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Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis

  • Review
  • Intervention


  • Brigitte M. Jolles,

    Corresponding author
    1. University of Lausanne, Department of Orthopaedic Surgery, LAUSANNE, Switzerland
    • Brigitte M. Jolles, Department of Orthopaedic Surgery, University of Lausanne, Hôpital Orthopédique de la Suisse Romande, 4, Avenue Pierre Decker, LAUSANNE, 1005, Switzerland.

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  • Earl R. Bogoch

    1. Director, Mobility Program, St. Michael's Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Osteoarthritis (OA) of the hip is a progressive condition that has no cure and often requires a total hip arthroplasty (THA). The principal methods for THA are the posterior and direct lateral approaches. The posterior approach is considered to be easy to perform, however, increased rates of dislocation have been reported. The direct lateral approach facilitates cup positioning which may decrease rates of hip dislocation and diminishes the risk of injury to the sciatic nerve. However, there is an increased risk of limp. Dislocation of a hip prosthesis is a clinically important complication after THA, in terms of morbidity implications and costs.


To determine the risks of prosthesis dislocation, postoperative Trendelenburg gait and sciatic nerve palsy after a posterior approach, compared to a direct lateral approach, for adult patients undergoing THA for primary OA and to update the previous review made in 2003.

Search methods

MEDLINE, EMBASE, CINAHL and Cochrane databases were searched and updated, from the previous search of 2002, to Oct 13, 2005. No language restrictions were applied.

Selection criteria

Published trials comparing posterior and direct lateral surgical approaches to THA in participants 18 years and older with a diagnosis of primary hip OA.

Data collection and analysis

Retrieved articles were assessed independently by the two reviewers for their methodological quality.

Main results

Four prospective cohort studies involving 241 participants met the inclusion criteria. The primary outcome, dislocation, was reported in two studies. No significant difference between posterior and direct lateral surgical approach was found [1/77 (1.3%) versus 3/72 (4.2%); relative risk (RR) 0.35; 95% confidence intervals (CI) 0.04 to 3.22]. The presence of postoperative Trendelenburg gait was not significantly different between these surgical approaches. The risk of nerve palsy or injury (all nerves taken together) was significantly higher among the direct lateral approaches [1/43 (2%) versus 10/49 (20%); RR 0.16, 95% CI 0.03 to 0.83]. However, there were no significant differences when comparing this risk nerve by nerve for both approaches, in particular for the sciatic nerve. Of the other outcomes considered only the average range of internal rotation in extension of the hip was significantly higher (weighted mean difference 16 degrees, 95% CI 8 to 23) in the posterior approach group (mean 35°, standard deviation 13°) compared to the direct lateral approach (mean 19°, standard deviation 13°).

Authors' conclusions

The quality and quantity of information extracted from the trials performed to date are insufficient to make any firm conclusion on the optimum choice of surgical approach in adult patients undergoing primary THA for OA.








搜尋包括MEDLINE, EMBASE, CINAHL and Cochrane databases (直到2005年10)。






4個研究包含241例病患符合納入規則。有2個研究有報告髖關節脫位,兩種術式無統計差異比率分別為1/77 (1.3%) 比 /72 (4.2%); 相對風險0.35; 95% CI 0.04 to 3.22。術後Trendelenburg gait在兩種手術方式並無顯著差異。神經傷害(所有神經算在一起)或麻痺風險在側面手術方式較多,1/43 (2%)比10/49 (20%);相對風險0.16, 95% CI 0.03 to 0.83。但若神經傷害分開算,則無顯著差異,尤其是坐骨神經傷害。只考慮髖關節伸展時內旋轉角度在後方術式較高(加權平均差異WMD 16度, 95% CI 8 to 23) (平均35, 標準差13),側面術式(平均19, 標準差13)。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


