1562 - Individual Trabecula Segmentation (ITS)-Based Morphological Analysis of Second-Generation HR-pQCT Compared to Gold-Standard µCT Scans of the Human Distal Radius and Tibia

INTRODUCTION: The effectiveness of total hip replacement as a surgical intervention has revolutionized the care of degenerative conditions of the hip joint. However, the surgeon is still left with important decisions in regards to how best deliver that care with choice of surgical approach being one of them especially in regards to the short-term clinical outcome. It is however unclear if a particular surgical approach offers a long-term advantage. This study aims to determine the influence of the three main surgical approaches to the hip on patient reported outcomes and quality of life after 5 years post-surgery.METHODS: We extracted from our prospective database all the patients who underwent a Total Hip Replacement surgery for osteoarthritis or osteonecrosis between 2008 and 2012 by an anterior, posterior or lateral approach. All the pre-operative and post-operative HOOS (Hip disability and Osteoarthritis Outcome Score) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores were noted. Analysis of covariance (ANCOVAs) were used to study the relationship between amount of change in HOOS and WOMAC subscales (dependant variables) and approach used, by also including confounding factors of age, gender, ASA (American Society of Anaesthesiologists) score, Charnley score and Body Mass Index. A total of 1895 patients underwent a primary total hip arthroplasty during the considered period. Among them, 367 had pre-operative and u22655 years post operative PROM scores (19.47%) RESULTS: The mean follow-up for the study cohort was 5.3 years (range 5 to 7 years) with, 277 at 5 years, 63 at 6 years, and 27 at 7 years. In the posterior approach group we had 138 patients (37.60%), 104 in the lateral approach (28.34%) and 125 in the anterior approach (34.06%). There were no significant differences between the 3 groups concerning the Charnley classification, BMI, Gender, ASA score, side and pre-operative functional scores. But, the anterior group was significantly younger. We did not observe any significant difference in the amount of change in HOOS and WOMAC subscales between the 3 groups. There were no differences either in the post-operative scores in ultimate value.DISCUSSION: Our monocentric observational study shows that the anterior, lateral or posterior surgical approaches provide predictable and comparable outcomes on HRQL and PROMs at long-term follow-up both in terms of final outcome but also in percent improvement.This study has several limitations. We excluded patients who underwent revision surgery leaving the unanswered question of how choice of surgical approach could lead to different revision rates, which have an impact on the functional outcomes. This holds true for the risk of instability associated with a surgical approach, which cannot be commented upon as those were either excluded (i.e. underwent revision surgery) or our sample was too small. Another limitation is the impact of adjacent joint arthritis and/or other joint replacement on PROMs. We did try to address this by controlling the Charnley classification, which did not show differences between the three approaches. Moreover, even if we controlled for the most important confounders by a multivariate analysis model, there is still some involved cofounders, which could potentially lead to a bias such as smoking, socio-economical status or femoral head diameter. But we do not have any reason to think that these parameters could be unequally distributed between the three groups. Finally, our study cohort represents of 19.47% of the complete cohort. The fact that not all patients have PROM's was pre-determined as eight years ago we instituted that only 1 in 5 patients that returned their pre-operative questionnaire would get their PROM's at follow-up. So, this is missing at random. Despite this, our statistical power was sufficient. Finally, although PROMs are part of the key performing indicators for joint arthroplasty, there is evidence that from a biomechanical standpoint i.e. gait studies, surgical approaches do differ which may explain why in the short term some approaches may provide a more rapid recovery with the differences attenuating over time.SIGNIFICANCE: Our study provides valuable information in regards to the significant benefits that total hip replacement provides in regards to quality of life related outcome as well as PROMs at long-term follow-up when comparing the three most common surgical approaches. Further studies are needed to assess the role of implant design as well as pre-rehabilitation protocols in further optimizing recovery both at the short and long term.

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