POSTERIOR APPROACH FOR TOTAL HIP ARTHROPLASTY: DOES IT INCREASE COMPLICATIONS?

Abstract

The optimum approach for Total Hip Arthroplasty is hotly debated. Many surgeons, especially the newly trained, have been wary of the posterior approach because of higher reported rates of dislocation.

We analysed 137 consecutive patients who underwent Primary Total Hip Replacement for Osteoarthritis during the first three years of practice of a newly appointed consultant with an interest in hip and knee arthroplasty. All surgeries were either performed by or under the direct supervision of the senior author. The posterior capsule and short external rotators were reattached to the Greater Trochanter as a routine.

Data was gathered prospectively by proforma for all the patients, one at the time of operation and one each at 3 months and 12 months from the surgery. 4 patients died due to causes unrelated to their arthroplasty (2.9%) and 6 patients (4.3%) were lost to follow up.

The patients were grouped into A, B and C depending on involvement of one hip, both hips and multiple joint diseases respectively and the patients were analysed for pain scores (1–6), function scores (1–6) and satisfaction levels (1–5) after the surgery. All the complications during and after surgery were noted, and special emphasis was laid on the incidence of dislocation, and factors contributing to it. The results were compared with the incidence reported in the literature for posterior and other approaches.

The results were gratifying and were comparable with major series of Total Hip Replacement via the posterior approach. Only one patient (0.7%) had a dislocation. This occurred during the index admission when the patient sat down on a ward toilet without a raised toilet seat. The hip was reduced under General Anaesthesia and he had no problem thereafter. 122 patients (96%) had no pain or minimal pain not limiting the activity after the surgery but 5 patients (4%), 3 from Group C had activity related pain or pain at rest. 93 patients (73%) were walking without a stick after surgery and 34 patients (27%) were using a stick for extra safety. 5 patients (4%) had superficial infection which settled with antibiotics and one patient (0.7%) had deep infection which required a Revision hip surgery. 6 patients developed Deep Vein Thrombosis (4.7%) and one patient (0.7%) had Pulmonary Embolism but all the patients returned to good function after treatment. One patient (0.7%) developed transient Sciatic nerve palsy but recovered completely.

We conclude that the posterior approach, already known to cause less blood loss and to allow optimum component positioning and alignment, is compatible with a low overall rate of early complications. Specifically, the dislocation rate is low and comparable with large series performed by approaches traditionally considered to carry a lower rate of dislocation.