Anterior vs Posterior Approach in THA

Study Overview
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Brief Summary
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Determining the best approach for a total hip arthroplasty (THA) implies that the procedure is kind on soft tissues, with the lowest complication rates, and easily reproducible. Although there have been several attempts to resolve this issue in the last decade, a definitive answer has not been found. Therefore, the investigators performed a prospective study to compare direct anterior versus posterior approach based on (1) hospital stay, (2) functional outcome, (3) pain, (4) implant position (5) complications and (6) surgical time.

Detailed Description
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In this multicentric, prospective, randomized clinical trial, 55 total hip arthroplasties were performed on 50 patients between February 2011 and July 2013. Patients meeting the inclusion criteria underwent surgical treatment using the DAA or PA, according to a randomization process. Radiological analysis assessed implant position, limb lengthening, and potential implant related complications. X-rays were performed at subsequent follow-up visits and consisted of an antero-posterior (AP) pelvic X-ray and a lateral projection of the hip. Two independent observers, not involved with patients or surgeries, reviewed all postoperative radiographs independently.Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study. Patients underwent either the posterior or direct anterior approach.

Official Title
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Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty: a Multicentric Prospective Randomized Clinical Study

Conditions
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Total Hip Arthroplasty

Intervention / Treatment
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* Procedure: Total hip arthroplasty


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primary total hip replacement due to osteoarthrosis or osteonecrosis patients older than 50 years. Exclusion Criteria: inflammatory arthritis, any previous ipsilateral hip surgery suffering from proximal femoral deformity BMI over 40 active infection severe contralateral hip disease, muscle contractures or neuromuscular pathology requiring structural bone grafts.

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: THA Posterior Approach<br>The posterior approach to the hip has been described by many authors and yields good results. Implants used were Quadra®-H stem and Versacup® hip system, Medacta, Switzerland, with metal on polyethylene bearing. All implants were non-cemented. | Procedure: Total hip arthroplasty<br>* Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study<br>|
| Active Comparator: THA Direct anterior approach<br>The modified Hueter approach, based on the Smith-Peterson approach, was performed for the direct anterior minimally invasive surgery. This approach could have some advantages as it is a muscle sparing approach, hence yielding a faster recovery. A traction table was used for DAA as surgeons were trained to use this method. No intra-operative fluoroscopy was used for implant confirmation.Implants used were Quadra®-H stem and Versacup® hip system, Medacta, Switzerland, with metal on polyethylene bearing. All implants were non-cemented. | Procedure: Total hip arthroplasty<br>* Two fellowship-trained surgeons in two separate hospitals performed all procedures. Both surgeons had previously performed over 100 cases with each approach, before initiating this study<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital stay | Length in days of hospital stay | Between 0 days and 1 month, average of 4 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| functional recovery | The Harris Hip Score (HHS) was used to measure pain and function.Grading for the Harris Hip Score is interpreted on a scale of 0 to 100 as follows: results <70 are Poor; 70 - 79 are Fair; 80-89 are Good; 90 -100 are Excellent | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | 
| pain assessment: VAS | Visual Analog Scale (VAS) was used. The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations, including those with rheumatic diseases. The pain VAS is a continuous scale comprised of a horizontal (HVAS) or vertical (VVAS) line, usually 10 centimeters (100 mm) in length, anchored by 2 verbal descriptors, one for each symptom extreme. The pain VAS is a single-item scale, anchored by no pain (score of 0) and pain as bad as it could be or worst imaginable pain (score of 100 [100-mm scale]) . It is one total score, without subscale. As the lowest score of zero means no pain, it is the best possible outcome. As the highest score of 100 means the worst imaginable pain, it is the worst possible outcome. | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | 
| implant position | Radiological assessment | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | 
| number of patients with per/post surgical complications. | Possible complications are: peroperative fracture, hip dislocation, infection, neurologic complication, vascular complication or hematoma. | 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years and 5 years postoperatively | 
| surgical time | Surgical time in minutes | Up to 240 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Direct anterior approach, posterior approach