primary THA were included in a retrospective descriptive study and divided into two groups according to surgical approach: anterior approach (AA) and postero-lateral approach (PLA). We compared demographic, perioperative data and functional outcome at 6 weeks and 6 months postoperatively according to Postel Merle d'Aubigné (PMA) and Harris (HHS) scores, radiological positioning of implants and postoperative complications.


Results: Each group comprised 100 patients. In the AA group, operative time was shorter, patients had less pain, less bleeding and a shorter hospital stay, better PMA and Harris scores at six weeks post-operatively, with no difference at six months, better positioning of the acetabular cup, undersizing of the femoral stem and more iatrogenic fractures of the proximal femur. Patients in the PLA group had fewer skin and nerve complications and more prosthetic instability.


Conclusion : Current data do not demonstrate superiority of one approach over another in primary THA. We recommend the choice of surgical approach according to the patient's characteristics and surgeons’ convictions.

Keywords:

Hip, Coxopathy, Total hip arthroplasty, Surgical approach, Anterior approach, Posterol-ateral approach

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