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  1. 1. Seema Marshall The George Washington University Clinical Internship I
  2. 2.     Greatest during first 3 months post-op For anterior or lateral approaches – greatest risk with extension & external rotation For posterior approach – greatest risk with excessive hip flexion & internal rotation Other risk factors: age, bone loss, RA, cognitive function, component orientation, implant design
  3. 3. Anterolateral Cons Lower dislocation rate Preserves abductor function Smaller incision site Pros Posterior Better recovery immediately post-op Abductor weakness Reportedly higher dislocation rates
  4. 4. Approach Rate Posterior with soft tissue repair* 0.49-1.01% Posterior without soft tissue repair 4.46% Anterior-lateral 0.70% Direct lateral 0.43%
  5. 5. Study Talbot et al., 2002 499 patients Peak et al., 2005 265 patients Ververeli et al., 2009 81 patients Restrepo et al., ongoing 2532 patients Rate 0.6% 0.33% 0 0.15%
  6. 6.  Faster recovery ◦ Earlier ambulation ◦ Earlier return to driving   Increased patient satisfaction Less financial burden http://www.orthopedicmo tion.com/orthotics.htm http://www.handic appedequipment.or g/tag/recommende d-toilet-seatsafter-surgery/
  7. 7.    No increase in dislocation without precautions for anterior approach Dislocation rates in posterior approach with soft tissue repair are comparable to anterior approach Need further studies to confirm safety of posterior approach without precautions
  8. 8.     D’Angelo F, Murena L and Cherubino P. The unstable total hip replacement. Indian Journal of Orthopaedics. 2008; 42:252-259. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, and Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clinical Orthopaedics and Related Research. 2006; 447:34-38. Restrepo C, Mortazavi SMJ, Brothers J, Parvizi J, and Rothman RH. Hip dislocation: are hip precautions necessary in anterior approaches? Clin Orthop Relat Res. 2011; 469(2):417-422. Palan J, Beard DJ, Murray DW, Andrew JG and Nolan J. Which approach for total hip arthroplasty. Clin Orthop Relat Res. 2009; 467:473-477.