Huebschmann Nathan A, Robin Joseph X, Bloom David A, Hepinstall Matthew S, Rozell Joshua C, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2025 Aug;40(8S1):S135-S142. doi: 10.1016/j.arth.2025.03.050. Epub 2025 Mar 24.
To our knowledge, outcomes of patients undergoing staged, bilateral total hip arthroplasty (THA) via dissimilar surgical approaches have not yet been investigated. This study examined demographics, implant selection, technology utilization, and component positioning between hips in patients who underwent one THA via posterior and one via direct anterior approach and secondarily evaluated patient-reported outcomes.
There were 36 patients (72 hips) who underwent staged, bilateral, primary, elective THAs via different approaches from January 2012 to December 2023. Patient demographics, intraoperative technology utilization, implants used, and preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement scores were recorded. The hip center of rotation, acetabular height and anteversion, and metaphyseal canal fill were measured on postoperative radiographs. Femoral stem coronal and sagittal plane angulation following both approaches were also compared on postoperative radiographs.
There were 15 (41.7%) patients who underwent posterior THA first. The mean time between operations was 5 years (range, 0.93 to 10.2). Intraoperative technology utilization was more common for the anterior THA (P = 0.002). There were no significant differences in hip center of rotation (P = 0.292), acetabular anteversion (P = 0.428), or acetabular height (P = 0.935) between patients' anterior and posterior approach THAs. The proportion of patients who had posterior stem angulation was significantly greater following anterior THA; neutral stem angulation was seen more frequently following posterior THA (P = 0.005). Lipped liners (P < 0.001), high offset femoral stems (P = 0.007), and dual or triple-taper stems (P < 0.001) were more commonly utilized in posterior THAs. For patients who had preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement for each hip, there was no significant difference in postoperative score improvement between anterior and posterior THAs (P = 0.697), with a mean follow-up time of 2.4 years (range, 0.3 to 9.28) for posterior and 6.1 years (range, 2.8 to 10.3) for anterior THAs (P = 0.249).
Patients undergoing staged, bilateral THAs via different surgical approaches exhibit radiographic characteristics likely attributable to technical challenges for each approach. However, these differences related to approach do not seem to impact short-term clinical and patient-reported outcomes.
据我们所知，尚未对通过不同手术入路分期进行双侧全髋关节置换术（THA）的患者的预后进行研究。本研究调查了通过后路和直接前路分别进行一次THA的患者的人口统计学特征、植入物选择、技术使用情况以及双侧髋关节组件的定位，并对患者报告的结局进行了二次评估。
2012年1月至2023年12月期间，共有36例患者（72髋）通过不同入路分期进行双侧初次择期THA。记录患者的人口统计学特征、术中技术使用情况、使用的植入物以及术前和术后的髋关节功能障碍和骨关节炎关节置换结局评分。在术后X线片上测量髋关节旋转中心、髋臼高度和前倾角以及干骺端髓腔填充情况。还在术后X线片上比较了两种入路后股骨柄在冠状面和矢状面的角度。
15例（41.7%）患者先进行了后路THA。两次手术之间的平均时间为5年（范围为0.93至10.2年）。术中技术在前路THA中使用更为普遍（P = 0.002）。患者前路和后路THA的髋关节旋转中心（P = 0.292）、髋臼前倾角（P = 0.428）或髋臼高度（P = 0.935）之间无显著差异。前路THA后出现后倾柄角度的患者比例明显更高；后路THA后中性柄角度更为常见（P = 0.005）。唇缘衬垫（P < 0.001）、高偏心距股骨柄（P = 0.007）和双锥或三锥柄（P < 0.001）在后路THA中使用更为普遍。对于每个髋关节均有术前和术后髋关节功能障碍和骨关节炎关节置换结局评分的患者，前路和后路THA术后评分改善无显著差异（P = 0.697），后路THA的平均随访时间为2.4年（范围为0.3至9.28年），前路THA为6.1年（范围为2.8至10.3年）（P = 0.249）。
通过不同手术入路分期进行双侧THA的患者表现出的影像学特征可能归因于每种入路的技术挑战。然而，这些与入路相关的差异似乎并未影响短期临床和患者报告的结局。
