This registry study of 122,345 primary THAs from the Australian National Joint Replacement Registry (2015–2018) asks whether surgical approach affects early revision rates. It compares posterior, lateral, and anterior approaches in patients operated on for osteoarthritis, adjusting for age, sex, BMI, ASA score, femoral head size, and fixation.
The narrative around THA approach has long been framed as a binary trade-off: posterior approach means more dislocations, anterior means faster recovery. This registry of 122,345 patients shows the real picture is more nuanced.
When counseling patients, the headline is reassuring: overall revision risk is equivalent across all three approaches. But the type of complication is not equivalent, and that matters for shared decision-making.
For a patient where instability is the primary concern (poor soft-tissue compliance, neuromuscular disease, revision setting), the data support favoring anterior or lateral over posterior. For a patient where femoral anatomy is complex or your femoral preparation is constrained, the anterior approach's 2× femoral loosening rate and doubled early fracture risk deserve explicit consideration.
The authors flag that the actual periprosthetic fracture burden after anterior approach is likely higher than these registry numbers show — fractures managed with cerclage wiring without component revision are not captured. When you choose the anterior approach, meticulous femoral preparation and appropriate stem sizing are not optional: they are the mechanism by which you prevent the dominant failure mode of this approach.
This registry study of 122,345 primary THAs from the Australian National Joint Replacement Registry (2015–2018) asks whether surgical approach affects early revision rates. It compares posterior, lateral, and anterior approaches in patients operated on for osteoarthritis, adjusting for age, sex, BMI, ASA score, femoral head size, and fixation.
The narrative around THA approach has long been framed as a binary trade-off: posterior approach means more dislocations, anterior means faster recovery. This registry of 122,345 patients shows the real picture is more nuanced.
When counseling patients, the headline is reassuring: overall revision risk is equivalent across all three approaches. But the type of complication is not equivalent, and that matters for shared decision-making.
For a patient where instability is the primary concern (poor soft-tissue compliance, neuromuscular disease, revision setting), the data support favoring anterior or lateral over posterior. For a patient where femoral anatomy is complex or your femoral preparation is constrained, the anterior approach's 2× femoral loosening rate and doubled early fracture risk deserve explicit consideration.
The authors flag that the actual periprosthetic fracture burden after anterior approach is likely higher than these registry numbers show — fractures managed with cerclage wiring without component revision are not captured. When you choose the anterior approach, meticulous femoral preparation and appropriate stem sizing are not optional: they are the mechanism by which you prevent the dominant failure mode of this approach.