International Orthopaedics

, Volume 39, Issue 12, pp 2309–2313 | Cite as

Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty

  • Johannes C. Reichert
  • Maximilian R. Volkmann
  • Maximilian Koppmair
  • Lars Rackwitz
  • Martin Lüdemann
  • Maximilian Rudert
  • Ulrich Nöth
Original Paper



The presented retrospective study compares clinical outcomes five years after total hip arthroplasty performed through a minimally invasive direct anterior approach and a direct transgluteal lateral approach.


A total of 171 arthroplasties in 167 patients were evaluated utilizing the Harris hip score (HHS), the SF-36, a daily activity questionnaire, and the UCLA activity score.


The average HHS showed no significant difference equalling 91.4 points in the anterior group and 92.4 in the lateral group (p = 0.952). The SF-36 physical component scores were 50.7 (anterior) and 50.0 (lateral) while the psychometric properties added up to 48.6 (anterior) and 50.3 (lateral) with no significant differences evident (p = 0.782, p = 0.071). Daily activity was found to result in 4,855 (anterior) and 5,016 (lateral) cycles, respectively (p = 0.364). No difference regarding pain sensation was determined (p = 0.859). A significant difference was found for the UCLA score, which was calculated to be 5.9 in the anterior and 6.4 in the lateral approach group (p = 0.008).


In summary, our mid-term results show comparable outcomes for both approaches regarding functionality, pain, quality of life and daily activity.


Total hip arthroplasty Direct anterior approach Transgluteal approach Outcome Mid-term 


Ethical approval

For this type of study, formal consent is not required.


  1. 1.
    Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP (2005) Minimally invasive total hip arthroplasty: a prospective randomized study. J Arthroplasty 20(2):139–144CrossRefPubMedGoogle Scholar
  2. 2.
    Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Noth U (2012) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36(3):491–498. doi: 10.1007/s00264-011-1280-0 PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Noth U, Nedopil A, Holzapfel BM, Koppmair M, Rolf O, Goebel S, Eulert J, Rudert M (2012) Minimally invasive anterior approach. Orthopade 41(5):390–398. doi: 10.1007/s00132-011-1894-3 CrossRefPubMedGoogle Scholar
  4. 4.
    Rachbauer F (2005) Minimally invasive total hip arthroplasty via direct anterior approach. Orthopade 34(11):1103–1104. doi: 10.1007/s00132-005-0854-1, 1106–1108, 1110CrossRefPubMedGoogle Scholar
  5. 5.
    Bauer R, Kerschbaumer F, Poisel S, Oberthaler W (1979) The transgluteal approach to the hip joint. Arch Orthop Trauma Surg 95(1–2):47–49CrossRefPubMedGoogle Scholar
  6. 6.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755PubMedGoogle Scholar
  7. 7.
    Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R (2002) Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 324(7351):1417PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Wollmerstedt N, Noth U, Ince A, Ackermann H, Martell JM, Hendrich C (2010) The daily activity questionnaire: a novel questionnaire to assess patient activity after total hip arthroplasty. J Arthroplasty 25(3):475–480. doi: 10.1016/j.arth.2009.01.005, e471-473CrossRefPubMedGoogle Scholar
  9. 9.
    Naal FD, Impellizzeri FM, Leunig M (2009) Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res 467(4):958–965. doi: 10.1007/s11999-008-0358-5 PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Muller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72(2):161–168PubMedGoogle Scholar
  11. 11.
    Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE (2007) Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. J Bone Joint Surg Am 89(6):1153–1160. doi: 10.2106/JBJS.F.00940 CrossRefPubMedGoogle Scholar
  12. 12.
    Jacquot F, Ait Mokhtar M, Sautet A, Doursounian L, Masquelet AC, Feron JM (2013) The mini postero-postero-lateral mini incision in total hip arthroplasty. Int Orthop 37(10):1891–1895. doi: 10.1007/s00264-013-1970-x PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25(5):671–679. doi: 10.1016/j.arth.2010.02.002, e671CrossRefPubMedGoogle Scholar
  14. 14.
    Dienstknecht T, Luring C, Tingart M, Grifka J, Sendtner E (2013) A minimally invasive approach for total hip arthroplasty does not diminish early post-operative outcome in obese patients: a prospective, randomised trial. Int Orthop 37(6):1013–1018. doi: 10.1007/s00264-013-1833-5 PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Pour AE, Parvizi J, Sharkey PF, Hozack WJ, Rothman RH (2007) Minimally invasive hip arthroplasty: what role does patient preconditioning play? J Bone Joint Surg Am 89(9):1920–1927. doi: 10.2106/JBJS.F.01153 CrossRefPubMedGoogle Scholar
  16. 16.
    Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 28(9):1634–1638. doi: 10.1016/j.arth.2013.01.034 CrossRefPubMedGoogle Scholar
  17. 17.
    Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC (1998) Assessing activity in joint replacement patients. J Arthroplasty 13(8):890–895CrossRefPubMedGoogle Scholar
  18. 18.
    Beverland D (2011) Approaches. In: Vidalain J-P, Selmi TAS, Beverland D et al (eds) The Corail® hip system. Springer Berlin Heidelberg, Heidelberg, pp 193–216. doi: 10.1007/978-3-642-18396-6_6 CrossRefGoogle Scholar
  19. 19.
    Bhargava T, Goytia RN, Jones LC, Hungerford MW (2010) Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics 33(7):472. doi: 10.3928/01477447-20100526-05 PubMedGoogle Scholar
  20. 20.
    Smith TO, Blake V, Hing CB (2011) Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop 35(2):173–184. doi: 10.1007/s00264-010-1075-8 PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Aszmann OC, Dellon ES, Dellon AL (1997) Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 100(3):600–604CrossRefPubMedGoogle Scholar
  22. 22.
    Hoberg M, Rudert M, Tillmann B (2012) Minimally invasive hip arthroplasty—what must be spared? Orthopade 41(5):338–345. doi: 10.1007/s00132-011-1888-1 CrossRefPubMedGoogle Scholar
  23. 23.
    Yi C, Agudelo JF, Dayton MR, Morgan SJ (2013) Early complications of anterior supine intermuscular total hip arthroplasty. Orthopedics 36(3):e276–e281. doi: 10.3928/01477447-20130222-14 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2015

Authors and Affiliations

  • Johannes C. Reichert
    • 1
  • Maximilian R. Volkmann
    • 2
  • Maximilian Koppmair
    • 2
  • Lars Rackwitz
    • 1
  • Martin Lüdemann
    • 2
  • Maximilian Rudert
    • 2
  • Ulrich Nöth
    • 1
  1. 1.Department of Orthopaedic and Trauma SurgeryEv. Waldkrankenhaus SpandauBerlinGermany
  2. 2.Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal ResearchJulius-Maximilians-UniversityWürzburgGermany

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