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Should Mrs. Jones Have a Hip Joint Replacement Using the Posterior Approach?

Doctor No. 1: Mrs. Jones needs a total hip replacement. I think we'll use the posterior approach and come in from behind. There's less blood loss, and it's easy to get to the hip.

Doctor No. 2: That may not be such a good idea. She's more likely to dislocate after a posterior operation. In fact, studies show the dislocation rate is two to three times higher than when the hip is put in from the front (anterior approach).

Doctor No. 1: There isn't a lot of agreement from various studies which way is best. I don't think a posterior approach has to mean dislocation. It depends on how we put the implant in and how well Mrs. Jones follows our instructions.

Doctor No. 2: I just read a study done by three doctors who replace the joint using a posterior operation. They repair the backside of the joint capsule after cutting into it. They also reattach the short muscles that rotate the hip. The soft-tissue repair seems to make a big difference in the number of hip dislocations.

Doctor No. 1: Really? Tell me more about the results.

Doctor No. 2: Dislocations only occurred in eight of the 945 total hip replacements put in using the posterior approach. That's less than one percent. Other studies report a range from one to nine percent with a posterior approach and up to three percent with an anterior method. In this study, two hips dislocated because of a traumatic injury. Only two of the eight had a second operation to revise the hip.

Doctor No. 1: So with the right-sized implant put in with good alignment, we can reduce the number of dislocations when using a posterior approach?

Doctor No. 2: Yes, so long as we make repairs to the soft tissues that are cut in the process. Let's go over our exam findings and see if she's a good candidate otherwise for a posterior approach.

Doctor No. 1: Great idea. I'll get her chart and meet you back here in five minutes.

References: Steven H. Weeden, MD, et al. The Early Dislocation Rate in Primary Total Hip
Arthroplasty Following the Posterior Approach with Posterior Soft-Tissue Repair. In The Journal of Arthroplasty. September 2003. Vol. 18. No. 6. Pp. 709-713.

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