The Journal Of Bone And Joint Surgery - Volume 99 - Issue 10 - p. 840-847

Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach

Mjaaland Knut Erik, MD; Svenningsen Svein, MD, PhD; Fenstad Anne Marie, MSc; Havelin Leif I., MD, PhD; Furnes Ove, MD, PhD; Nordsletten Lars, MD, PhD

Hip

Background: Since 2008, there has been an increase in the use of minimally invasive surgery (MIS) through an anterior or anterolateral approach for total hip arthroplasty (THA) in Norway. We compared the MIS approaches with the conventional posterior and direct lateral approaches in terms of revision rates and risk of revision.

Methods: On the basis of data in the Norwegian Arthroplasty Register, 21,860 THAs with an uncemented stem, performed between 2008 and 2013, were identified and included in the cohort. Of these THAs, 2,017 were done through an MIS anterior approach; 2,087, through an MIS anterolateral approach; 5,961, through a posterior approach; and 11,795, through a direct lateral approach. Follow-up ended on December 31, 2015. Two and 5-year survival rates were calculated using Kaplan-Meier survival analysis. Relative risk (RR) was calculated using Cox regression analysis, with adjustment for age, sex, primary diagnosis, American Society of Anesthesiologists (ASA) grade, femoral head size, cup fixation, type of articulation, and duration of surgery and using 6 revision end points based on cause: any cause, infection, dislocation, femoral fracture, aseptic loosening, and other/unknown cause. The median duration of follow-up was 4.3 years.

Results: There were no significant differences among the surgical approaches with regard to the 2 and 5-year survival rates or RR of revision due to any cause. The RR of revision due to infection was 0.53 (95% confidence interval [CI] = 0.36 to 0.80, p = 0.002) for the MIS anterior and anterolateral approaches and 0.57 (95% CI = 0.40 to 0.80, p = 0.001) for the posterior approach compared with the direct lateral approach. The RR of revision due to dislocation was 2.1 (95% CI = 1.5 to 3.1, p < 0.001) for the posterior approach compared with the direct lateral approach but no significant difference in risk was found when the MIS anterior and anterolateral approaches were compared with the direct lateral approach (RR = 0.71, 95% CI = 0.40 to 1.3, p = 0.25).

Conclusions: The revision rates and risk of revision associated with the MIS anterior and anterolateral approaches were not increased compared with those of the conventional posterior and direct lateral approaches.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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