Download Mini-Posterior- Better From the Back? Anterior vs. Posterior

11/18/2015
Mini-PosteriorBetter From the Back?
Ken Mathis, MD
Associate Professor
University of Texas Health Science Center Houston
Department of Orthopedics
Disclosures
Zimmer: royalties, Joint Development, LLC: consulting
Anterior vs. Posterior
My Experience: 2001-2006
DA Disadvantages
• Special table(s) $$$$ (run 2
rooms?)
• Longer surgical times and
set up time
• Learning curve issues
• Table can break
• How good are you at
extensile app for DA?
• Intraoperative fluoroscopy
and wear lead
DA Marketing Issues
• Google search yielded
222,000 results
• Over 60% are private
practice MD’s
• No long term follow up data
• False claims not supported
– better outcomes, “no muscle
cut”, more rapid recovery
– Reminds me of the patented
MIS “two incision ” claims
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Anterior vs. Posterior Approach for Total Hip
Arthroplasty, a Systematic Review and Metaanalysis
Higgins, et.al. JOA 30(2015)
• 17 studies totaling 2302 participants
• Pooled data showed difference in LOS and
dislocations favoring DA approach
• Postop pain and function
– Anterior approach favored in only 4 studies
• “No clear superiority of either approach”
Dislocations
Blood Loss and Wounds
Higgins, et.al.
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Fractures and OR Time
Higgins, et.al.
• 222 consecutive patients
– Same implants used
• 126 DA and 96 MP
• Both experienced surgeons
– DA over 300 cases experience
– MP older, experienced
Direct Anterior
• DA at 14 days had
higher VAS pain scores,
more req. gait aids
• @ 8 weeks had HHS=95,
but lower return to
work, and driving
Mini Posterior
• MP had shorter OR time
• @ 8 weeks HHS=89
• More superficial wound
problems (none
required return to OR)
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No Differences
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component position,
LOS,
DC home,
feet walked,
ADL’s
OR Time
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Assume extra 20 minutes avg per case
Busy surgeon with 250 hips/yr
250 X 20 = 5,000 minutes (83.3 hours/yr)
Assume avg 54 minutes/case for posterior THR
5,000 min/54 min per case = 92.6 extra cases
93 cases @ $1400/case = $130,200/yr
10 more years of practice X $130,200 =
$1,302,000
Conclusions
• No clear differences for any parameter in the
best clinical trial done at Mayo Clinic
• Equivalent results are possible with either
approach
• For me to wear lead all day, get irradiated, and
spend more time in the OR, results need to be
significantly different
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Thank You
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