Skip to main content

No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome

International Orthopaedics volume 40, pages 2025–2030 (2016)Cite this article

Abstract

Purpose

The aim was to compare the muscle damage and functional outcomes between patients who underwent total hip arthroplasty through a direct anterior (49 patients) or a lateral approach (50 patients).

Methods

A randomized, controlled, prospective study. The study variables were muscle damage based on post-operative levels of serum markers (citokynes and acute phase reactants) and MRI, and Harris hip score.

Results

Post-operatively, there were significantly higher mean levels in the lateral group related to interleukin 6 and 8, and tumor necrosis factor-alpha up to fourth postoperative day. By MRI at six post-operative months, the fatty atrophy in the gluteus muscles was more in the lateral group, but similar in the other muscles. The mean thickness of the tensor fasciae latae was significantly lower in the anterior group. Functional outcome was similar between groups at three and 12 post-operative months.

Conclusions

Muscle damage due to the surgical approach had no influence on functional outcome after three post-operative months. Both anterior and lateral approaches for THA are similarly safe and feasible, so the choice depends only on the preference and experience of the surgeon.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Chechik O, Khashan M, Lador R, Salai M, Amar E (2013) Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg 133:1595–1600. doi:10.1007/s00402-013-1828-0

    Article  PubMed  Google Scholar 

  2. Cebatorius A, Robertsson O, Stucinskas J, Smailys A, Leonas L, Tarasevicius S (2015) Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian Arthroplasty Register. Int Orthop 39:1073–1600. doi:10.1007/s00264-014-2618-1

    Article  PubMed  Google Scholar 

  3. Wallner O, Stark A, Muren O, Eisler T, Sköldenberg O (2015) Unstable hip arthroplasties. A prospective cohort study on seventy dislocating hips followed up for four years. Int Orthop 39:1037–1044. doi:10.1007/s00264-014-2583-8

    Article  PubMed  Google Scholar 

  4. Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12:123–129. doi:10.1007/s10195-011-0144-0

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dosanjh S, Matta J, Bhandari M (2009) The final straw: a qualitative study to explore patient decisions to undergo total hip arthroplasty. Arch Orthop Trauma Surg 129:719–727. doi:10.1007/s00402-008-0671-1

    Article  PubMed  Google Scholar 

  6. Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124. doi:10.1097/01.blo.0000194309.70518.cb

    Article  PubMed  Google Scholar 

  7. Picado CH, Garcia FL, Marques W Jr (2007) Damage to the superior gluteal nerve after direct lateral approach to the hip. Clin Orthop Relat Res 455:209–211

    Article  PubMed  Google Scholar 

  8. Goebel S, Steinert A, Schillinger J, Eulert J, Broscheit J, Rudert M, Nöth U (2012) Reduced post-operative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36:491–498. doi:10.1007/s00264-011-1280-0

    Article  PubMed  Google Scholar 

  9. Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Artroplast 25:671–679. doi:10.1016/j.arth.2010.02.002

    Article  Google Scholar 

  10. Queen RM, Butler RJ, Watters TS, Kelley SS, Attarian DE, Bolognesi MP (2011) The effect of total hip arthroplasty surgical approach on postoperative gait mechanics. J Arthroplasty 26(Suppl 1):66–71. doi:10.1016/j.arth.2011.04.033

    Article  PubMed  Google Scholar 

  11. Bremer AK, Kalberer F, Pfirrmann W (2011) Soft- tissue changes in hip abductor muscles and tendons after total hip replacement. J Bone Joint Surg Br Vol 93:886–889. doi:10.1302/0301-620X.93B7.25058

    CAS  Article  Google Scholar 

  12. Järvinen TA, Järvinen TL, Kaariainen M, Kalimo H, Järvinen M (2005) Muscle injuries: biology and treatment. Am J Sports Med 33:745–764. doi:10.1177/0363546505274714

    Article  PubMed  Google Scholar 

  13. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg (Br) 64:17–19. doi: 0301-620X/82/1018-0017

    CAS  Google Scholar 

  14. Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M (2005) Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology 235:969–976. doi:10.1148/radiol.2353040403

    Article  PubMed  Google Scholar 

  15. Müller M, Tohtz S, Dewey M, Springer I, Perka C (2010) Evidence of reduced muscle trauma through a minimally invasive anterolateral approach by means of MRI. Clin Orthop Relat Res 468:3192–3200. doi:10.1007/s11999-010-1378-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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 51:737–755

    CAS  PubMed  Google Scholar 

  17. Granchi D, Savarino L, Ciapetti G, Cenni E, Rotini R, Mieti M, Baldini N, Giunti A (2003) Immunological changes in patients with primary osteoarthritis of the hip after total joint replacement. J Bone Joint Surg (Br) 85:758–764. doi:10.1302/0301-620X.85B5.13729

    Google Scholar 

  18. Minetto MA, Oprandi G, Saba L, Mussino S, Aprato A, Massè A, Angeli A, Gallinaro P (2006) Serum interleukin-6 response to elective total hip replacement surgery. Int Orthop 30:172–176. doi:10.1007/s00264-006-0073-3

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. White J, Kelly M, Dunsmuir R (1998) C-reactive protein level after total hip and total knee replacement. J Bone Joint Surg (Br) 80:909–911. doi: 0301-620X/98/58708

    CAS  Article  Google Scholar 

  20. Cohen RG, Katz JA, Skrepnik NV (2009) The relationship between skeletal muscle serum markers and primary THA. Clin Orthop Relat Res 467:1747–1752. doi:10.1007/s11999-009-0809-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Reichert JC, Volkmann MR, Koppmair M, Rackwitz L, Lüdemann M, Rudert M, Nöth U (2015) Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty. Int Orthop 39:2309–2313. doi:10.1007/s00264-015-2732-8

    Article  PubMed  Google Scholar 

  22. Kobayashi H, Homma Y, Baba T, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2015) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int Orthop. doi:10.1007/s00264-015-3059-1

    Google Scholar 

Download references

Author information

Affiliations

  1. Orthopaedic Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain

    Belén De Anta-Díaz, Juan Serralta-Gomis & Eliana Benavidez

  2. Orthopaedic Surgery, Miguel Hernandez University, Alicante, Spain

    Alejandro Lizaur-Utrilla & Fernando Anacleto López-Prats

  3. Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain

    Alejandro Lizaur-Utrilla

Authors
  1. Belén De Anta-Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Serralta-Gomis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alejandro Lizaur-Utrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eliana Benavidez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fernando Anacleto López-Prats
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alejandro Lizaur-Utrilla.

Ethics declarations

Conflict of interest

The authors declare have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

De Anta-Díaz, B., Serralta-Gomis, J., Lizaur-Utrilla, A. et al. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. International Orthopaedics (SICOT) 40, 2025–2030 (2016). https://doi.org/10.1007/s00264-015-3108-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-3108-9

Keywords

  • Hip approach
  • Functional outcome
  • Muscle damage
  • Total hip arthroplasty