In the January 18, 2017 issue of the Journal of Bone and Joint Surgery, Dr. Michael Meneghini and coauthors reported on revision rates following different surgical approaches to hip replacement. They found that patients who had undergone a direct anterior approach, particularly early in the learning curve for a particular surgeon, had a higher risk of revision of the femoral component when compared to a lateral or a posterior approach. The authors noted that the posterior approach was associated with a higher rate of revision for dislocation. They also noted that acetabular or socket loosening was higher with a posterior approach when compared to an anterior approach. While the surgeons in this series found a higher rate of revision of the femoral component with an anterior approach, that has not been the experience we have found.
We published our results in the 2013 Journal of Arthroplasty where we compared direct anterior approach hip replacement to posterior approach hip replacement. We found a faster recovery, reduced pain and a quicker return to work, and this difference was significant up until the three month mark after surgery. At 6 months, there did not appear to be a difference between an anterior and posterior approach. We have now followed these patients out for a minimum of five years and have found no significant change in our results. There has not been any revision of the anterior approach patients over the first 5 years. There have been no femoral loosening or revision for fracture. We are in the process of putting together our data for publication later this year.
To summarize, in our experience and the experience of many others, the anterior approach is associated with less pain, a lower dislocation rate, shorter hospital stay and more accurate placement of the implants. Upon further follow-up, there has been no deterioration of our results with the anterior approach out to five years. We continue to be proponents of this approach for hip replacement. There is definitely a learning curve that varies from surgeon to surgeon but probably is in the range of 50 cases. We have now done over 1800 direct anterior approaches and find it to be a gratifying approach to total hip replacement.