| Abstract [eng] |
Research aim. The aim of this study was to evaluate and compare total hip arthroplasties performed via an anterior, posterior and lateral approach. To provide anatomical access, clinical outcomes, complications and long-term results specific to the approach. Objectives. 1. Anatomical and surgical comparison of total hip replacement approaches with an emphasis on soft-tissue preservation and reconstruction of the hip joint. 2. Comparison of perioperative data, early postoperative recovery of patients, complications and long-term outcomes. 3. Practical guidelines for choosing a surgical approach to total hip replacement in adults. Methods. The literature review was conducted on the PubMed and Google Scholar databases using the following keywords: (“total hip arthroplasty” OR “total hip replacement” OR “THA”) AND (“anterior approach” OR “posterior approach” OR “lateral approach”). Articles published in the last 10 years (2015-2025) in English were selected. Results. The posterior approach provides the best exposure to the hip allowing excellent access to both the acetabulum and femoral canal enabling complex reconstructions. However, the posterior approach does cut several important posterior structures which may increase the risk of postoperative hip dislocation, although a good soft-tissue closure avoids this. The lateral approaches provide a good exposure to the hip allowing posterior coverage without damaging important posterior structures. However, splitting the gluteus medius may temporarily weaken the abductors with decrease in muscle strength. Patients may have a transient change in gait that resolves within 6–12 months. The direct anterior approach to the hip joint offers a unique intermuscular and internervous space between the gluteus medius and the vastus lateralis muscle allowing abductors preservation without significant weakness. Early mobilization is possible without early postoperative pain. Potential risks to the technique include lateral femoral cutaneous nerve dysfunction. Technique can be mastered within a specific learning curve. Initial benefits of an anterior approach to total hip arthroplasty, such as quick recovery, may be negated by aggressive rehabilitation. While the specific complications of hip arthroplasty approaches are often attributed to the surgical exposure, they are more often related to the surgeon’s experience and the underlying surgical technique (tissue handling). Conclusion. No single approach has a long-term advantage. Different techniques have different profiles of early recovery and complications. Performing the technique that is chosen, a comparable functional result and component life can be achieved. The choice of appropriate surgical approach will be based on several factors including the patient and their problem, their goals, and the surgeon’s experience and ability to implement a high-quality rehabilitation program. |
