Abstract
Background
Comparisons of patient-reported outcomes (PROs) based on surgical approach for total
hip arthroplasty (THA) in the United States are limited to series from single surgeons
or institutions. Using prospective data from a large, multicenter study, we compare
preoperative to postoperative changes in PROs between posterior, transgluteal, and
anterior surgical approaches to THA.
Methods
Patient-reported function, global health, and pain were systematically collected preoperatively
and at 1, 3, and 6 months postoperatively from patients undergoing primary THA at
26 sites participating in the Comparative Effectiveness of Pulmonary Embolism Prevention
After Hip and Knee Replacement (ClinicalTrials.gov: NCT02810704). Outcomes consisted
of the brief Hip disability and Osteoarthritis Outcome Score, the Patient-Reported
Outcomes Measurement Information System Physical Health score, and the Numeric Pain
Rating Scale. Operative approaches were grouped by surgical plane relative to the
abductor musculature as being either anterior, transgluteal, or posterior.
Results
Between 12/12/2016 and 08/31/2019, outcomes from 3018 eligible participants were examined.
At 1 month, the transgluteal cohort had a 2.2-point lower improvement in Hip disability
and Osteoarthritis Outcomes Score (95% confidence interval, 0.40-4.06; P = .017) and a 1.3-point lower improvement in Patient-Reported Outcomes Measurement
Information System Physical Health score (95% confidence interval, 0.48-2.04; P = .002) compared to posterior approaches. There was no significant difference in
improvement between anterior and posterior approaches. At 3 and 6 months, no clinically
significant differences in PRO improvement were observed between groups.
Conclusion
PROs 6 months following THA dramatically improved regardless of the plane of surgical
approach, suggesting that choice of surgical approach can be left to the discretion
of surgeons and patients without fear of differential early outcomes.
Keywords
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Article info
Publication history
Published online: October 17, 2019
Accepted:
October 8,
2019
Received in revised form:
September 29,
2019
Received:
August 3,
2019
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.10.017.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Letter to the Editor on “Patient-Reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches”The Journal of ArthroplastyVol. 35Issue 9
- PreviewFinch et al [1] set out to answer a simple but important question: Is one approach to the hip superior to any other? Three thousand patients followed prospectively should provide adequate power for their conclusion that all approaches to the hip are equally safe and effective. However, type II errors may still have been made, owing to the ceiling effect of the metrics used.
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