HSS researchers examine 138 total hip patients: 'Incision location does not matter,' says Dr. Michael Ast

The anterior and posterior incision approaches to total hip replacement deliver equivalent outcomes, according to a study of patients treated at New York City-based Hospital for Special Surgery.

Researchers analyzed data from 138 patients who had same-day outpatient hip replacements in 2019. Patients' preoperative, intraoperative and postoperative care was the same; only the surgical approach varied. Comparison groups were matched for age and body mass index.

The study's senior author was Michael Ast, MD, a hip and knee surgeon at HSS. HSS surgeons perform about 4,000 hip replacements annually and select either the anterior or posterior approach according to their preference, training and expertise.

Six things to know:

1. Time to walking, surgery duration, pain at discharge, and complication and readmission rates at 90 days after surgery were "clinically and statistically the same" among patients regardless of the surgical approach.

2. No statistically significant differences in outcomes were found between the two groups within 90 days of surgery.

3. Neither group had reoperations.

4. Two patients in the anterior approach group experienced complications, and three patients in the posterior approach group experienced complications.

5. Early ambulation was linked to earlier discharge and decreased use of pain medication during the hospital stay for all patients.

6. Dr. Ast and his colleagues plan to rerun the analysis when they have data for 500 patients in each group. In the initial study, each group included 69 patients.

"We now have evidence to show that incision location does not matter in total hip replacement," Dr. Ast said. "What does matter is surgical expertise, careful patient selection for outpatient procedures and high-level care before, during and after surgery."

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