Comparison of three approaches for primary Total Hip Arthroplasty

Primary Total Hip Arthroplasty (THA) will be compared using three different surgical approaches. Anterior, Lateral and Posterior. Each approach has approximately the same surgical time of 90-120 minutes. Posterior Approach: This approach is the most common approach for THA worldwide today, made popular by Moore in 1959. This approach also allows excellent visualisation of the femoral shaft but involves detachment of the short external rotators of the hip with a posterior capsulotomy. Hardinge Approach: This was first described by Hardinge in 1982. This approach requires the reflection of gluteus medius and minimus muscles off the greater trochanter. Anterior Approach: Initial description of this approach to the hip joint was by Smith-Petersen. It utilises the anatomic internervous plane between the superior gluteal nerve laterally and femoral nerve medially and has recently been popularised for THR, but it’s first reported use dates back to 1947 in France by Judet and colleagues. Patients will be randomised to surgical approach for THA. Each consultant surgeon will perform the approach which is their usual standard of care. Pre-operatively and post-operatively PROMs (OHS, VAS) will be taken at 6 weeks, 6, 12 and 24 months. Complications will be monitored, specifically dislocation, infection and revision.