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Abstract

Lateral Hardinge’s versus Posterior Southern Moore’s Approach in Total Hip Arthroplasty-A Prospective Cohort Study

Introduction:

Degenerative hip disorders are one of the most common and debilitating musculoskeletal disorders with increased morbidity and decreased quality of life. Total hip arthroplasty is a novel surgical procedure which has relieved millions of people from incapacitating pain arising from the hip joint. Posterior approach for total hip arthroplasty is the most commonly performed surgery with ease to operate with less tissue dissection and blood loss, whereas lateral approach is having an advantage of better exposure of acetabulum and fewer chances of dissection at the cost of extensive tissue dissection.

Objective:

To study the functional outcome and the complications associated with total hip arthroplasty by Hardinge’s vs Moore’s approach using a modular prosthesis.

Materials and Methods:

The selection of patients was randomized by selecting every alternate case of degenerative hip disease by Hardinge ’ s (Group ‘ L ’ ) or Moore’s (Group ‘P’) approach. We recruited 89 cases for this study and all cases were operated by the same surgeon. The preoperative, intraoperative parameters and postoperative events were compared with both the surgical approaches. All patients were followed up regularly according to our study protocol and were evaluated functionally with Modified Harris’ Hip scores.

Results:

The functional evaluation with Modified Harris hip score showed excellent results in 32 patients (68.08%), good in 13 patients (27.65%) and poor in 2 patients (4.25%) in group ‘L’and excellent in 26 patients (61.90%), good in 13 patients (30.95%) and poor in 3 patients (7.14%) in Group ‘P’. The complications rate was higher in group ‘P’when compared to Group ‘ L ’ . With proper patient selection, adequate planning, armamentarium and meticulous surgical technique, we have achieved results comparable to other authors. Long term studies are necessary to study the late complications and to prove the efficacy of the implants and procedure. The correlation analysis with Spearman’s Rank correlation coefficient showed a highly positive correlation between Hardinge’s approach (Group ‘L’) and complications (rho ‘ρ’= 0.83) than the moderately positive correlation between Moore’s approach (Group ‘P’) and complications(rho ‘ρ’=0.59). There is a significant statistical difference between surgical approach (Hardinge’s and Moore’s) and complications between two groups with p<0.05.

Conclusion:

We conclude that Hardinge’s approach for total hip arthroplasty using a modular prosthesis is a rewarding procedure with excellent exposure of proximal femur and acetabulum which avoids trochanteric osteotomy and can be used for primary or revision procedures and it permits early mobilization of the patient following surgery.


Author(s): Madhan Jeyaraman*, Ravinath TM, Ajay SS, Sabarish K and Ravi Weera AV

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