Critically Appraised Topic
One of the patients I worked with in the hospital was a 72 year old female with a diagnosis of left hip osteoarthritis, status post total hip arthroplasty (THA) performed via the posterior approach. She was very concerned about following her posterior hip precautions, afraid she might dislocate her hip. This fear translated into a fear of getting up and engaging in physical therapy, as I worked with her on transfers, gait training, and stair training over the course of her three day admission. I wondered if her functional outcomes would be better if her operation had been performed with a different approach and less restrictive precautions.
Which THA surgical approach, posterior or anterior, results in better early and long-term pain-related and functional outcomes for the patient with hip osteoarthritis?
Clinical Bottom Line
Based on the results of the outcomes from Barrett et al., Rodriguez et al., Yang et al. and Taunton et al., limited evidence suggests that anterior approach THA may result in better early functional outcomes and pain level than posterior approach THA. The internal validity of the studies was fair to good, with the most significant threats being lack of randomization in one study, failure to account for study losses, and extraneous variables due to lack of strict protocol in several of the studies. Unfortunately, it is difficult to generalize the results of these studies to a broad patient population, as there were only six surgeons who were involved in performing surgeries in these four studies. Additional research should be performed with multiple facilities and surgeons involved and a strict protocol used throughout long-term follow up.
Jeffery, Anne L., "Differences in Functional and Pain-related Outcomes for Patients Following Total Hip Arthroplasty Performed Using a Posterior versus Anterior Approach" (2014). PT Critically Appraised Topics. 54.