title: Prosthesis survival after total hip arthroplasty--does surgical approach matter? Analysis of 19,304 Charnley and 6,002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register.
abstract: OBJECTIVE
  Controversies still exist about whether there is any effect of operative approach on survival of hip prostheses. We compared long-term survival of primary total hip arthroplasties in a well-defined study population from a national prospective population-based registry with regard to the three most commonly used surgical approaches.
  
  
  METHODS
  We assessed prosthesis survival according to surgical approach (the lateral with or without trochanteric osteotomy, and the posterolateral) for 19,304 Charnley and 6,002 Exeter total hip arthroplasties performed from 1987 to 2004.
  
  
  RESULTS
  For Charnley total hip arthroplasties, lateral approach with trochanteric osteotomy had a lower probability of revision than lateral approach without trochanteric osteotomy (RR=0.6, 95% CI: 0.5-0.8). The lower revision rate was due to fewer revisions for aseptic loosening and dislocation. The differences had declined in the latest time period (1995-2004). We observed no differences between lateral approach without trochanteric osteotomy and posterolateral approach, except that there were more revisions due to dislocation in the posterolateral approach group (RR=1.9, 95%CI: 1.1-3.2). No statistically significant differences were observed for Exeter total hip arthroplasties.
  
  
  CONCLUSIONS
  For Charnley prostheses, the lateral approach with trochanteric osteotomy gave a reduced revision risk compared to the other approaches, which was due to fewer revisions for dislocation, and in the first time period also fewer revisions due to aseptic loosening.
authors.affiliation: Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway. addi@lyse.net
authors.forename: Astvaldur J
authors.initials: AJ
authors.lastname: Arthursson
authors.forename: Ove
authors.initials: O
authors.lastname: Furnes
authors.forename: Birgitte
authors.initials: B
authors.lastname: Espehaug
authors.forename: Leif I
authors.initials: LI
authors.lastname: Havelin
authors.forename: Jon Arne
authors.initials: JA
authors.lastname: Söreide
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D016896:Treatment Outcome