{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:12Z","timestamp":1787755632637,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Compared with other total hip arthroplasty (THA) approaches, the anterior approach has an increased rate of revision for femoral-sided complications, and certain stems may increase this risk. The present study aimed to assess the outcome of THA by surgical approach, according to the femoral stem utilized in the procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for osteoarthritis via the anterior or posterior approach with use of 1 of 5 of the most common cementless femoral stems from January 2015 to December 2019. The primary outcome measures were the cumulative percent revision (CPR) for all causes and for femoral stem loosening and fracture. The CPR was compared between THAs performed via the anterior and posterior approaches for all stems and for each individual femoral stem, as well as between individual femoral stems for each approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study included 48,716 THAs performed with use of cementless stems, of which 22,840 utilized an anterior approach and 25,876 utilized a posterior approach. There was no difference in the all-cause CPR between the anterior and the posterior approach, but the anterior approach had a higher CPR for loosening (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.48 to 2.69; p &lt; 0.001) and fracture (HR, 1.78; 95% CI, 1.34 to 2.35; p &lt; 0.001). There was apparent variation in the CPR across the different cementless stems when an anterior approach was utilized. The Quadra-H (Medacta) had a higher all-cause CPR when compared with the Polarstem (Smith &amp; Nephew; HR, 1.49; 95% CI, 1.16 to 1.91; p = 0.002) and Corail (DePuy Synthes; HR, 1.31; 95% CI, 1.00 to 1.70; p = 0.0478). Variation was less apparent with the posterior approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>THAs performed via the anterior approach had higher rates of revision for femoral stem loosening and fracture, with greater variation in outcomes between individual stems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.00487","type":"journal-article","created":{"date-parts":[[2021,10,15]],"date-time":"2021-10-15T21:53:15Z","timestamp":1634334795000},"page":"24-32","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["The Effect of Surgical Approach and Femoral Prosthesis Type on Revision Rates Following Total Hip Arthroplasty"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0608-3065","authenticated-orcid":false,"given":"Wayne","family":"Hoskins","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia"},{"name":"Traumaplasty Melbourne, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2971-9222","authenticated-orcid":false,"given":"Sophia","family":"Rainbird","sequence":"additional","affiliation":[{"name":"Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Peng","sequence":"additional","affiliation":[{"name":"Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E.","family":"Graves","sequence":"additional","affiliation":[{"name":"Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1656-5762","authenticated-orcid":false,"given":"Roger","family":"Bingham","sequence":"additional","affiliation":[{"name":"Traumaplasty Melbourne, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,10,14]]},"reference":[{"issue":"5","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.arth.2014.12.022","article-title":"Evaluating online information regarding the direct anterior approach for total hip arthroplasty","volume":"30","author":"Mohan","year":"2015","journal-title":"J Arthroplasty."},{"issue":"21","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.2106\/JBJS.19.01289","article-title":"Early Rate of Revision of Total Hip Arthroplasty Related to Surgical Approach: An Analysis of 122,345 Primary Total Hip Arthroplasties","volume":"102","author":"Hoskins","year":"2020","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1016\/j.arth.2018.01.014","article-title":"Early failure of primary total hip arthroplasty: is surgical approach a risk factor?","volume":"33","author":"Angerame","year":"2018","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.arth.2016.09.012","article-title":"The direct anterior approach is associated with early revision total hip arthroplasty","volume":"32","author":"Eto","year":"2017","journal-title":"J Arthroplasty."},{"issue":"6","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1007\/s11999.0000000000000208","article-title":"Do stem design and surgical approach influence early aseptic loosening in cementless THA?","volume":"476","author":"Janssen","year":"2018","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"559","DOI":"10.3109\/17453674.2012.742394","article-title":"The type of surgical approach influences the risk of revision in total hip arthroplasty: a study from the Swedish Hip Arthroplasty Register of 90,662 total hip replacements with 3 different cemented prostheses","volume":"83","author":"Lindgren","year":"2012","journal-title":"Acta Orthop."},{"issue":"2","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2106\/JBJS.16.00060","article-title":"Direct anterior approach: risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study","volume":"99","author":"Meneghini","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.ocl.2009.04.004","article-title":"Complications of the direct anterior approach for total hip arthroplasty","volume":"40","author":"Barton","year":"2009","journal-title":"Orthop Clin North Am."},{"issue":"2","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s11999-014-3827-z","article-title":"Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results","volume":"473","author":"Poehling-Monaghan","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"342","DOI":"10.3109\/17453674.2012.711701","article-title":"High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach","volume":"83","author":"Spaans","year":"2012","journal-title":"Acta Orthop."},{"issue":"10","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.arth.2015.04.026","article-title":"Difference in stem alignment between the direct anterior approach and the posterolateral approach in total hip arthroplasty","volume":"30","author":"Abe","year":"2015","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.arth.2019.10.060","article-title":"The effect of size for a hydroxyapatite-coated cementless implant on component revision in total hip arthroplasty: an analysis of 41,265 stems","volume":"35","author":"Hoskins","year":"2020","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.arth.2016.08.027","article-title":"A prospective randomized clinical trial in total hip arthroplasty\u2014comparing early results between the direct anterior approach and the posterior approach","volume":"32","author":"Cheng","year":"2017","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1097\/01.blo.0000533621.57561.a4","article-title":"Is cemented or cementless femoral stem fixation more durable in patients older than 75 years of age? A comparison of the best-performing stems","volume":"476","author":"Tanzer","year":"2018","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1080\/17453674.2017.1317515","article-title":"Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty","volume":"88","author":"Zijlstra","year":"2017","journal-title":"Acta Orthop."},{"issue":"7S","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"S363","DOI":"10.1016\/j.arth.2021.02.012","article-title":"Periprosthetic Femur Fracture Risk: Influenced by Stem Choice, Not Surgical Approach","volume":"36","author":"Sershon","year":"2021","journal-title":"J Arthroplasty."},{"issue":"9","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/j.arth.2016.02.045","article-title":"Risk factors for perioperative femoral fractures: cementless femoral implants and the direct anterior approach using a fracture table","volume":"31","author":"Hartford","year":"2016","journal-title":"J Arthroplasty."},{"issue":"12","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"3860","DOI":"10.1007\/s11999-015-4565-6","article-title":"What is the learning curve for the anterior approach for total hip arthroplasty?","volume":"473","author":"de Steiger","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.arth.2017.09.015","article-title":"Perioperative fractures in cementless total hip arthroplasty using the direct anterior minimally invasive approach: reduced risk with short stems","volume":"33","author":"Dietrich","year":"2018","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.arth.2017.09.065","article-title":"Cementless tapered-wedge stem length affects the risk of periprosthetic femoral fractures in direct anterior total hip arthroplasty","volume":"33","author":"Tamaki","year":"2018","journal-title":"J Arthroplasty."},{"issue":"5","key":"bib21-20250430","first-page":"1","article-title":"The effect of surgical approach on early complications of total hip arthroplasty","volume":"1","author":"Tay","year":"2019","journal-title":"Arthroplasty."},{"issue":"10","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1111\/ans.16149","article-title":"Early surgical complications of total hip arthroplasty related to surgical approach","volume":"90","author":"Hoskins","year":"2020","journal-title":"ANZ J Surg."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00487","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:46:15Z","timestamp":1787751975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00487"}},"subtitle":["An Analysis of the Most Commonly Utilized Cementless Stems"],"short-title":[],"issued":{"date-parts":[[2021,10,14]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.21.00487","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,14]]}}}