First Systematic Review of Anterior vs. Posterior in THA
In the first systematic review of prospective studies comparing outcomes through 90 days of anterior approach posterior approach in primary total hip arthroplasty (THA), researchers found that the anterior approach resulted in less pain, better hip functioning, and a decreased need for narcotics.
The study, “Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review with Meta-Analysis,” will appear mid-2018 in the Journal of Arthroplasty.
Larry E. Miller, Ph.D. is with Miller Scientific Consulting in Asheville, North Carolina. Dr. Miller, and a co-author on the study, commented to OTW, “Dr. Samir Bhattacharyya from DePuy Synthes approached me to take a closer look at the published literature on anterior approach hip arthroplasty.”
“After a number of evidentiary and methodology-oriented conversations, it was apparent to both of us that it would be of great interest for patients, providers, and surgeons to know how anterior approach helps patients during short term recovery, specifically in terms of pain relief and improved functioning. The impact of better patient outcomes in the short-term may result in significant societal and economic benefits.”
“Although several systematic reviews had previously investigated differences in patient outcomes with anterior approach vs. posterior approach in hip arthroplasty, all of these reviews included a mixture of prospective and retrospective studies. The novel aspect of our study was that it was the first systematic review on the topic to include only prospective comparative studies, which translates to higher methodological quality and reproducible results.”
“Patients treated with the anterior approach reported less pain, lower narcotic usage, and better hip function in the first 90 days after surgery compared to patients who underwent hip arthroplasty using posterior approach. These differences were statistically significant, clinically important, and therefore the potential positive impacts on patients’ and caregivers’ lives should not be overlooked. We were also interested in whether there were any differences in complication rates between the anterior and posterior approach. Overall, we found no significant differences between approaches in complication rates over 90 days following the procedure.”
“Total hip replacement is a significant event in patient’s lives. Dr. Bhattacharyya and I discussed and agreed that choosing to undergo total hip arthroplasty could be one of the most involved decisions a patient and his or her family can make. He correctly pointed out that the experience from the short-term recovery from the surgery may have prolonged impact on patients’ quality of life and mobility. This paper shows improved functioning and less pain along with less narcotic use within 90 days post-surgery. As adoption of the anterior approach continues to increase, it is critical for surgeons and patients to understand the benefits and limitations of all total hip arthroplasty surgical approaches and to collectively make informed decisions based on the highest quality clinical evidence.”
“This study builds on the mounting evidence that the anterior approach improves patient outcomes with total hip arthroplasty, optimizes the patient experience, and likely reduces the overall cost of perioperative care. In a cost-constrained healthcare system, the anterior approach may benefit patients (better outcomes), their caregivers (smaller caregiving burden), and providers (lower perioperative costs).”
