Minimal-Invasive Posterior, Anterior and Anterolateral Approach in Hip Replacement: Is There a Difference in Functional Outcome and Restoration of Hip Biomechanics?

Kohnen, Christian [UCL] Van Cauter, Maïté [UCL] M'Bra, Kouamane Innocent [UCL] Feyder, Cathy [UCL] Wallard, Laura [UCL] Detrembleur, Christine [UCL] Mahaudens, Philippe [UCL] Postlethwaite, Didier [UCL] Dubuc, Jean-Emile [UCL] Cornu, Olivier [UCL]

Especially, the direct anterior approach by Hueter, mostly due to the faster recovery and shorter hospital stay. Beside the functional recovery, the goal of a hip replacement is to restore hip biomechanics by correct implant placement. Most studies in the literature are comparing the posterior (PA) and Direct Anterior Approach (DAA) but few are comparing them to the minimal invasive Anterolateral Approach (ALA) described by Rottinger. The goal of our study is to compare these 3 approaches by assessing the functional outcome and quality of life, hip biomechanics restoration and length of stay. Methods: We did a prospective study in 52 patients divided into posterior approach (n=16), a direct anterior approach (n=17) and anterolateral approach (n=19). Four well-trained senior surgeons performed all procedures. Functional outcome and health-related quality of life evaluated by the Oxford Hip Score (OHS) and SF-36 were assessed preoperatively at 6 months of follow up by an independent collaborator. The hip offset and leg length discrepancy are measured on standard x-ray preoperatively and at 6 months of follow up. Results: We found a significant improvement of OHS and SF-36 score at 6 months but no significant difference between the 3 approaches. Correct offset and leg length discrepancy restoration is seen without any difference between the 3 groups. Hospital stay was significantly longer in the PA group (7days vs 5 days in DAA and ALA, p<0.001). Conclusion: Good functional outcome, health-related quality of life and hip biomechanics restoration is achieved after hip replacement by posterior, direct anterior and anterolateral approach without having a significant difference between them. The only difference found was correlated to the length of stay, which was longer in the PA group.