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The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12months follow-up. An explorative randomised controlled trial

  • Signe Rosenlund
    Correspondence
    Corresponding author at: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
    Affiliations
    Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, DK-5000 Odense C, Denmark

    Department of Orthopaedic Surgery and Traumatology, Zealand University Hospital, Lykkebækvej 1, DK-4600 Køge, Denmark
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  • Leif Broeng
    Affiliations
    Department of Orthopaedic Surgery and Traumatology, Zealand University Hospital, Lykkebækvej 1, DK-4600 Køge, Denmark
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  • Søren Overgaard
    Affiliations
    Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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  • Carsten Jensen
    Affiliations
    Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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  • Anders Holsgaard-Larsen
    Affiliations
    Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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      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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      References

        • Amlie E.
        • Havelin L.I.
        • Furnes O.
        • Baste V.
        • Nordsletten L.
        • Hovik O.
        • et al.
        Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1476 patients 1–3 years after surgery.
        Acta Orthop. 2014; 85: 463-469
        • Arthursson A.J.
        • Furnes O.
        • Espehaug B.
        • Havelin L.I.
        • Soreide J.A.
        Prosthesis survival after total hip arthroplasty-does surgical approach matter? Analysis of 19,304 Charnley and 6002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register.
        Acta Orthop. 2007; 78: 719-729
        • Bennett D.
        • Humphreys L.
        • O'Brien S.
        • Orr J.
        • Beverland D.E.
        Temporospatial parameters of hip replacement patients ten years post-operatively.
        Int. Orthop. 2009; 33: 1203-1207
        • Bergh I.
        • Sjostrom B.
        • Oden A.
        • Steen B.
        An application of pain rating scales in geriatric patients.
        Aging (Milano). 2000; 12: 380-387
        • Berstock J.R.
        • Blom A.W.
        • Beswick A.D.
        A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty.
        Ann. R. Coll. Surg. Engl. 2015; 97: 11-16
        • Chechik O.
        • Khashan M.
        • Lador R.
        • Salai M.
        • Amar E.
        Surgical approach and prosthesis fixation in hip arthroplasty world wide.
        Arch. Orthop. Trauma Surg. 2013; 133: 1595-1600
        • Cimolin V.
        • Galli M.
        Summary measures for clinical gait analysis: a literature review.
        Gait Posture. 2014; 39: 1005-1010
        • Cimolin V.
        • Galli M.
        • Vimercati S.L.
        • Albertini G.
        Use of the Gait Deviation Index for the assessment of gastrocnemius fascia lengthening in children with Cerebral Palsy.
        Res. Dev. Disabil. 2011; 32: 377-381
        • Cohen J.
        A power primer.
        Psychol. Bull. 1992; 112: 155-159
        • Downing N.D.
        • Clark D.I.
        • Hutchinson J.W.
        • Colclough K.
        • Howard P.W.
        Hip abductor strength following total hip arthroplasty: a prospective comparison of the posterior and lateral approach in 100 patients.
        Acta Orthop. Scand. 2001; 72: 215-220
        • Esbjornsson A.C.
        • Rozumalski A.
        • Iversen M.D.
        • Schwartz M.H.
        • Wretenberg P.
        • Brostrom E.W.
        Quantifying gait deviations in individuals with rheumatoid arthritis using the Gait Deviation Index.
        Scand. J. Rheumatol. 2014; 43: 124-131
        • Ewen A.M.
        • Stewart S.
        • St Clair Gibson A.
        • SN K.
        • Caplan N.
        Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis.
        Gait Posture. 2012; 36: 1-6
        • Foucher K.C.
        • Hurwitz D.E.
        • Wimmer M.A.
        Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients.
        J. Biomech. 2007; 40: 3432-3437
        • Frison L.
        • Pocock S.J.
        Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design.
        Stat. Med. 1992; 11: 1685-1704
        • Galli M.
        • Cimolin V.
        • De Pandis M.F.
