The Influence of Surgical Approach on Cemented Stem Stability An RSA Study

The surgical approach used is an important aspect of hip arthroplasty and will have an effect on the loading of the implant. Our goal was to establish whether there was a difference in early stem migration between the posterior and the lateral surgical approaches. The migration patterns of 45 Exeter stems in 45 patients were measured using radiostereometric analysis during a 2-year period; 19 of the stems were implanted using the posterior approach and 26 were implanted using the lateral approach. From postoperative radiostereometric measurements it was established that there was no difference in initial stem position between the two approaches. The posterior approach group had greater internal rotation of the stem, approximately 2° during the first 2 years. The lateral group had almost 1/2 this amount of internal rotation. Overall stem subsidence was similar between the groups. These differences suggest that the lateral approach may give a survival advantage, especially for less rotationally stable stem designs and suboptimal cementing technique. The posterior approach gives rise to greater degree of internal rotation during the first 2 years.

Level of Evidence: Therapeutic Level II. See the Guidelines for Authors for a complete description of levels of evidence.