Short-term comparison of postural effects of three minimally invasive hip approaches in primary total hip arthroplasty: Direct anterior, posterolateral and Röttinger

Abstract

Introduction: There is renewed interest in total hip arthroplasty (THA) with the development of minimally invasive approaches. The anterior and Röttinger approaches are attractive for their anatomical and minimally invasive character, but with no comparative studies in the literature definitely suggesting superiority in terms of quality of functional recovery. We therefore performed a case-control study, assessing: 1) whether the postural parameters of patients operated on with the anterior, Röttinger and posterior minimally invasive approaches were similar to those of asymptomatic subjects, and 2) whether there were any differences in postural parameters between the three approaches at short-term follow-up.

Hypothesis: We hypothesized that the anterior and Röttinger approaches are less disruptive of postural parameters than the posterior approach.

Methods: Seventy subjects (44 primary THA patients and 26 asymptomatic control subjects) were enrolled. Operated subjects were divided into 3 experimental groups corresponding to the 3 minimally invasive approaches: posterior (n=14), anterior (n=15) and Röttinger (n=15). Two single-leg stance tests (left followed by right leg stance; 10s per test) were carried out on a stabilometric platform, within 2months after surgery for all THA patients, and for controls. Six significant parameters were selected for statistical analysis: test performance, mediolateral and anteroposterior displacements of the center of pressure (CP), path length, average CP displacement speed, and the ellipse containing 95% of CP projections. Non-parametric statistical tests were used to compare groups.

Results: There was no difference between the 3 study groups and the control group according to age, gender, BMI, or side (or between study groups regarding WOMAC score). No significant differences between approaches were found for success on postural tests (P=0.14). Subjects operated on with the anterior or Röttinger approach showed significant differences from asymptomatic subjects for 2 postural parameters: path length (Röttinger P=0.04, anterior P=0.03) and average CP displacement speed (Röttinger P=0.04, anterior P=0.03). Subjects operated on through the posterior approach showed no significant differences from asymptomatic subjects.

Discussion: The study hypothesis, that the anterior and Röttinger approaches for hip arthroplasty are less disruptive of postural parameters than the posterior approach, was not confirmed. The anterior and Röttinger approach groups showed higher average CP displacement speed and path length, suggesting that they use up more energy resources to maintain static balance. The posterior approach had the least impact on postural parameters in the first 2 postoperative months.

Level of evidence: III, case-control study.

Keywords: Minimally invasive approaches; Static postural balance; Total hip arthroplasty.