Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial

Abstract

Background:

There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA).

Methods:

A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups.

Results:

Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance (p < 0.05) and there was no difference in HHS (p < 0.05) at the 6- and 12-months follow-up evaluations.

Conclusion:

Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm.

Trial registration number:

ClinicalTrials.gov NCT04640740 (retrospectively registered).

Keywords

Anterolateral approach isokinetic test abductor strength total hip arthroplasty

Get full access to this article

View all access options for this article.

References

Edmunds

Boscainos

. Effect of surgical approach for total hip replacement on hip function using Harris Hip scores and Trendelenburg’s test. A retrospective analysis. Surgeon 2011; 9: 124–129.

Husby

Helgerud

Bjørgen

, et al. Early maximal strength training is an efficient treatment for patients operated with total hip arthroplasty. Arch Phys Med Rehabil 2009; 90: 1658–1667.

Palan

Beard

Murray

, et al. Which approach for total hip arthroplasty: anterolateral or posterior? Clin Orthop Relat Res 2009; 467: 473–477.

Jolles

Bogoch

. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev 2006; 3: CD003828.

Mulliken

Rorabeck

Bourne

, et al. A modified direct lateral approach in total hip arthroplasty: a comprehensive review. J Arthroplasty 1998; 13: 737–747.

Smith

Wylde

Berstock

, et al. Surgical approach and patient-reported outcomes after total hip replacement. Hip Int 2012; 22: 355–361.

Masonis

Bourne

. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res 2002; 405: 46–53.

Iorio

Healy

Warren

, et al. Lateral trochanteric pain following primary total hip arthroplasty. J Arthroplasty 2006; 21: 233–236.

Havelin

Fenstad

Salomonsson

, et al. The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop 2009; 80: 393–401.

10.

Hailer

Weiss

Stark

, et al. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop 2012; 83: 442–448.

11.

Kärrholm

Rogmark

Naucler

, et al. The Swedish Hip Arthroplasty Register Annual Report 2018. 2018. DOI: 10.18158/HkqHN6sL8.

12.

Spaans

van den Hout

Bolder

. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 2012; 83: 342–346.

13.

Poehling-Monaghan

Kamath

Taunton

, et al. Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results. Clin Orthop Relat Res 2015; 473: 623–631.

14.

Chechik

Khashan

Lador

, et al. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg 2013; 133: 1595–1600.

15.

Amlie

Havelin

Furnes

, et al. Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1,476 patients 1-3 years after surgery. Acta Orthop 2014; 85: 463–469.

16.

Berstock

Blom

Beswick

. A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty. Ann R Coll Surg Engl 2015; 97: 11–16.

17.

Jelsma

Pijnenburg

Boons

, et al. Limited benefits of the direct anterior approach in primary hip arthroplasty: a prospective single centre cohort study. J Orthop 2017; 14: 53–58.

18.

Carlson

Robinson

Jr . Surgical approaches for primary total hip arthroplasty. A prospective comparison of the Marcy modification of the Gibson and Watson-Jones approaches. Clin Orthop Relat Res 1987; 222: 161–166.

19.

Gibson

. Posterior exposure of the hip joint. J Bone Joint Surg Br 1950; 32-B: 183–186.

20.

Moyer

Lanting

Marsh

, et al. Postoperative gait mechanics after total hip arthroplasty: a systematic review and meta-analysis. JBJS Rev 2018; 6: e1.

21.

Gore

Murray

Sepic

, et al. Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion. Clin Orthop Relat Res 1982; 165: 180–187.

22.

Lin

Jan

Liu

, et al. Effects of anterolateral minimally invasive surgery in total hip arthroplasty on hip muscle strength, walking speed, and functional score. J Arthroplasty 2007; 22: 1187–1192.

23.

Tudor

Ruzic

Vuckovic

, et al. Functional recovery after muscle sparing total hip arthroplasty in comparison to classic lateral approach - a three years follow-up study. J Orthop Sci 2016; 21: 184–190.

24.

Winther

Foss

Husby

, et al. A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty. Acta Orthop 2018; 89: 295–301.

25.

Rosenlund

Broeng

Overgaard

, et al. The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12months follow-up. An explorative randomised controlled trial. Clin Biomech (Bristol, Avon) 2016; 39: 91–99.

26.

Rosenlund

Broeng

Holsgaard-Larsen

, et al. Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach. Acta Orthop 2017; 88: 239–247.

27.

Downing

Clark

Hutchinson

, et al. Hip abductor strength following total hip arthroplasty: a prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 2001; 72: 215–220.

28.

Inaba

Kobayashi

Yukizawa

, et al. Little clinical advantage of modified Watson-Jones approach over modified mini-incision direct lateral approach in primary total hip arthroplasty. J Arthroplasty 2011; 26: 1117–1122.

29.

Kiyama

Naito

Shinoda

Maeyama

. Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplasty 2010; 25: 76–80.

30.

Winther

Husby

Foss

, et al. Muscular strength after total hip arthroplasty. A prospective comparison of 3 surgical approaches. Acta Orthop 2016; 87: 22–28.

31.

Hassan

Doherty

Mockett

, et al. Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis. Ann Rheum Dis 2002; 61: 422–428.