Comparing THA anterior and posterior approaches for gluteus medius repair: outcomes at a minimum 2-year follow-up

Abstract

Introduction:

Previous reports have shown that addressing gluteus medius (GM) tears during total hip replacement (THA) provides favourable clinical outcomes compared to cases without GM repair. However, there is limited discussion in the literature regarding the relationship between the direct anterior approach (DAA) or posterior approach (PA) and patient-reported outcomes (PROs) when performing GM repair. The purpose of this study was to evaluate and compare minimum 2-year patient-reported outcomes and survivorship between patients undergoing GM repair during DAA THA versus PA THA.

Methods:

Data from patients undergoing THA between April 2010 and December 2022 was retrospectively reviewed. Included patients had preoperative and 2-year follow-up data for the following PROs: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement HOOS-JR), Forgotten Joint Score (FJS), visual analogue scale (VAS) and patient satisfaction or a documented endpoint (revision surgery). Patients were divided by the approach used during the THA, DAA or PA, and then matched in a 1:1 ratio based on age, sex, BMI, follow-up time, and the thickness of the GM tear (<50% thickness, >50% thickness, full thickness).

Results:

26 hips in the DAA cohort were matched with 26 hips in the PA cohort. There were no significant differences in demographics, the composition and distribution of GM tears, and the use of robotic assistance between the cohorts. Both cohorts demonstrated significant improvement across all PROs (p < 0.01) while also yielding comparable postoperative PROs (p > 0.05), Forgotten Joint Score (FJS, p = 0.72), patient satisfaction (p = 0.56), rates of achieving clinically relevant thresholds (p > 0.05), and rates of revision surgery (p > 0.05).

Conclusions:

Patients undergoing THA with concomitant GM repair via either the DAA or PA demonstrated favourable functional outcomes, with a high percentage achieving clinically-relevant thresholds. Both approaches resulted in comparable levels of clinical improvement and short-term survivorship.