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Outcomes of Minimally Invasive Anterolateral THA Are Not Superior to Those of Minimally Invasive Direct Lateral and Posterolateral THA

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There has been considerable interest in minimally invasive surgical (MIS) THA in recent years. The MIS anterolateral approach, or the MIS Watson-Jones approach, is a novel intermuscular abductor-sparing technique. Early reports from case series suggest the potential for superior function and reduced complications; however, the available information from clinical reports is inadequate to suggest surgeons should change from their accepted standard approach.

Questions/purposes

We examined the potential superiority of this anterolateral approach, as judged by quality-of-life (QoL) measures, radiographic parameters, and complications, compared to limited-incision MIS direct lateral and MIS posterolateral approaches.

Methods

We performed a prospective randomized controlled trial involving five surgeons at three centers, recruiting 156 patients undergoing primary THA to receive either the MIS anterolateral or the surgeon’s preferred approach (direct lateral or posterolateral). For the 135 patients we report, we collected patient-reported WOMAC, SF-36, Paper Adaptive Test in 5 Domains of Quality of Life in Arthritis Questionnaire [PAT5D], and patient satisfaction scores. We recorded complications and evaluated radiographs for prosthetic component position, subsidence, and fracture. Minimum followup was 24 months (mean, 30 months; range, 24–42 months).

Results

QoL and patient-reported satisfaction were similar between groups. Radiographic evaluation demonstrated no differences in acetabular component positioning; however, mean stem subsidence was 4.6 mm for the MIS anterolateral group and 4.1 mm for the alternate group, with differences observed among the three centers for stem subsidence and fracture. One center had increased rate of fracture requiring treatment and need for revision in the MIS anterolateral group.

Conclusions

We found no superiority of the MIS anterolateral approach but observed intersite differences in painful stem subsidence and fracture. We have returned to the standard surgical approaches in use before the trial.

Level of Evidence

Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Daphné Savoy for her assistance in the preparation of this manuscript and Abdul Aziz for his participation with patient followup and data collection for this study.

Author information

Authors and Affiliations

  1. Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada

    Nelson V. Greidanus MD, MPH, Samir Chihab MD, Donald S. Garbuz MD, MHSc, Bassam A. Masri MD & Clive P. Duncan MD, MSc

  2. Division of Orthopaedics (Arthroplasty), Department of Surgery, McGill University, Montréal, QC, Canada

    Michael Tanzer MD

  3. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Allan E. Gross MD

Authors
  1. Nelson V. Greidanus MD, MPH
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  2. Samir Chihab MD
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  3. Donald S. Garbuz MD, MHSc
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  4. Bassam A. Masri MD
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  5. Michael Tanzer MD
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  6. Allan E. Gross MD
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  7. Clive P. Duncan MD, MSc
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Corresponding author

Correspondence to Nelson V. Greidanus MD, MPH.

Additional information

The institutions of the authors (NVG, SC, DSG, BAM, MT, AEG, CPD) have received funding from Zimmer, Inc (Warsaw, IN, USA). One or more of the authors (DSG, BAM, CPD) certify that each has received or may receive payments or benefits, during the study period, an amount in excess of $10,000, from Zimmer, Inc. The remaining authors certify that they have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

The work was performed at the University of British Columbia (Vancouver, British Columbia, Canada), the University of Toronto (Toronto, Ontario, Canada), and McGill University (Montréal, Québec, Canada).

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Greidanus, N.V., Chihab, S., Garbuz, D.S. et al. Outcomes of Minimally Invasive Anterolateral THA Are Not Superior to Those of Minimally Invasive Direct Lateral and Posterolateral THA. Clin Orthop Relat Res 471, 463–471 (2013). https://doi.org/10.1007/s11999-012-2603-1

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  • DOI: https://doi.org/10.1007/s11999-012-2603-1

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