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Abstract

Introduction

Most total hip arthroplasties (THAs) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery.

Methods

A retrospective cohort study of 205 patients who underwent revision THA for aseptic loosening. Patients rated their pain from 0-10 and completed the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), WOMAC and Short form-12 questionnaires.

Results

205 patients (209 hips) from a cohort of 238 patients (243 hips, 86%) were available for analysis. The mean follow-up was 5 years (SD 1.71). Grouping by approach 20% (43/209) had both primary and revision procedures via a lateral approach, 20% (43/209) had their primary surgery via a lateral approach and their revision surgery via a posterior approach, whilst 60% (123/209) had both procedures via a posterior approach. The WOMAC and OHS were significantly better in patients who had a posterior approach for both primary and revision surgery, compared to those that did not (OHS p = 0.028, WOMAC p = 0.026). We found no significant differences in pain, satisfaction or health-related quality of life between the groups.

Discussion

Choice of approach for revision hip arthroplasty is influenced by a number of factors, but in clinical situations where either a lateral or posterior approach could be used, the posterior approach appears to be associated with better joint-specific outcomes. Registry data may help further explore the associations between surgical approach and the outcome from revision THA.

Keywords

Arthroplasty Hip Joint patient outcome assessment Replacement Revision

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References

National Joint Registry for England, Wales and Northern Ireland. 11^th Annual Report. National Joint Registry for England, Wales and Northern Ireland; 2014. Available at: http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2011th%20Annual%20Report%202014.pdf. Accessed September 2016.

Jolles

B.M.

, Bogoch

E.R.

Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis.

Cochrane Database Syst Rev. 2006; 19(3): CD003828.

Park

Y.S.

, Moon

Y.W.

, Lim

B.H.

, Shon

M.S.

, Lim

S.J.

A comparative study of the posterolateral and anterolateral approaches for isolated acetabular revision.

Arch Orthop Trauma Surg. 2011; 131(7): 1021–1026.

Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2013. Available at: https://aoanjrr.sahmri.com/annual-reports-2013. Accessed September 2016.

American Joint Replacement Registry. Annual Report 2013. Available at: https://teamwork.aaos.org/ajrr/AJRR%20Documents/AJRR_2013_Annual_Report.pdf. Accessed September 2016.

Garellick

, Karrholm

, Lindahl

, Malchau

, Rogmark

, Rolfson

Swedish Hip Arthroplasty Register, Annual Report 2013. Available at: http://www.shpr.se/en/Publications/DocumentsReports.aspx. Accessed September 2016.

Havelin

L.I.

, Furnes

, Engesaeter

. Norwegian National Advisory Unit on Arthroplasty and Hip Fractures, 2015 Annual Report. Available at: http://nrlweb.ihelse.net/Rapporter/Report2015_english.pdf. Accessed September 2016.

National Research Ethics Service. Defining research. 2007. Available from: http://www.nres.nhs.uk/EasySiteWeb/GatewayLink.aspx?alld=355.

Mahomed

, Gandhi

, Daltroy

, Katz

J.N.

The self-administered patient satisfaction scale for primary hip and knee arthroplasty.

Arthritis. 2011; 2011: 591253.

10.

Dawson

, Fitzpatrick

, Carr

, Murray

Questionnaire on the perceptions of patients about total hip replacement.

J Bone Joint Surg Br. 1996; 78(2): 185–190.

11.

Bellamy

, Buchanan

W.W.

, Goldsmith

C.H.

, Campbell

, Stitt

L.W.

Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.

J Rheumatol. 1988; 15(12): 1833–1840.

12.

Ware

Jr. , Kosinski

, Keller

S.D.

A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.

Med Care. 1996; 34(3): 220–233.

13.

Murray

D.W.

, Fitzpatrick

, Rogers

. The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007; 89(8): 1010–1014.

14.

Beard

D.J.

, Harris

, Dawson

. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2015; 68(1): 73–79.

15.

Tubach

, Ravaud

, Baron

. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005; 64(1): 29–33.

16.

SooHoo

Li Z, Chenock K, Bozic KJ. Responsiveness of Patient Reported Outcomes Measures in Total Joint Arthroplasty patients.

J Arthroplasty. 2015; 30: 176–191.

17.

Kerboull

Selecting the surgical approach for revision total hip arthroplasty.

Orthop Traumatol Surg Res. 2015; 101(1) (Suppl): S171–S178.

18.

Masterson

E.L.

, Masri

B.A.

, Duncan

C.P.

Surgical approaches in revision hip replacement.

J Am Acad Orthop Surg. 1998; 6(2): 84–92.

19.

Glassman

A.H.

Exposure for revision: total hip replacement.

Clin Orthop Relat Res. 2004; 420: 39–47.

20.

Manrique

, Chen

A.F.

, Heller

, Hozack

W.J.

Direct anterior approach for revision total hip arthroplasty.

Ann Transl Med. 2014; 2(10): 100–105.

21.

Baker

A.S.

, Bitounis

V.C.

Abductor function after total hip replacement. An electromyographic and clinical review.

J Bone Joint Surg Br. 1989; 71(1): 47–50.

22.

von Roth

, Abdel

M.P.

, Wauer

. Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint J. 2014; 96-B(12): 1618–1622.

23.

Berstock

J.R.

, Blom

A.W.

, Beswick

A.D.

A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty.

Ann R Coll Surg Engl. 2015; 97(1): 11–16.

24.

Alberton

G.M.

, High

W.A.

, Morrey

B.F.

Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options.

J Bone Joint Surg Am. 2002; 84-A(10): 1788–1792.

25.

Garbuz

D.S.

, Xu

, Sayre

E.C.

Patients’ outcome after total hip arthroplasty: a comparison between the Western Ontario and McMaster Universities index and the Oxford 12-item hip score.

J Arthroplasty. 2006; 21(7): 998–1004.

26.

Imam

M.A.

, Barke

, Stafford

G.H.

, Parkin

, Field

R.E.

Loss to follow-up after total hip replacement: a source of bias in patient reported outcome measures and registry datasets?

Hip Int. 2014; 24(5): 465–472.

Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty