Posterior vs lateral approach meta-analysis

A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty.

Berstock JR, Blom AW, Beswick AD. Annals of the Royal College of Surgeons of England 2015 · PMID 25519259 · doi:10.1308/003588414x13946184904008

Question

Do complication rates differ between the posterior and lateral approaches to total hip arthroplasty?

Design

Systematic review and meta-analysis of prospective controlled studies, including a small number of RCTs.

Patients

Patients undergoing primary total hip arthroplasty via a posterior or direct lateral approach.

Intervention

Posterior approach

Comparison

Lateral (Hardinge-type) approach

Primary outcome

Complications including dislocation, Trendelenburg gait, component malposition and heterotopic ossification, plus function

Key result

The posterior approach significantly reduced Trendelenburg gait and stem malposition compared with the lateral approach, with non-significant trends towards less dislocation and heterotopic ossification; neither approach gave better function.

Limitations

Few, small prospective studies of variable quality, so the evidence base is thin and a definitive trial is needed.

Impact on practice

Supports choosing the approach on surgeon experience and patient factors; the posterior approach with capsular repair remains the most common in the UK.