Comparing the anterior, posterior and lateral approach: gait analysis in total hip arthroplasty

The choice of surgical approach for total hip arthroplasty (THA) remains a contentious issue with regards to clinical outcome optimization and restoring patient function. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis.

Patients undergoing THA for primary osteoarthritis of the hip were assigned to 1 of 3 surgical approaches: anterior, posterior and lateral. Standardized implants were used at the time of surgery. Three-dimensional gait analysis was performed preoperatively and at 6 and 12 weeks postoperatively. At each time point, we compared temporal parameters, kinematics and kinetics.

We included 30 patients in our analysis (10 anterior, 10 posterior, and 10 lateral). The groups were similar with respect to age (p = 0.27), body mass index (p = 0.16), and Charlson Comorbidity Index score (p = 0.66). Temporal parameters were similar among the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6 weeks (p = 0.041). Affected leg ipsilateral trunk lean during stance was higher in the lateral group than in the other cohorts at 6 weeks (p = 0.008) and 12 weeks (p = 0.040). The anterior and posterior groups showed increased external rotation at 6 weeks (p = 0.003) and 12 weeks (p = 0.012) compared with the lateral group.

Temporal gait parameters were similar following THA for all approaches. Differences in gait kinematics and kinetics exist; however, given the small absolute differences, the clinical importance of these changes remains undetermined.