Details
Category: Volume 07 Issue 01 January 2019
Hits: 1229

Title: Total Hip Arthroplasthy: Comparison of Lateral and Posterior Approach

Authors: Dr M. Sudhir, Dr M.Chandrashekar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.92

Abstract

 

The primary goal of total hip arthroplasthy is to improve pain and function. This study was conducted at department of orthopaedics, Kamineni academy of medical sciences and research centre, Hyderabad during January to December 2017 after obtaining permission from hospital ethics committee. This study includes 30 patients which were divided into lateral and posterior approach groups each consist of 15 members. The mean age was 55 years. It includes 17 males and13 females. The duration of surgery in lateral and posterior approaches were 128 and 95 minutes respectively. functional outcome  were assessed  postoperatively in both the lateral surgical approach group patients and  posterior  surgical  approach  group  patients  using  the  Harris  Hip  Score  system to evaluate pain and function. The significant improvement was appreciated in the posterior group when compared to lateral group. Trendelenburg test was assessed preoperatively and postoperatively. Although, there is more improvement in the posterior group than the lateral, the p value was not significant. Electrophysiologial study was normal both preoperatively and postoperatively in both groups and hence not significant. The  mean  Rivermed  gait  score  in  posterior approach group were 2.70 and mean Rivermed gait score in lateral approach grop were 3.0.There is better  improvement  of  gait  in  posterior  approach  group  than  the  lateral  approach  group. Horizontal  and  vertical  femoral  offset  ratio  were evaluated  postoperatively,  in  both  lateral  surgical  approach  group  patients  and  posterior  surgical  approach  group  patients  using  the  radiography which was comparable in both groups. Post operative complications like posterior dislocation of hip was observed in one case of posterior approach and Trendelenburg positive score was observed in 4 cases of lateral approach.  This study concludes that both were found to be good and any of them can be selected for the total hip arthroplasthy.

Keywords: Total hip arthroplasthy, lateral approach, posterior approach, Harris Hip  Score, Trendelenburg test .

References

  1. Ring PA, Complete replacement arthroplasty of the hip by the ring prosthesis. J Bone Joint Surg Br 1968;50: 720-31.
  2. Learmonth I, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–19. 
  3. Chang R, Pellissier J, Hazen G. A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996;275:858–65. 
  4. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–9. 
  5. Pospischill M, Kranzl A, Attwenger B, et al. Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. J Bone Joint Surg Am. 2010;92:328–37
  6. Rathod P, Orishimo K, Kremenic I, et al. Similar improvement in gait parameters following direct anterior and posterior approach total hip arthroplasty. J Arthroplasty. 2014;29:1261–4. 
  7. Frndak PA, Mallory TH, Lombardi Jr AV: Translateral surgical approach to the hip. The abductor muscle “split”. Clin Orthop 95:135–141, 1993
  8. Moore AT. In: American Academy of Orthopaedic Surgeons editor (s). Instructional Course Lectures. Vol. 16, St Louis: CVMosby, 1959.
  9. Harris WH. Traumatic arthritis of the hip after dislocation andacetabular fractures: treatment by Mold arthroplasty. An endresult study using a newmethod of result evaluation. J Bone Joint Surg [Am] 1969;51-A:737–55.
  10. Pai VS :Significance of the Trendelenburg test in total hip arthroplasty. Influence of lateral approaches.J Arthroplasty.1996 Feb;11(2):174-9.
  11. Lord S.E, Halligan P.W, Wade D.T: Visual gait analysis:the development of a clinical assessment and scale.Clin Rehabil 1998; 12;107
  12. Hoppenfeld S, DeBoer  P,  Buckley    Surgical  exposures  in  orthopaedics:  the  anatomic  approach. Philidelphia,  PA:  Lippincott  Williams and Wilkins;2009
  13. Kwon MS, Kuskowski M, Mulhall K, et al. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res.2006;447:34
  14. Learmonth ID, Allen PE. The Omega Lateral Approach to thehip .J Bone Joint Surg [Br] 1996;78-B:559-61.
  15. Muller ME. Total Hip replacement: Planning Technique andComplications In: Surgical Management of Degenerative arthritis of the Lower Limb. Heidelberg: Lea and Febiger; 1975,p. 91
  16. Baker AS, Bitounis VC. Abductor function after total hip replacement .An electromyographic and clinical review. J Bone Joint Surg 1989;71- B:47-50.
  17. Gore DR, Murray SP, Sepic SB, Gardner GM: Anterolateral compared to posterior approach in total hip arthroplasty: Difference in component positioning, hip strength, and hipmotion. Clin Orthop 165:180–187, 1982
  18. 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;19:873–5.
  19. Downing ND, Clark DI, Hutchinson JW, Colclough K, Howard PW. Hip abductor strength following total hip arthroplasty - Aprospective comparison of the posterior and lateral approach in100 patients. Acta Orthop Scand 2001;72:215–20.
  20. Zimmera, W. G. Hawkes, J. I. Hudson et al, “Outcomes of surgical management in patients aged 65 years and older: cemented versus cementless femoral compoments and lateral or anterolateral versus posterior anatomical approach,” J. Orthop. Res, vol. 20(2), pp. 182- 191,2002

Corresponding Author

Dr M. Chandrashekar

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no: 94918 17769