        • Schwartz M.H.
        • Albertini G.
        Use of the Gait Deviation index for the evaluation of patients with Parkinson's disease.
        J. Mot. Behav. 2012; 44: 161-167
        • Gore D.R.
        • Murray M.P.
        • Sepic S.B.
        • Gardner G.M.
        Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion.
        Clin. Orthop. Relat. Res. 1982; 180–7
        • Gorton 3rd, G.E.
        • Hebert D.A.
        • Gannotti M.E.
        Assessment of the kinematic variability among 12 motion analysis laboratories.
        Gait Posture. 2009; 29: 398-402
        • Hassan B.S.
        • Doherty S.A.
        • Mockett S.
        • Doherty M.
        Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis.
        Ann. Rheum. Dis. 2002; 61: 422-428
        • Holnapy G.
        • Illyes A.
        • Kiss R.M.
        Impact of the method of exposure in total hip arthroplasty on the variability of gait in the first 6 months of the postoperative period.
        J. Electromyogr. Kinesiol. 2013; 23: 966-976
        • Hoppenfeld S.
        • de Boer P.
        • Buckley R.
        Surgical Exposures in Orthopaedics. The Anatomic Approach.
        The Hip, Fourth Edition, Lippinoctt Williams & Wilkins2009
        • Jensen C.
        • Penny J.O.
        • Nielsen D.B.
        • Overgaard S.
        • Holsgaard-Larsen A.
        Quantifying Gait quality in patients with large-head and conventional total hip arthroplasty-A prospective cohort study.
        J. Arthroplast. 2015; 30 (e1): 2343-2348
        • Jensen C.
        • Rosenlund S.
        • Nielsen D.B.
        • Overgaard S.
        • Holsgaard-Larsen A.
        The use of the Gait Deviation Index for the evaluation of participants following total hip arthroplasty: an explorative randomised trial.
        Gait Posture. 2015; 42: 36-41
        • Jensen C.
        • Aagaard P.
        • Overgaard S.
        Recovery in mechanical muscle strength following resurfacing vs standard total hip arthroplasty - a randomised clinical trial.
        Osteoarthr. Cartil. 2011; 19: 1108-1116
        • Jolles B.M.
        • Bogoch E.R.
        Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis.
        Cochrane Database Syst. Rev. 2006; (Cd003828)
        • Kiyama T.
        • Naito M.
        • Shinoda T.
        • Maeyama A.
        Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches.
        J. Arthroplast. 2010; 25: 76-80
        • Learmonth I.D.
        • Young C.
        • Rorabeck C.
        The operation of the century: total hip replacement.
        Lancet. 2007; 370: 1508-1519
        • Lindgren J.V.
        • Wretenberg P.
        • Karrholm J.
        • Garellick G.
        • Rolfson O.
        Patient-reported outcome is influenced by surgical approach in total hip replacement: a study of the Swedish Hip Arthroplasty Register including 42,233 patients.
        Bone Joint. J. 2014; 96-B: 590-596
        • Maanum G.
        • Jahnsen R.
        • Stanghelle J.K.
        • Sandvik L.
        • Larsen K.L.
        • Keller A.
        Face and construct validity of the Gait Deviation Index in adults with spastic cerebral palsy.
        J. Rehabil. Med. 2012; 44: 272-275
        • Madsen M.S.
        • Ritter M.A.
        • Morris H.H.
        • Meding J.B.
        • Berend M.E.
        • Faris P.M.
        • et al.
        The effect of total hip arthroplasty surgical approach on gait.
        J. Orthop. Res. 2004; 22: 44-50
        • Masonis J.L.
        • Bourne R.B.
        Surgical approach, abductor function, and total hip arthroplasty dislocation.
        Clin. Orthop. Relat. Res. 2002; 46–53
        • McGrory B.J.
        • Morrey B.F.
        • Cahalan T.D.
        • An K.N.
        • Cabanela M.E.
        Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty.
