Highlights
- •Lateral and posterior approaches are commonly used for total hip arthroplasty.
- •Lateral approach may cause reduced hip muscle strength and altered gait pattern.
- •A randomized controlled trial comparing lateral and posterior approaches.
- •We found no difference in the overall gait function between groups.
- •Patients in the posterior approach group improved more in abductor muscle strength.
Abstract
Background
The lateral and the posterior approach are the most commonly used procedures for total
hip arthroplasty. Due to the detachment of the hip abductors, lateral approach is
claimed to cause reduced hip muscle strength and altered gait pattern. However, this
has not been investigated in a randomised controlled trial. The aim was to compare
the efficacy of total hip arthroplasty performed by lateral or posterior approach
on gait function and hip muscle strength up to 12 months post-operatively. We hypothesised that posterior approach would be superior
to lateral approach.
Methods
Forty-seven patients with primary hip osteoarthritis were randomised to total hip
arthroplasty with either posterior or lateral approach and evaluated pre-operatively,
3 and 12 months post-operatively using 3-dimensional gait analyses as objective measures of
gait function, including Gait Deviation Index, temporo–spatial parameters and range
of motion. Isometric maximal hip muscle strength in abduction, flexion and extension
was also tested.
Findings
Post-operatively, no between-group difference in gait function was observed. However,
both hip abductor and flexor muscle strength improved more in the posterior approach
group: −0.20(Nm/kg)[95%CI:−0.4 to 0.0] and −0.20(Nm/kg)[95%CI:−0.4 to 0.0], respectively.
Interpretation
Contrary to our first hypothesis, the overall gait function in the posterior approach
group did not improve more than in the lateral approach group. However, in agreement
with our second hypothesis, patients in the posterior approach group improved more
in hip abductor and flexor muscle strength at 12 months. Further investigation of the effect of reduced maximal hip muscle strength
on functional capacity is needed.
ClinicalTrials.gov. No.: NCT01616667
Keywords
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Article Info
Publication History
Published online: September 30, 2016
Accepted:
September 29,
2016
Received:
February 2,
2016
Identification
Copyright
© 2016 Elsevier Ltd. All rights reserved.
