An investigative retrospective audit reviewing functional outcomes of antero-lateral and posterior surgical approaches in patients post THR.
(Project I A R L A)
Objectives
Total Hip Replacement (THR)has revolutionised the treatment for patients with end stage osteoarthritis, providing pain relief, improved function and quality of life. A number of surgical approaches are used with anterolateral and posterior approaches being used most commonly in our orthopaedic unit. All patients in our unit have the option to attend a rehabilitation class at 12 weeks post surgery. This audit was a retrospective review to comparing functional outcomes in Total Hip Replacement patients at week one and week 12 following both surgical approaches. Differences in early outcome may be indicative of the need to provide different rehabilitation programmes depending on surgical approach.
Methods
This was a retrospective audit of the effect of surgical approach on a range of functional outcomes in patients following total hip replacement (THR). This audit examined 63 patients in total, 45 who had the anterolateral surgical approach and 18 who underwent a posterior approach This audit was part of a larger randomised controlled trial, the results of which have been already published (Monaghan et al 2016). Data was collected on both patient groups at day 5 post surgery and repeated at 12 weeks post surgery. The main outcome measurement tool was the Western Ontario and Mc Master Universities Osteoarthritis index questionnaire. The Secondary outcome measurement tool was pain as measured by the Visual Analogue Pain scale. Other outcome measurements were completed at 12 weeks only. These included Dynamometry strength of the Hip abductors on the surgical side, Walking Speed as measured by the Six Minute Walking Test, Real time ultrasound of the Posterior Gluteus Medius on the Operated side and Physical and Mental Health scores as measured by the SF12 questionnaire.
Results
There was no significant difference found between the two groups found in any of the outcome measurements post surgery. All outcomes had improved significantly for both groups from week 1 to week 12.
Conclusion
This retrospective audit demonstrates no significant difference in functional outcome for patients following anterolateral or posterior approach total hip replacement. This supports the current practice in physiotherapy of rehabilitation for both groups using the same exercise programme.
Funding.
This project was part of a larger randomised controlled trial funded by a HRB fellowship grant from 2012-2015.
Ethics Approval
Ethical permission was ought and obtained from the Health Service Executive Dublin North East prior to commencement of the project.
