Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial - 30/10/20

Doi : 10.1016/j.otsr.2020.08.011

Kevin Moerenhout ^a,^b,^⁎ , Benoit Benoit ^a, Henry S. Gaspard ^c, Dominique M Rouleau ^a, G. Yves Laflamme ^a
^a Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
^b Department of Orthopaedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland
^c Orthopedic Surgery, Hull Hospital, 116, boulevard Lionel-Émond, J8Y 1W7 Gatineau, Québec, Canada

^⁎Corresponding author at: Department of Orthopaedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland.Department of Orthopaedics and Traumatology, Lausanne University Hospitalrue du Bugnon 46LausanneCH-1011Switzerland

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 30 October 2020
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Greater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections?

Hypothesis

Our hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA.

Patients and methods

A secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the anterior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach. Study outcomes were Modified Harris Hip Score (MHHS), satisfaction score, pain when lying on the affected side, and requiring an injection. Hip offset, femur lateralization and leg lengthening were measured before and after surgery.

Results

Forty-five patients were available for complete follow-up at a mean of 62 months (range: 48–74). The incidence of GTP was higher in the posterior approach [PA: 6/21 (29%) vs DAA 4/24 (17%)) (p=0.3). Patients operated through a PA experienced more pain [5/21 (24%) of patients; VAS=mean 5.3] when lying on their operated side, compared to DAA patients [2/24 (8%) of patients; VAS=mean 2) (p=0.2)]. However, MHHS, patient satisfaction with surgery, radiological assessment for hip offset, femur lateralization or leg lengthening, and injections required were similar for both approaches. Overall, satisfaction and functional outcome with surgery was significantly lower in GTP patients, regardless of the approach.

Conclusions

GTP impacts patient satisfaction and functional outcome in total hip arthroplasty patients. PA patients reported more trochanteric pain than DAA patients, which affected their clinical outcome.