Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches

Total hip replacement (THR) has become one of the most commonly performed orthopedic surgical procedures, and levels of patient satisfaction are generally high. (1) Nevertheless, some controversy still exists regarding [...]
Background: The most effective surgical approach to total hip replacement (THR) remains controversial. Most studies that have compared approaches have reported only short-term outcome data. It is therefore unclear in the literature if a particular surgical approach offers long-term advantages. The aim of this study was to determine the effect of the 3 main surgical approaches to THR on patient-reported outcomes 5 years after surgery. Methods: All patients who underwent a THR for osteoarthritis or osteonecrosis between 2008 and 2012 by an anterior, posterior or lateral approach at The Ottawa Hospital in Ontario, Canada, were included in the study. All preoperative and postoperative scores for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) questionnaires were recorded. Analy sis of covariance was used to study the relationship between the amount of change in scores on the HOOS and WOMAC subscales (dependent variables) and the surgical approach. The confounding factors of age, sex, American Society of Anesthesiologists (ASA) class, Charnley classification and body mass index were included in the analysis. Results: There were 138 patients (37.6%) in the posterior approach group, 104 (28.3%) in the lateral approach group and 125 (34.1%) in the anterior approach group. There were no significant differences among the 3 groups in terms of Charnley classification, body mass index, sex, ASA class, surgical side and preoperative functional scores. We did not observe any sig nificant differences in the amount of change in the scores for HOOS and WOMAC subscales among the 3 groups. There were also no differences in the final postoperative scores. Conclusion: Our findings suggest that the choice of surgical approach in primary THR surgery without revision has no influence on functional outcomes and quality of life after 5 years. Further studies are needed to assess how patient age and sex may influence the functional outcome of individual surgical approaches. Contexte : L'approche chirurgicale la plus efficace pour l'arthroplastie totale de la hanche (ATH) n'a pas ete determinee. La plupart des etudes qui ont compare les differentes approches n'ont fait etat que de donnees a court terme. Donc, la litterature nous renseigne peu sur leurs bienfaits a long terme. Le but de cette etude est de verifer l'effet des 3 principales approches chirurgicales pour l'ATH sur les parametres rapportes par les patients 5 ans apres la chirurgie. Methodes : Tous les patients soumis a une ATH pour arthrose ou osteonecrose entre 2008 et 2012 par approche anterieure, posterieure ou laterale a l'Hopital d'Ottawa, en Ontario, au Canada, ont ete inclus dans l'etude; et tous les scores preoperatoires et postoperatoires des questionnaires HOOS (Hip Disability and Osteoarthritis Outcome Score) et WOMAC (Western Ontario and MacMaster Universities Osteoarthritis Index) ont ete enregistres. L'analyse de covariance a servi a etudier le lien entre l'ampleur des changements aux scores des sous-echelles HOOS et WOMAC (variables dependantes) et l'approche chirurgicale. L'analyse a aussi tenu compte de facteurs de confusion tels que l'age, le sexe, la classe ASA (American Society of Anesthesiologists), classification de Charnley et indice de masse corporelle. Resultats : Le groupe soumis a l'approche posterieure comptait 138 patients (37,6 %), a l'approche laterale 104 (28,3 %) et a l'approche anterieure 125 (34,1 %). Il n'y avait pas de differences significatives entre les 3 groupes aux plans de la classification de Charnley, de l'indice de masse corporelle, du sexe, de la classe ASA, du cote ou la chirurgie a ete effectuee et des parametres fonctionnels preoperatoires. Nous n'avons observe aucune difference significative quant a l'ampleur du changement aux scores des sous-echelles HOOS et WOMAC entre les 3 groupes; il en est alle de meme pour les scores postoperatoires finaux. Conclusion : Selon nos observations, le choix de l'approche chirurgicale pour l'ATH primaire sans revision n'exerce aucune influence sur les parametres fonctionnels et la qualite de vie apres 5 ans. Il faudra proceder a d'autres etudes pour evaluer l'influence potentielle de l'age et du sexe sur les parametres fonctionnels des differentes approches.