1) The anterior and posterior approaches for total hip arthroplasty (THA) were compared in several studies. 2) No differences were found between the approaches in terms of dislocation risk, functional outcomes, or muscle strength recovery at mid- and long-term follow up. 3) The anterior approach was associated with a longer learning curve but may have fewer femur fractures and blood loss compared to the posterior approach.

1. Anterieure vs Posterolaterale
benadering bij primaire THP
Veltman / Poolman
23 augustus 2016

2. Intro
• THP zeer succesvolle operatie
• >90% tevreden over resultaat
• Ruim 28.000 THP jaarlijks in NL
• Meest gebruikte benaderingen posterolateraal (62%), direct
lateraal (20%) en anterieur (12%)
• Optimale benadering onderwerp van discussie
• Spierkracht

3. Benadering
• Posterolateraal
• Anterieur

4. Anterieur vs Posterieur
Voordelen
• Laag luxatierisico
• Weinig spierschade
• Minder pijn postoperatief
• Snellere revalidatie
• Operatie in rugligging
Nadelen
• Langere leercurve (100pt)
• Meer femur fracturen
• Meer bloedverlies
• Langere operatieduur
• Revisie benadering
Voordelen
• Korte leercurve (50pt)
• Bewezen goede lange termijn
resultaten
• Weinig bloedverlies
Nadelen
• Meer spierschade
• Groter luxatierisico

5. PICO
• P: patiënten totale heup prothese
• I: anterieure benadering
• C: posterolaterale benadering
• O: uitkomst (OK, functie, tevredenheid, complicaties)

6. Search
• ("arthroplasty, replacement, hip"[MeSH Terms] OR
("arthroplasty"[All Fields] AND "replacement"[All
Fields] AND "hip"[All Fields]) OR "hip replacement
arthroplasty"[All Fields] OR ("total"[All Fields] AND
"hip"[All Fields] AND "arthroplasty"[All Fields]) OR
"total hip arthroplasty"[All Fields]) AND
((anterior[All Fields] AND approach[All Fields]) OR
(posterolateral[All Fields] AND approach[All
Fields]))

7. Resultaten
• 598 studies
• Higgins et al: systematic review 2015 (2 RCT, 5
prospectief vergelijkend, 10 retrospectief vergelijkend)
Sindsdien:
• Malek et al
• Maratt et al
• Winther et al

8. Uitkomsten HHS, VAS, SF36, loopafstand

10. Anterieur vs Posterieur

11. • 448 patients undergoing unilateral primary THA
• 265 patients (age 71, 117 male) direct anterior
approach
• 183 patients (age 70, 86 male) posterior approach
• No difference in age, gender, ASA grade, BMI, the
side of the operation, pre-operative Oxford Hip
Score (OHS) and attendance at ‘Joint school’.

13. • 2147 DAA THA patients were matched with PA THA based
on age, gender, BMI and ASA using data from a state joint
replacement registry

15. In 60 patients leg press and abduction strength were
evaluated 2 weeks or less preoperatively, 2 and 8 days
postoperatively, and at 6-week and 3-month follow-up.

17. Discussion
• Leercurve anterieure benadering langer
• Luxatie risico gelijk
• Anterieure benadering mogelijk meer femur fracturen en
meer bloedverlies
• Posterieure benadering langere opname (1 dag)
• Functionele uitkomst (op middel- en lange termijn) gelijk
• Beide benaderingen goede optie in ervaren handen
• Placebo effect

18. Referenties
• LROI jaarverslag 2014
• Higgins BT, et al. Anterior vs. Posterior Approach for Total Hip Arthroplasty, a
Systematic Review and Meta-analysis. The Journal of Arthroplasty 30 (2015) 419–434
• Malek IA, et al. A comparison between the direct anterior and posterior approaches for
total hip arthroplasty. Bone Joint J 2016;98-B:754–60.
• Maratt JD, et al. No Difference in Dislocation Seen in Anterior Vs Posterior Approach
Total Hip Arthroplasty. The Journal of Arthroplasty. DOI 10.1016/j.arth.2016.02.071
• Winther SB, et al. Muscular strength after total hip arthroplasty. A prospective
comparison of 3 surgical approaches. Acta Orthopaedica 2016; 87 (1): 22–28
• De Anta-Díaz B, et al. No differences between direct anterior and lateral approach for
primary total hip arthroplasty related to muscle damage or functional outcome.
International Orthopaedics (SICOT). DOI 10.1007/s00264-015-3108-9