Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study. Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. Objective functional assessment of total hip arthroplasty following two common surgical approaches: The posterior and direct lateral approaches Minimally invasive total hip arthroplasty: a prospective randomized study. The effect of total hip arthroplasty surgical approach on postoperative gait mechanics. [Minimally invasive posterior approach for total hip arthroplasty]. Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. Prospective randomized study of two surgical approaches for total hip arthroplasty. Blood Loss in the Minimally Invasive Posterior Approach to Total Hip Arthroplasty: A Comparative Study Can the Length of Hospital Stay After Total Hip Arthroplasty be Predicted by Preoperative Physical Function Characteristics? Patient’s perspective on direct anterior versus posterior approach total hip arthroplasty Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach [Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach]. Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique: a prospective and randomized study.
Studies suggest that  total hip arthroplasty ( THA )  performed through direct anterior ( DA ) approach has better functional outcomes than other surgical approaches . The immediate to very early outcomes of DA THA are not known . A prospect i ve , r and omized study examined the very early outcome of THA performed through DA versus direct lateral approach . The functional outcomes on day 1 , day 2 , week 6 , week 12 , 6 months , and 1 year were measured . Patients receiving DA THA  had significantly higher functional scores during the early period following surgery . The difference in functional scores leveled out at 6 months Background For total hip arthroplasty ( THA ) , minimally invasive surgery ( MIS ) uses a smaller incision and less muscle dissection than the classic approach ( CLASS ) , and may lead to faster rehabilitation . Questions / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization sequence was stratified for two groups of surgeons , ie , those using a posterolateral approach ( PL-CLASS or PL-MIS ) and those using an anterolateral approach ( AL-CLASS or AL-MIS ) . Length of the incisions was 18 cm for the CLASS procedures . MIS incisions were extended at the skin level to 18 cm at the end of the procedure . The primary end point was the Harris hip score ( HHS ) at 6 weeks postoperatively . Patient-centered question naires were obtained preoperatively and after 6 weeks and 1 year . Results For the patients in the MIS group ( average 7.8 cm incision length ) , statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year . This difference was small and mainly caused by the favorable results of the PL-MIS . In the MIS group , surgical time was longer . A learning curve was observed based on operation time and complication rate . Although not statistically significant , the perioperative complication rate was rather high in the ( anterolateral ) MIS group . Conclusions The minimal invasive approach in THA did not show a clinical ly relevant superior outcome in the first postoperative year . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence The purpose of this retrospective study was to compare wound complication rates between primary THAs performed via a posterior or direct anterior approach .  From our prospect i ve outcomes registry , we identified 1288 primary THAs performed via a posterior approach and 505 via a direct anterior approach .  The direct anterior approach result ed in a significantly greater number of wound complications that required reoperation than the posterior approach ( 7/505 ( 1.4 % ) vs. 3/1,288 ( 0.2 % ) , P=0.007 ) . As such , patients should be counseled on the potential increased risk of early wound complications with the direct anterior approach , and future research is needed to determine if alternative closure techniques can reduce the risk of wound complication BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments Abstract Despite the high number of total hip arthroplasty ( THA )  procedures performed each year , there is no common consensus on the best surgical approach . Gait is known to improve following THA although it does not return to what is typically quantified as normal , and surgical approach is believed to be a contributing factor . The current study evaluates post-operative hip function  and provides an objective assessment following two common surgical approaches : the McFarl and —Osborne direct lateral and the southern posterior .  Faced with the common problem of providing an objective comparison from the wealth of data collected using motion analysis techniques , the current study investigates the application of an objective classification tool to provide information on the effectiveness of each surgery and to differentiate between the characteristics of hip function following the two approaches . Seven inputs for the classifier were determined through statistical analysis of the biomechanical data . The posterior approach group exhibited greater characteristics of non-pathological gait and displayed a greater range of functional ability as compared with the lateral approach cohort . The classification tool has proved to be successful in characterizing non-pathological and THA function but was insufficient in distinguishing between the two surgical cohorts Patients without prior hip surgery and body mass index lower than 30 undergoing primary total hip arthroplasty were eligible to participate in a r and omized prospect i ve study comparing a minimally invasive with a st and ard approach . The patients were r and omized  to receive incisions  of 8 cm ( group A , n = 28 ) or 15 cm ( group B , n = 32 ) . The groups were similar demographically . Patients in group A had significantly less intraoperative blood loss ( P < .003 ) and less total blood loss ( P < .009 ) . Fewer patients in group A limped at 6 weeks ( P < .04 ) . Operative time , transfusion requirements , narcotic usage , length of hospital stay , achievement of rehabilitation milestones , cane usage , and complications were similar in both groups . There was no difference between the groups at 1- and 2-year follow-up . Compared with a st and ard incision , patients who underwent a minimally invasive total hip arthroplasty demonstrated decreased blood loss and limped less at 6-week follow-up Surgical approach for total hip arthroplasty ( THA ) is determined by clinician preference from limited prospect i ve data . This study aim ed to examine the effect of surgical approach ( direct lateral , posterior , and anterolateral ) on 6-week postoperative gait mechanics . Thirty-five patients ( direct lateral , 8 ; posterior , 12 ; anterolateral , 15 ) were tested preoperatively and 6 weeks after THA .  