The influence of surgical approach on outcome in Birmingham hip resurfacing.
Various approaches have been described for metal-on-metal hip resurfacing. We compared the posterolateral and direct lateral approaches for complications, pain, function, and implant survival in the short and medium term for two surgeons in a consecutive series of 790 patients (909 hips; July 1997 to July 2004) followed until July 2007. The direct lateral approach group included 135 resurfacing procedures and the posterolateral group included 774 procedures. There was no difference between the two groups for age or gender. The minimum followup for the anterolateral group was 2 years (mean, 5.1 years; range, 2.0-9.4 years) and for the posterolateral group 2 years (mean, 5.5 years; range, 2.0-9.6 years). There were no differences between the two approaches for complications, additional surgery, implant survival, or Oxford hip scores. The 8-year survival rate was 97.9% (95% confidence interval, 89.9-100) for the direct lateral approach and 97.2% (95% confidence interval, 93.9-99.3) for the posterolateral approach. This study indicates both approaches offer excellent pain reduction and return to function after Birmingham hip resurfacing with no difference in survival or in the incidence of complications. An 8-year survival rate of 97% can be achieved using either the posterolateral approach or the direct lateral approach.


METHODS
Level III, therapeutic study. See the Guidelines for authors for a complete description of levels of evidence.
McBryde
Callum W
CW
Research and Teaching Centre, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK, B31 2AP. cwmcbryde@hotmail.com
Revell
Matthew P
MP
Thomas
Andrew M
AM
Treacy
Ronan B
RB
Pynsent
Paul B
PB
D018771:Arthralgia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016022:Case-Control Studies; D002857:Chromium; D003035:Cobalt; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
D002857:Chromium; D003035:Cobalt