此Cochrane摘要回顧了我們從研究所知道的,從後側或外側進入來開全人工髖置換手術治療退化性關節炎效果的比較。審查表明:髖部退化性關節炎: 沒有足夠的證據可以肯定是否髖關節置換手術由後(返回)或橫向(側面)方法來開哪個較好。什麼是髖部退化性關節炎和目前有哪些類型的全人工髖關節置換手術?退化性關節炎(OA)是最常見的一種關節炎,可以影響到髖部。在一些人的髖部破壞和疼痛可能嚴重到需要手術。在這些人中,髖關節可以用人工全髖關節置換手術替換掉。在全人工髖關節置換手術中,外科醫生可以從髖關節後部切開或側向切開。一些醫生認為,後切比較好,因為患者在手術後可能較少有走路的問題。其他醫生認為,側向的方式比較好,因為患者可能較少有機會造成神經損傷,和術後髖關節脫臼。髖關節脫臼會造成疼痛和患者需要到醫院去把髖部復位。本次文獻回顧結果是什麼呢?該研究患者的人工全髖關節置換手術有用後切(髖部後方)或橫向(髖關節側面)。討論由後或外側切入的好處。在作過全髖關節置換術患者: ‧後切可以提高運動範圍勝過外側切入 ‧後切和外切可改善功能能力大致相同,但沒有足夠的證據來肯定這些好處。 全人工髖關節置換術後切和外切的方式造成的傷害: ‧後切或外切在術後髖關節脫臼的機會相同 ‧後切或外切在術後走路困難的機會相同 ‧後切可能造成的神經損傷較少於外切,但沒有足夠的證據可以肯定這些傷害。














参加者241例を組み入れた4件の前方視的なコホート研究が、本レビューに含むための基準に合致した。主要アウトカムの脱臼は、2件の研究で報告されていた。後方アプローチと直接側方アプローチのあいだに有意差は確認されなかった[1/77(1.3%)と3/72(4.2%)、相対リスク(RR)0.35、95%信頼区間(CI) 0.04~3.22]。術後トレンデレンブルク歩行の有無にこれらの術法のあいだで有意差はなかった。神経麻痺または損傷のリスク(すべての神経に関して一緒にまとめて)は直接側方アプローチ群で有意に高かった[1/43(2%)と10/49(20%)、RR 0.16、95%CI 0.03~0.83]。しかしながら、このリスクを2つの術法で神経ごとに、特に坐骨神経について比較すると、有意差はなかった。検討したその他のアウトカムの中では、股関節を広げた時の内旋の平均範囲のみが、直接側方アプローチ群(平均19°、標準偏差13°)に比べて後方アプローチ群(平均35°、標準偏差13°)で有意に大きかった(加重平均差16度、95%CI 8~23)。




監  訳: 2006.10.7

実施組織: 厚生労働省委託事業によりMindsが実施した。

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Plain language summary

Total hip arthroplasty for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effects of a posterior or lateral approach in total hip replacement surgery for osteoarthritis. The review shows that:

In people with osteoarthritis of the hip, there is not enough evidence to be certain about whether the posterior (back) or the lateral (side) approach to total hip replacement surgery is better.

What is osteoarthritis of the hip and what types of total hip replacement surgery are there?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hips. In some people, the damage and pain in the hip may be severe enough for surgery. In these people, the whole hip joint can be replaced by an artificial joint with total hip replacement surgery.

In total hip replacement surgery, the surgeon can make the cut from the posterior (back) or lateral (side) of the hip. Some surgeons believe that the posterior approach is better because people may have less problems walking after surgery. Other surgeons believe that the lateral approach is better because people may have less chance of nerve damage and less chance of dislocating their hip after surgery. Dislocating a hip causes pain and people may need to go to hospital to put the hip back in place.

What are the results of this review?
People in the studies had total hip replacement surgery that was either done from the posterior (back of the hip) or from the lateral (side of the hip).

Benefits of posterior and lateral approach
In people who had total hip replacement surgery:

the posterior approach may improve range of motion more than the lateral approach
the posterior and lateral approaches may improve function about the same

But there is not enough evidence to be certain about these benefits.

Harms of posterior and lateral approach
In people who had total hip replacement surgery:

the chance of dislocating the hip after surgery may be about the same with either the posterior or lateral approach
the chance of having difficulty walking may be about the same with either the posterior or lateral approach
the posterior approach may cause less nerve damage than the lateral approach

But there is not enough evidence to be certain about these harms.

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