Patients underwent a gait analysis at a self-selected walking speed . A 2-way analysis of variance was used for analysis . Stride length , step length , peak hip extension , and walking speed increased after THA . The 3 surgical approach variables were not significantly different for any of the study variables after THA . All patients showed some increase in selected variables after THA regardless of surgical approach . In this study , surgical approach did not appear to significantly influence the early postoperative gait mechanics that were quantified The mini-posterior approach for total hip arthroplasty ( THA )  belongs to the mini-incision approaches . In comparison to st and ard approaches , less muscle trauma result ing in less pain , less blood loss and faster rehabilitation in the early postoperative period are attributed to this approach , as known for all other minimally invasive approaches . In a prospect i ve study of 100 cases of THA it could be shown that this is true when comparing the mini-posterior approach with the posterolateral approach . Lower levels of muscle enzymes as a parameter for muscle trauma , could not be seen In this prospect i ve study we compared clinical and radiological results and rehabilitation progress of 64 patients who underwent total hip arthroplasty using the st and ard lateral approach with 64 patients operated with a minimal-invasive ( MIS ) posterior approach .  The outcome of our study did not show any significant differences with regard to patient 's safety such as complication rate and radiological assessment of the cup position . There was no difference in the duration of surgery , blood loss , hospital stay and postoperative leg length discrepancy . Rehabilitation milestones were achieved earlier by MIS patients and three and six months postoperatively , the Harris Hip Score of the MIS group was significantly higher The benefits of different surgical approaches for total hip arthroplasty continue to be debated . One hundred patients were prospect ively enrolled and r and omized into 2 groups . One group underwent total hip arthroplasty through a single-incision modified Smith-Peterson approach , whereas the other group  underwent total hip arthroplasty through a direct lateral approach . All patients received the same postoperative protocol . Evaluation included operative time , estimated blood loss , analgesia requirement , transfusions , and length of stay . Functional outcome was assessed preoperatively and postoperatively . Up to 1-year follow-up , the direct anterior group demonstrated significantly better improvement in both the mental and physical health dimensions of Short Form-36 and Western Ontario McMaster Osteoarthritis Index compared with direct lateral approach group . At 2 years , the results in both groups were the same AIMS Our primary aim was to evaluate whether there is really less bleeding in patients for whom the minimally invasive posterior approach is used in comparison with the direct lateral approach for primary total hip arthroplasty . Our secondary aim was to evaluate the clinical functional results after six months as well as the postoperative radiographic result . METHODS In a comparative non-r and om prospect i ve study , 76 adult patients underwent elective total hip arthroplasty using one of two approaches . The minimally invasive posterior approach ( 34 cases ; mini-incision group ) was compared with the st and ard direct lateral approach ( 42 cases ; control group ) . RESULTS Lower total estimated bleeding ( means of 1083.5 ml versus 1682.3 ml ; p < 0.001 ) and lower intraoperative bleeding ( means of 745.6 ml versus 1282.8 ml ; p < 0.001 ) were found in the mini-incision group . There was , however , no difference in the volume of blood drained after the operation ( means of 340 ml and 399 ml ; p = 0.77 ) . There was also a difference between the two groups regarding the need for allogenic transfusion ( 8.8 % in the mini-incision group versus 28.6 % , p = 0.02 ) . We observed a better clinical result in the mini-incision group ( p = 0.002 ) despite the lack of difference between the two groups in relation to the radiographic result . DISCUSSION Our results draw attention to the possibility that other authors may have underestimated blood losses when using minimally invasive approaches . CONCLUSION The minimally invasive approach gave rise to a positive final impression with regard to lower blood loss Objective The aim of the present study was to identify independent preoperative hip function characteristics sensitive for preoperative intervention that are predictive of an extended length of hospital stay ( LOS ) after primary total hip arthroplasty ( THA ) .  Design This is a longitudinal cohort study . A retrospective chart analysis was conducted on prospect ively collected data of patients ( 158 ) who underwent unilateral primary elective cemented THA in a 4-yr period . The main outcome measure was LOS after primary THA . Results The median LOS was 6.0 days . The authors found an 18.5 % increased chance of requiring an LOS of more than 6 days ( odds ratio , 2.15 ; 95 % confidence interval , 1.03–4.50 ) for the patients who needed to use a walking aid preoperatively and a 23.6 % increased chance ( odds ratio , 2.74 ; 95 % confidence interval , 1.31–5.74 ) for the patients who had difficulties managing stairs . Sex , age , body mass index , comorbidity , and preoperative pain did not reach the level of significance in the multivariate analysis . Conclusions Patients who are at risk for a longer stay in the hospital after THA can be identified preoperatively on simple physical function characteristics . These findings enable the identification of appropriate patients for preoperative training to improve functional recovery and decrease the LOS after primary THA Purpose Total hip arthroplasty approach comparison focused on patient ’s perspective . The direct anterior approach ( DAA ) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome . However , the question if the level of DAA promotion is justified seems to be rarely posed . Methods A single-surgeon consecutive series of patients who underwent bilateral THA , one in DAA and the other in posterior approach ( PA ) .  