Nancy E. Reid, MHA, DHSc, PA-C, DFAAPA
Total hip arthroplasty (THA) has been defined as the most successful surgery in the 20th century, as it is efficacious in treating pain and restoring the level of physical activity in line with the patient's age. One of the most common postoperative complications of THA is dislocation. Dislocation rates vary among specialized surgical approaches. In this study, the lowest dislocation rate among the anterolateral approach (ALA), posterolateral approach (PLA), direct lateral approach (DLA), and direct anterior approach (DAA) was examined. Each approach has associated precautions or risks that are essential to prevent dislocation in the early phases of postoperative care. The ALA risks include no early abduction, extension, or external rotation of the operative leg. The PLA cautions patients with hip flexion to 90⁰, adduction past midline and internal rotation of the affected side. The DLA patient follows precautions for no active abduction, passive adduction, or internal rotation. The DAA follows no extension, or external rotation of the operative side. This approach has the least precautions. Improved surgical technique including muscle sparing methodologies have decreased risk of dislocation overall. Patient education including preoperative classes directed by nurse navigators have also contributed to major awareness of hip precautions. Archives report increased dislocation rates for PLA compared to DLA, ALA, and DAA, but pooled data studies do not support this finding. In contemporary practice, the higher risk associated with PLA had declined and did not entail a substantial increased risk of revision surgery due to dislocation within 2 years from primary surgery compared with other approaches. The study yielded no statistically significant difference in dislocation rates among novel and deep-rooted approaches and the need for further investigation is truly warranted.
Lignore JS. Lowest Total Hip Dislocation Rates Among Anterior, Posterior, and Lateral Approaches. Lynchburg Journal of Medical Science. 2021; 3(4).
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