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Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach—a University clinic case control study of 120 cases

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The surgical approach used in total hip arthroplasty (THA) has been identified as a factor affecting the outcome. In our University Hospital, the posterior surgical approach is the gold standard. The Rottinger approach is an anterolateral approach which is truly minimally invasive, as it does not vertically cut any muscle fibers. The objective of this study was to determine the difference in surgical outcomes between the posterior hip approach and the Rottinger approach which was newly adopted at our Hospital.

Methods

In a retrospective study, a total of 120 patients underwent THA; 60 patients using the Rottinger approach by the young consultant surgeon and another 60 patients using the standard posterior approach by the senior orthopaedic surgeon. Patients have been controlled for age, gender, and ASA grades. All preoperative demographic data showed no significant difference between the control and study groups. The following parameters were analyzed: incision length, duration of the surgery, intraoperative blood loss, WOMAC index, Harris Hip Score, range of motion at 3 and 12 months after surgery, time of quitting the crutches, and willingness for the contralateral hip arthroplasty.

Results

WOMAC index, surgical time, and incision lengths have been without significant difference in both approaches. Intraoperative blood loss was significantly lower in the Rottinger group (CI:  − 10.903,  − 0.064). Harris Hip score was significantly higher (CI: 4.564, 12.973) in the Rottinger group at 3 months, but similar (CI:  − 3.484, 2.134) at 12 months follow-up. At 3 months, active flexion and extension were significantly higher in the Rottinger group (CI: 0.595, 8.239; 2.487, 4.480, respectively), and active abduction and passive adduction (CI:  − 5.662,  − 0.338;  − 6.290,  − 1.410, respectively) in the posterior approach group. Patients in the Rottinger approach group on average quit crutches 3 weeks earlier and had no postoperative dislocations compared to 2 dislocations in the control group.

Conclusion

The Rottinger approach offered faster rehabilitation with less need for crutches and with lower complication rates.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, University Hospital Mostar, Bijeli brijeg bb, 88000, Mostar, Bosnia and Herzegovina

    Marko Ostojić, David Kordić, Goran Moro & Zdenko Ostojić

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  1. Marko Ostojić
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  2. David Kordić
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  3. Goran Moro
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  4. Zdenko Ostojić
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Corresponding author

Correspondence to Marko Ostojić.

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Conflict of interest

The first author is a consultant for Lima Corporate, who he does demonstrational surgeries for and has received a speaker’s honorarium from Lima Corporate. Other authors declare they have no conflict of interest.

Ethical approval

The Bioethics Committee of the University Hospital Mostar, Bosnia and Herzegovina approved the study which was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments (2008) or comparable ethical standards.

Informed consent

Informed consent on invasive medical interventions is obtained from all patients in our Department. All individual participants included in the study also did the informed consent where they also gave consent to have their data published for scientific publishing purposes.

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Ostojić, M., Kordić, D., Moro, G. et al. Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach—a University clinic case control study of 120 cases. Arch Orthop Trauma Surg 142, 747–754 (2022). https://doi.org/10.1007/s00402-020-03719-6

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  • DOI: https://doi.org/10.1007/s00402-020-03719-6

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