Abstract
Introduction
Total hip arthroplasty (THA) is undertaken to relieve pain and to restore mobility. The orthopaedic community remains divided on the influence of surgical approach in achieving functional recovery most quickly and effectively. We report a study comparing THA performed through a posterior (Posterior) against anterior approach (Heuter).
Methods
Fifty patients were prospectively enrolled and randomized for Posterior or Heuter procedures. Informed patient consent and local ethics approval was obtained. All patients received an uncemented, ceramic-on-ceramic prosthesis performed by a single surgeon.
Functional outcome was assessed by time to achieve milestones of walking, stair climbing, hip movement and balance. Kinematic data on level-ground walking and the effect of fatigue was assessed using a portable gait analysis system at 6-, 12-, and 24-weeks post-operatively.
Results
The Heuter group showed significantly quicker balance control, on average 10 days earlier, than the posterior group (p< 0.05). The achievement of the other milestones of independent and distance walking, stair climbing and hip movement also showed quicker recovery overall in the Heuter group; this was, however, not statistically significant (p>0.05).
Kinematic data suggested that there were no statistical differences in stance phase stability (p=0.73) or pulling acceleration (p=0.77) between the 2 groups at each time point. Fatigue, effected via timed, gentle mobilisation on a treadmill, also did not significantly result in a difference.
Discussion
The Heuter approach is rarely used in the UK, although its recent resurgence can be attributed to its perceived theoretical benefit of sparing muscle; this contrasts with the detachment of muscle required for the Posterior approach. Our experience show that the Heuter approach does not compromise the quality of gait, and it offers advantages in the rate of functional recovery, especially that of balance control.
