revision joint replacement

There has been a lot written recently about the relative strengths and weaknesses of the different approaches to carrying out a total hip replacement.

The Bone and Joint Journal published a thorough assessment recently which evaluated “five commonly used surgical approaches with respect to the incidence of surgery-related complications”, the findings of which are helpful for both patients and surgeons, when considering which approach to use.

The following five approaches were evaluated:

  • Posterior
  • Anterior
  • Direct lateral
  • Anterolateral
  • Northern approach

A number of the more common complications were then recorded against each approach. These complications included “prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture” and also the rate of revision joint replacement surgery required.

London hip surgeon Mr Simon Bridle favours the posterior approach, which comes out well in the evaluation. In fact, of all the methodological comparisons that have surfaced recently, the posterior approach is regarded positively. The report concludes: “we found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate.”

The interesting finding of this recent report is how the anterior approach fares in the comparison. There are a lot of practitioners who offer this approach and it is heavily marketed, but the data here shows that it actually comes out with the highest complication rate.

Anterior versus posterior approach to hip replacement

There are some key differences in the anterior approach versus the posterior approach, which are detailed below. These differences will ultimately be responsible for the differences in how these two approaches fare in a comparative exercise. Firstly, the incision is made in a different place. With the anterior approach, the incision is at the front of the hip whereas, with the posterior approach, it is done at the side.

The challenge for orthopaedic surgeons carrying out the anterior approach is that it is much harder to see what they are doing, compared with the ease that the posterior approach allows. This is because the anterior approach allows surgeons to work between the muscles, whereas the posterior approach involves cutting through the muscles and then repairing them once the new joint is inserted.

Although initial healing time may be faster for the anterior approach, the relative lack of complications associated with the posterior approach and how it relates to revision joint replacement is one of the reasons this approach is used by Mr Simon Bridle. To discuss the procedure in more detail, call 020 8947 9524 to arrange a consultation.