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Implant Selection and Radiographic and Clinical Outcomes in Patients Receiving Staged Bilateral Total Hip
Nathan A Huebschmann1, Joseph X Robin1, David A Bloom1
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Insights
This study compared outcomes of staged bilateral total hip arthroplasty (THA) using posterior and direct anterior approaches. While radiographic differences exist, patient outcomes were similar, suggesting both approaches are effective for THA.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Outcomes of staged, bilateral total hip arthroplasty (THA) using dissimilar surgical approaches remain understudied.
- This research investigates patient demographics, implant choices, technology use, and component positioning in THA patients receiving both posterior and direct anterior approaches.
Purpose of the Study:
- To compare radiographic characteristics and patient-reported outcomes between posterior and direct anterior approach THAs in a staged bilateral setting.
- To identify any differences in implant selection and technology utilization between the two surgical approaches.
Main Methods:
- A cohort of 36 patients (72 hips) underwent staged, bilateral primary THAs using different surgical approaches (posterior and direct anterior).
- Data collected included patient demographics, intraoperative technology use, implant types, and Hip Dysfunction and Osteoarthritis Outcome Scores (HDAO S).
- Postoperative radiographs were analyzed for hip center of rotation, acetabular positioning, metaphyseal canal fill, and femoral stem angulation.
Main Results:
- Intraoperative technology utilization was more frequent with the direct anterior approach (P = 0.002).
- No significant differences were observed in hip center of rotation, acetabular anteversion, or acetabular height between the approaches.
- Posterior THAs more frequently used lipped liners, high offset stems, and dual/triple-taper stems, while posterior stem angulation was more common after anterior THA (P = 0.005).
- No significant difference in postoperative HDAO S improvement was found between the anterior and posterior approaches (P = 0.697).
Conclusions:
- Staged bilateral THAs via different surgical approaches demonstrate approach-specific radiographic variations, likely due to technical factors.
- These radiographic differences do not appear to negatively impact short-term clinical and patient-reported outcomes.
Background:
To our knowledge, outcomes of patients undergoing staged, bilateral total hip arthroplasty (THA) via dissimilar surgical approaches have not yet been investigated. This study examined demographics, implant selection, technology utilization, and component positioning between hips in patients who underwent one THA via posterior and one via direct anterior approach and secondarily evaluated patient-reported outcomes.
Methods:
There were 36 patients (72 hips) who underwent staged, bilateral, primary, elective THAs via different approaches from January 2012 to December 2023. Patient demographics, intraoperative technology utilization, implants used, and preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement scores were recorded. The hip center of rotation, acetabular height and anteversion, and metaphyseal canal fill were measured on postoperative radiographs. Femoral stem coronal and sagittal plane angulation following both approaches were also compared on postoperative radiographs.
Results:
There were 15 (41.7%) patients who underwent posterior THA first. The mean time between operations was 5 years (range, 0.93 to 10.2). Intraoperative technology utilization was more common for the anterior THA (P = 0.002). There were no significant differences in hip center of rotation (P = 0.292), acetabular anteversion (P = 0.428), or acetabular height (P = 0.935) between patients' anterior and posterior approach THAs. The proportion of patients who had posterior stem angulation was significantly greater following anterior THA; neutral stem angulation was seen more frequently following posterior THA (P = 0.005). Lipped liners (P < 0.001), high offset femoral stems (P = 0.007), and dual or triple-taper stems (P < 0.001) were more commonly utilized in posterior THAs. For patients who had preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement for each hip, there was no significant difference in postoperative score improvement between anterior and posterior THAs (P = 0.697), with a mean follow-up time of 2.4 years (range, 0.3 to 9.28) for posterior and 6.1 years (range, 2.8 to 10.3) for anterior THAs (P = 0.249).
Conclusions:
Patients undergoing staged, bilateral THAs via different surgical approaches exhibit radiographic characteristics likely attributable to technical challenges for each approach. However, these differences related to approach do not seem to impact short-term clinical and patient-reported outcomes.
