Should Mrs. Jones Have a Hip Joint Replacement Using the Posterior Approach?Doctor No. 1: Mrs. Jones needs a total hip replacement. I think we'll use the posterior approach and come in from behind. There's less blood loss, and it's easy to get to the hip.
Doctor No. 2: That may not be such a good idea. She's more likely to dislocate after a posterior operation. In fact, studies show the dislocation rate is two to three times higher than when the hip is put in from the front (anterior approach).
Doctor No. 1: There isn't a lot of agreement from various studies which way is best. I don't think a posterior approach has to mean dislocation. It depends on how we put the implant in and how well Mrs. Jones follows our instructions.
Doctor No. 2: I just read a study done by three doctors who replace the joint using a posterior operation. They repair the backside of the joint capsule after cutting into it. They also reattach the short muscles that rotate the hip. The soft-tissue repair seems to make a big difference in the number of hip dislocations.
Doctor No. 1: Really? Tell me more about the results.
Doctor No. 2: Dislocations only occurred in eight of the 945 total hip replacements put in using the posterior approach. That's less than one percent. Other studies report a range from one to nine percent with a posterior approach and up to three percent with an anterior method. In this study, two hips dislocated because of a traumatic injury. Only two of the eight had a second operation to revise the hip.
Doctor No. 1: So with the right-sized implant put in with good alignment, we can reduce the number of dislocations when using a posterior approach?
Doctor No. 2: Yes, so long as we make repairs to the soft tissues that are cut in the process. Let's go over our exam findings and see if she's a good candidate otherwise for a posterior approach.
Doctor No. 1: Great idea. I'll get her chart and meet you back here in five minutes.
Steven H. Weeden, MD, et al. The Early Dislocation Rate in Primary Total Hip
Arthroplasty Following the Posterior Approach with Posterior Soft-Tissue Repair. In The Journal of Arthroplasty. September 2003. Vol. 18. No. 6. Pp. 709-713.
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