Moderator Trousdale: We don’t have many marketing issues in Rochester because we live in a farm town in southern Minnesota, but Larry lives in a city that may be the pinnacle of marketing. Larry, tell us how prevalent you think marketing is in your region of the country, and what do we do about it as a society because it’s certainly an issue, I think?
Dr. Dorr: Marketing is very heavy for the anterior approach, at least in California/western United States, and part of it around L.A. is because Joel was there…for surgeons to think they had to compete with Joel a lot of them converted to that approach.
And the fact of the matter is that I am a little disappointed that our leadership hasn’t responded to the marketing and hasn’t supported the posterior surgeons. There’s been no support. The companies—every one of them—are the ones really promoting this because they are trying to sell implants through an approach.
There needs to be a counter marketing to the public to let them know that there isn’t any difference.
Moderator Trousdale: In defense there is some data, though. I still think the posterior approach in my hands is better than the direct anterior approach. You’ve got to weigh the pros and cons. Larry, does the direct anterior approach win on early instability?
Dr. Dorr: Yes.
Moderator Trousdale: And Larry, does the direct anterior approach win on early recovery at weeks one or two?
Dr. Dorr: No.
Moderator Trousdale:Michael?
Dr. Taunton: Yes.
Moderator Trousdale: We’ve got nice consensus there.
Dr. Dorr: Everybody is going to believe their own data. He’s got his data; his patients recover. But my published data shows what my patients do, and it’s out there for both three and six weeks. And his data has got to beat that before he’s going to say he is better than I am.
Moderator Trousdale: Well, he has a comparator group.
Dr. Dorr: Yes, but that’s at Mayo Clinic.
Moderator Trousdale: Fair enough. Which was a lot quicker recovery….
Dr. Dorr: If it was Hospital for Special Surgery we might believe it.
Dr. Taunton: That was a dig, ladies and gentlemen.
Moderator Trousdale: Femoral fracture rate, Michael? Should we assume the early femoral fracture rate is a little higher with the direct anterior approach versus the posterior approach?
Dr. Taunton: Absolutely. I think the early fracture rate is higher with the anterior approach. We see in numerous studies—you’ll see in that Norwegian registry that although the dislocation rate was lower, the rate of femoral failure was higher in the direct anterior approach, which is what caused the revision rate to be similar.
Moderator Trousdale: Michael, before we finish this can you comment on skin issues? Some people think that the skin issue is a little bit of a bigger deal with the direct anterior approach versus a side incision. Skin issues with the direct anterior? Who wouldn’t you do the direct anterior approach on?
Dr. Taunton: We looked at this and patients that are female, diabetic, with BMI greater than 40 had an almost 19% risk of having a wound complication of any type. Therefore, in those patients I do tend to go to the posterior approach.
Moderator Trousdale: Thank you, gentlemen. Well done.
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My name is Dr.K.Mohan Iyer,Senior Consultant Orthopaedic Surgeon,Bangalore,India.My website is:kmohaniyer.com and my email address is:kmiyer28@hotmail.com.
At the moment I am editing my book titled `Posterior Approach to the Hip joint. and would certainly request you for a chapter on this topic which may be extremely useful in India.It may be approximately 10 pages(A4 size) to include text and figures.You will have time till 1st September 2021 to complete it.I trust that you will not mind sharing this interesting topic in my book `Posterior Approach to the Hip Joint’.You also have the liberty of including more authors who may be of help to you in this chapter.
I would be extremely thankful for your reply concerning this.
Sorry for this email and would be looking forward to your reply.
PS:I am extremely punctual and prompt in my email correspondence leaving no email unanswered in 24 hours.
With very best wishes,Yours Sincerely,
K.Mohan Iyer(3/7/2021)