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

Jolles BM., Bogoch ER.

Summary

Total hip arthroplasty for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effects of a posterior or lateral approach in total hip replacement surgery for osteoarthritis. The review shows that:

In people with osteoarthritis of the hip, there is not enough evidence to be certain about whether the posterior (back) or the lateral (side) approach to total hip replacement surgery is better.

What is osteoarthritis of the hip and what types of total hip replacement surgery are there?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hips. In some people, the damage and pain in the hip may be severe enough for surgery. In these people, the whole hip joint can be replaced by an artificial joint with total hip replacement surgery.

In total hip replacement surgery, the surgeon can make the cut from the posterior (back) or lateral (side) of the hip. Some surgeons believe that the posterior approach is better because people may have less problems walking after surgery. Other surgeons believe that the lateral approach is better because people may have less chance of nerve damage and less chance of dislocating their hip after surgery. Dislocating a hip causes pain and people may need to go to hospital to put the hip back in place.

What are the results of this review?
People in the studies had total hip replacement surgery that was either done from the posterior (back of the hip) or from the lateral (side of the hip).

Benefits of posterior and lateral approach
In people who had total hip replacement surgery:

the posterior approach may improve range of motion more than the lateral approach
the posterior and lateral approaches may improve function about the same

But there is not enough evidence to be certain about these benefits.

Harms of posterior and lateral approach
In people who had total hip replacement surgery:

the chance of dislocating the hip after surgery may be about the same with either the posterior or lateral approach
the chance of having difficulty walking may be about the same with either the posterior or lateral approach
the posterior approach may cause less nerve damage than the lateral approach

But there is not enough evidence to be certain about these harms.