The same implant design and same component sizes were used for the both sides . All the operations were performed by a single surgeon under the same pre- and post-operative care protocol . Results Twenty-one patients underwent bilateral THA , mean age 60.09 years .  Oxford Hip Score ( OHS ) was used for functional outcome assessment . There were no statistically significant differences between two approaches in terms of functional outcome ( mean OHS for DAA series was 42.95 and that for the PA was 43.38 , p 0.07 at an alpha level of 0.05 ) . Fifteen patients gave the advantage to PA , and six patients favoured DAA . Conclusion By study design , we tried to reduce the biases and acquire approach appraisal from patient ’s perspective . We anticipated the outcome in favour of DAA , but the results favoring PA came as a surprise . Future prospect i ve r and omized studies on evaluation of DAA and other approaches not only from surgeon ’s or industry ’s point of view , performed on a larger and more uniform groups , are warranted to further explore the subjective differences between DAA and PA Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients Surgical approaches to the hip for total hip arthroplasty ( THA ) are termed minimally invasive when allowing for a skin incision length of 10 cm or less . The aim of this study was to explore if a minimally invasive posterior approach compared to a classic anterolateral approach negatively influenced surgical time , blood loss , implant position , or perioperative complications .  Two groups of THA patients mainly differing with respect to the surgical approach were compared . Results of 76 consecutive THA via a posterior mini-incision approach were recorded prospect ively and those of 76 controls operated via a classic anterolateral approach were recorded retrospectively .  THA was performed by the same surgeon in every case . Surgical time or intraoperative blood loss were not different among the groups . Total 24-h blood loss was significantly less in patients undergoing THA via minimally invasive posterior  approaches . Median cup inclination was 45 degrees in both groups . Cup anteversion was 15 degrees ( classic anterolateral ) and 12 degrees ( minimally invasive posterior ) , respectively . Stem position was regarded as neutral in 80 % of THA through classic anterolateral and in 76 % through minimally invasive dorsal incisions . Complications occurred in 8 % ( classic anterolateral ) and 9 % ( minimally invasive posterior ) of THA patients . Surgical time , blood loss , risk of malpositioned implants , or complications were not increased for THA patients operated through minimally invasive posterior incisions compared to those operated via classic anterolateral approaches OBJECTIVE To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery .  DESIGN This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty ( THA ) .  Temporospatial , kinetic , and kinematic data as well as functional outcomes were collected . Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries . SETTING A controlled laboratory study . PARTICIPANTS This study examined 35 patients with primary , unilateral THA . The THA surgical approaches that were used in these patients included 12 direct lateral , 18 posterior , and 11 anterolateral . All the patients were assessed 1 year after THA . Patients were excluded from the study if they had contralateral hip pain or pathology , or any prior lower extremity total joint replacements . MAIN OUTCOME MEASUREMENTS Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected . In addition , a series of physical performance measures were collected . RESULTS No main effects for the physical performance measures or biomechanical variables were observed among the approach groups . Significant limb-to-limb asymmetries were observed among all the patients , with decreased sagittal plane range of motion , peak extension , and peak vertical ground reaction forces on the operative side . CONCLUSION The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable . However , 1 year after THA , the patients demonstrated asymmetric gait patterns regardless of surgical approach , which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA The purpose of this prospect i ve r and omized study was to compare the early results of primary total hip arthroplasties performed with a minimally invasive technique or a st and ard technique . A consecutive series of 70 patients who underwent primary bilateral simultaneous total hip arthroplasties was studied . All procedures were performed through a posterolateral approach . Operative times and duration of hemovac drains were significantly shorter in the group with a minimally invasive technique ( P < .05 ) . However , there was a risk of infection when using this technique . There were no any late transfusions in any of our patients postdischarge . This minimally invasive technique did not offer any advantages because the results were not different , and in our h and s , it increased our infection rate
The posterolateral approach reported the lowest value for the surgical duration .
The posterolateral approach reported the shortest hospitalization length .
The posterolateral approach reported shorter surgical duration and hospitalization length .
Concerning the analysis of total estimated blood loss , no significant result was obtained .
Despite the numerous studies , there is no consensus concerning the best approach for  total hip arthroplasty ( THA )  , and debates are ongoing .
The purpose of this study was to perform a Bayesian network meta- analysis ( NMA ) comparing several approaches for primary THA .
The focus was on peri-operative outcomes : surgical duration , total estimated blood loss , and length of the hospitalization .