title: Surgical approach and patient-reported outcomes after total hip replacement.
abstract: BACKGROUND
  Previous research has mainly focused on how factors such as surgical approach might affect implant survivorship and the incidence of complications. Given the increasing interest in patient-reported outcomes, the purpose of this study is to explore whether surgical approach is associated with patient-reported pain, function, and satisfaction at 1-3 years after primary total hip replacement (THR).
  
  
  METHODS
  Details of surgical factors were collated from operation notes for all consecutive patients at our centre from 2004-2006. All patients were mailed a questionnaire 1-3 years following surgery that collected WOMAC pain and function scores and the Self-Administered Patient Satisfaction Scale for Primary Hip and Knee Arthroplasty. Of the eligible 1,315 patients, 911 patients returned a completed questionnaire (69% response rate). Multivariable fractional logit models were used to identify whether surgical approach was associated with outcome scores.
  
  
  RESULTS
  Surgical approach was found to be a significant predictor of patient-reported outcomes at 1-3 years after surgery, even after controlling for patient-specific factors. A posterior approach was associated with better scores on all three outcome measures. On average, predicted outcome scores for a typical patient with a posterior approach were between 3.5 and 7.2 percentage points higher than an equivalent patient with an anterolateral approach.
  
  
  CONCLUSIONS
  These findings suggest that clinical decisions concerning surgical approach may have an observable impact on patient-reported levels of pain, function, and satisfaction following THR.
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Smith
authors.forename: Vikki
authors.initials: V
authors.lastname: Wylde
authors.forename: James R
authors.initials: JR
authors.lastname: Berstock
authors.forename: Angus D
authors.initials: AD
authors.lastname: Maclean
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000523:psychology; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D010146:Pain; D010147:Pain Measurement; D017060:Patient Satisfaction; D020127:Recovery of Function; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome