title: Posterior approach to optimise patient-reported outcome from revision hip arthroplasty.
abstract: BACKGROUND
  Most total hip arthroplasties (THAs) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery.
  
  
  METHODS
  A retrospective cohort study of 205 patients who underwent revision THA for aseptic loosening. Patients rated their pain from 0-10 and completed the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), WOMAC and Short form-12 questionnaires.
  
  
  RESULTS
  205 patients (209 hips) from a cohort of 238 patients (243 hips, 86%) were available for analysis. The mean follow-up was 5 years (SD 1.71). Grouping by approach 20% (43/209) had both primary and revision procedures via a lateral approach, 20% (43/209) had their primary surgery via a lateral approach and their revision surgery via a posterior approach, whilst 60% (123/209) had both procedures via a posterior approach.The WOMAC and OHS were significantly better in patients who had a posterior approach for both primary and revision surgery, compared to those that did not (OHS p = 0.028, WOMAC p = 0.026). We found no significant differences in pain, satisfaction or health-related quality of life between the groups.
  
  
  CONCLUSIONS
  Choice of approach for revision hip arthroplasty is influenced by a number of factors, but in clinical situations where either a lateral or posterior approach could be used, the posterior approach appears to be associated with better joint-specific outcomes. Registry data may help further explore the associations between surgical approach and the outcome from revision THA.
authors.affiliation: Musculoskeletal Research Unit, Southmead Hospital, Bristol - UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Blackburn
authors.affiliation: Musculoskeletal Research Unit, Southmead Hospital, Bristol - UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Lim
authors.affiliation: Musculoskeletal Research Unit, Southmead Hospital, Bristol - UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Harrowell
authors.affiliation: Musculoskeletal Research Unit, Southmead Hospital, Bristol - UK.|Royal Orthopaedic Hospital, Birmingham - UK.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Parry
authors.affiliation: Musculoskeletal Research Unit, Southmead Hospital, Bristol - UK.
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
authors.affiliation: Musculoskeletal Research Unit, Southmead Hospital, Bristol - UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Whitehouse
mesh_terms: D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D000071066:Patient Reported Outcome Measures; D018579:Patient Selection; D020127:Recovery of Function; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome