{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:56:36Z","timestamp":1782928596178,"version":"3.54.5"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Total hip replacement (THR) is clinically and cost-effective. The surgical approach employed influences the outcome; however, there is little generalisable and robust evidence to guide practice.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 723,904 primary THRs captured in the National Joint Registry, linked to hospital inpatient, mortality and patient-reported outcome measures (PROMs) data with up to 13.75\u2009years follow-up, were analysed. There were seven surgical approach groups: conventional posterior, lateral, anterior and trans-trochanteric groups and minimally invasive posterior, lateral and anterior. Survival methods were used to compare revision rates and 90-day mortality. Groups were compared using Cox proportional hazards and Flexible Parametric Survival Modelling (FPM). Confounders included age at surgery, sex, risk group (indications additional to osteoarthritis), American Society of Anesthesiologists grade, THR fixation, thromboprophylaxis, anaesthetic, body mass index (BMI) and deprivation. PROMs were analysed with regression modelling or non-parametric methods.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Unadjusted analysis showed a higher revision risk than the referent conventional posterior for the conventional lateral, minimally invasive lateral, minimally invasive anterior and trans-trochanteric groups. This persisted with all adjusted FPM and adjusted Cox models, except in the Cox model including BMI where the higher revision rate only persisted for the conventional lateral approach (hazard rate ratio (HRR) 1.12 [95% CI 1.06,1.17] <jats:italic>P<\/jats:italic>\u2009&lt;\u20090\u00b7001) and trans-trochanteric approaches (HRR 1.48 [95% CI 1.14,1.91] <jats:italic>P<\/jats:italic>\u2009=\u20090.003). PROMs demonstrated statistically, but not clinically, significant differences. Self-reported complications were more frequent with the conventional lateral approach, and the risk of 90-day mortality was higher (HRR 1.15 [95%CI 1.01\u20131.30] <jats:italic>P<\/jats:italic>\u2009=\u20090.029).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Lateral approaches for THR are associated with worse outcomes, including more deaths and revisions, than the posterior approach. We recommend the posterior approach should be considered the current standard approach for THR. Large well-designed studies are needed to assess any potential benefits from using minimally invasive posterior approaches and the conventional anterior approach.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12916-020-01672-0","type":"journal-article","created":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T01:02:28Z","timestamp":1596675748000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["The effect of surgical approach in total hip replacement on outcomes: an analysis of 723,904 elective operations from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man"],"prefix":"10.1186","volume":"18","author":[{"given":"Ashley W.","family":"Blom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda P.","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulraj S.","family":"Matharu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Reed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Whitehouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,8,6]]},"reference":[{"issue":"10172","key":"1672_CR1","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/S0140-6736(18)31665-9","volume":"393","author":"JT Evans","year":"2019","unstructured":"Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. 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NHS Health Research Authority advise that secondary uses of anonymised data for audit, research and quality improvement do not require approval by a research ethics committee. With support under Section 251 of the NHS Act 2006, the Ethics and Confidentiality Committee (ECC), (now the Health Research Authority Confidentiality Advisory Group) allows the NJR to collect patient data where consent is indicated as \u2018Not Recorded\u2019.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Before Personal Data and Sensitive Personal Data is recorded, express written patient consent is provided. The NJR records patient consent as either \u2018Yes\u2019, \u2018No\u2019 or \u2018Not Recorded\u2019.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AWB is a principal investigator on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker. GSM has received financial support for other research work from Arthritis Research UK, The Orthopaedics Trust, The Royal College of Surgeons of England and The Royal Orthopaedic Hospital Hip Research and Education Charitable Fund. GSM has also received personal fees for undertaking medicolegal work for Leigh Day. MRR has received grant funding or lecture fees from the Health Foundation, Stryker, Zimmer Biomet, Heraeus Medical, 3M healthcare, Vifor Pharma and Schuelke. MRW is a co-applicant on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"242"}}