        J. Bone Joint Surg. (Br.). 1995; 77: 865-869
        • Moher D.
        • Hopewell S.
        • Schulz K.F.
        • Montori V.
        • Gotzsche P.C.
        • Devereaux P.J.
        • et al.
        CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.
        BMJ. 2010; 340: c869
        • Mulliken B.D.
        • Rorabeck C.H.
        • Bourne R.B.
        • Nayak N.
        A modified direct lateral approach in total hip arthroplasty: a comprehensive review.
        J. Arthroplast. 1998; 13: 737-747
        • Nankaku M.
        • Tsuboyama T.
        • Kakinoki R.
        • Kawanabe K.
        • Kanzaki H.
        • Mito Y.
        • et al.
        Gait analysis of patients in early stages after total hip arthroplasty: effect of lateral trunk displacement on walking efficiency.
        J. Orthop. Sci. 2007; 12: 550-554
      1. Plug-in gait product guide – foundation notes.
        Vicon Motion Systems, Oxford2010 (http://www.irc-web.co.jp/vicon_web/news_bn/PIGManualver1.pdf)
        • Queen R.M.
        • Schaeffer J.F.
        • Butler R.J.
        • Berasi C.C.
        • Kelley S.S.
        • Attarian D.E.
        • et al.
        Does surgical approach during total hip arthroplasty alter gait recovery during the first year following surgery?.
        J. Arthroplast. 2013; 28: 1639-1643
        • Rabe-Hesketh S.
        • Skrondal A.
        Multilevel and Longitudinal Modeling Using Stata.
        Stata Press, Second Edition2008
        • Rasch A.
        • Dalen N.
        • Berg H.E.
        Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA.
        Acta Orthop. 2010; 81: 183-188
        • Rasmussen H.M.
        • Nielsen D.B.
        • Pedersen N.W.
        • Overgaard S.
        • Holsgaard-Larsen A.
        Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: intra-rater reliability and agreement across two repeated sessions.
        Gait Posture. 2015; 42: 133-137
        • Rosenlund S.
        • Broeng L.
        • Jensen C.
        • Holsgaard-Larsen A.
        • Overgaard S.
        The effect of posterior and lateral approach on patient-reported outcome measures and physical function in patients with osteoarthritis, undergoing total hip replacement: a randomised controlled trial protocol.
        BMC Musculoskelet. Disord. 2014; 15: 354
        • Schwartz M.H.
        • Rozumalski A.
        The Gait Deviation Index: a new comprehensive index of gait pathology.
        Gait Posture. 2008; 28: 351-357
        • Schwartz M.H.
        • Rozumalski A.
        • Trost J.P.
        The effect of walking speed on the gait of typically developing children.
        J. Biomech. 2008; 41: 1639-1650
        • van der Esch M.
        • Holla J.F.
        • van der Leeden M.
        • Knol D.L.
        • Lems W.F.
        • Roorda L.D.
        • et al.
        Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study.
        Arch. Phys. Med. Rehabil. 2014; 95: 1962-1968
        • Whatling G.M.
        • Dabke H.V.
        • Holt C.A.
        • Jones L.
        • Madete J.
        • Alderman P.M.
        • et al.
        Objective functional assessment of total hip arthroplasty following two common surgical approaches: the posterior and direct lateral approaches.
        Proc. Inst. Mech. Eng. H. 2008; 222: 897-905
        • Widler K.S.
        • Glatthorn J.F.
        • Bizzini M.
        • Impellizzeri F.M.
        • Munzinger U.
        • Leunig M.
        • et al.
        Assessment of hip abductor muscle strength. A validity and reliability study.
        J. Bone Joint Surg. Am. 2009; 91: 2666-2672
        • Winther S.B.
        • Husby V.S.
        • Foss O.A.
        • Wik T.S.
        • Svenningsen S.
        • Engdal M.
        • et al.
        Muscular strength after total hip arthroplasty.
        Acta Orthop. 2015; 86: 1-7