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Posterior approach may provide successful outcomes in primary, revision THA

ByCasey Tingle

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Wayne G. Paprosky

KOLOA, Hawaii — When planned carefully and used consistently, the posterior approach in primary and revision hip arthroplasty may provide outcomes similar to the direct anterior approach, according to a presenter here.

“The posterior approach is a workhorse and is still, probably, most commonly used,” Wayne G. Paprosky, MD, FACS, said in his presentation at Orthopedics Today Hawaii. “Just beware the fact that there is a learning curve and ... you have to look at everything before you make your decision to change in midstream.”

Previously published research has shown no significant difference between the anterior and posterior approaches, according to Paprosky, with similar results in cup inclination and anteversion, as well as dislocation rates.

“When the gait parameters are tested, there may be a slight improvement in the very short term in the [direct anterior approach] DAA over the posterior approach but, again, not a lot of differences,” Paprosky said. “So, I think you have to be able to do what you do best and try to avoid all the promotional issues.”

Surgeons should also stick with the approach they know when it comes to revision cases, such as an isolated acetabular revision, which Paprosky noted is the most common revision surgery and should be performed as maximally invasive instead of minimally invasive.

“If you are doing just a few revisions a year, it is probably not a good time to start doing these things that you are not familiar with,” Paprosky said. “People are familiar with the posterior approach.”

He added the posterior approach can also be used in extended a trochanteric osteotomy.

“[The posterior approach] provides a window of opportunity to do a varus remodeling, abductor tension, cement removal and removal of well-fixed stems,” Paprosky said. “You can do it, for the most part, prior to dislocation [or] after dislocation.” – by Casey Tingle

Reference:

Paprosky WG. Posterior approach for primary and revision. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.

Disclosure: Paprosky reports he receives royalties from Zimmer and Stryker; is a consultant for Zimmer, Medtronic-Salient, Stryker, Intellijoint and CeramTec; and receives medical education from DePuy Synthes.