Single-incision modified Smith-Peterson approach for THA may offer benefits in early outcomes

Restrepo C. J Arthroplasty. [Published online April 9, 2010]. doi:10.1016.j.arth.2010.02.002.

Using a single, direct anterior approach is a good option for total hip arthroplasty, offering short-term benefits over a direct lateral approach, according to results of a prospective trial.

From 2005 to 2007, a team of investigators, led by William J. Hozack, MD, enrolled 100 consecutive patients and randomized them into two groups. One group underwent total hip arthroplasty (THA) through a single-incision modified Smith-Peterson approach; the second group received THA via direct lateral approach.

All patients underwent the same preoperative protocol, postoperative rehabilitation and pain management. There were 17 men and 33 women in the direct anterior group; there were 22 men and 27 women in the direct lateral group.

The investigators evaluated the patients based on operative time, estimated blood loss, analgesia requirement, transfusions and length of stay. They assessed functional outcome before and after surgery using the Harris Hip Score, the Lower Extremity Functional Score, the Western Ontario McMaster Osteoarthritis Index (WOMAC), the Linear Analog Scale Assessment, the Short-Form 36 and the mobility and locomotion subscores of the Functional Independence Measure.

At up to 1-year follow-up, the direct anterior group had significantly better improvement in the mental and physical health dimensions of the Short-Form 36 and WOMAC compared with the direct lateral approach. At 2-year follow-up, the results were the same for both groups.

“Although both groups of patients in this prospective, randomized study have excellent clinical results, there seem to be subtle advantages to the direct anterior approach as measured by outcome measurements such as the Western Ontario McMaster Osteoarthritis Index, Short-Form 36 and the Linear Analog Scale Assessment scores,” Hozack and colleagues wrote in their study.