Speaker: Posterior approach to THA is ‘tried and tested’
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The posterior approach may be the best operative approach to primary total hip arthroplasty because it is reproducible, easy to teach, has low complication rates and minimal downsides, according to an orthopedic hip specialist.
Donald S. Garbuz, MD, MHSc, FRCSC, professor and head of the division of lower limb reconstruction and oncology at the University of British Columbia, made his case for the posterior approach to primary THA during a debate at the Current Concepts in Joint Replacement Winter Meeting.
Garbuz noted seven points to consider when choosing either the direct anterior approach (DAA) or the posterior approach to THA: ease, safety, exposure, implant fixation, recovery, stability and function.
“[The posterior approach] is easily taught. It is relatively bloodless. You get a good view of both the socket and femur,” Garbuz said in his presentation. “It is an extensile approach – both for the femur and the acetabulum, and it is easily converted to a transfemoral approach if you need it, especially in revision surgery.”
Garbuz also cited the success of the posterior approach with instability.
“I think with modern surgical techniques including posterior repair, judicious use of dual-mobility and large heads, dislocation rate is less than 1% with the posterior approach,” he said. “In addition, when you look at the data, there might be an increase in dislocation rate with the anterior approach.”
Other disadvantages of the DAA include increased risk of infection, fractures and femoral loosening, limited fixation options and implant choices, potential for damage to the lateral femoral cutaneous nerve and “a steep learning curve,” Garbuz said. Surgeons must also have a specialized table, a minimum of two assistants and intraoperative fluoroscopy is often needed, he added.
“So, should we stick the posterior approach? My answer is yes,” Garbuz concluded. “It works. It is easy to teach. You can make it small and large, and it is tried and tested.”
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Garbuz DS. For primary THA, the best operative approach is ... posterior approach: Lowest complication rate, most reproducible. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-12, 2020 (virtual meeting).
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