Another paper using the anterior approach in 189 female patients had 81 with some incontinence prior to surgery. At three months from surgery, 64% of the sufferers were improved, and only 4% worsened. (Tamaki et al) A third paper looked at stress vs urge incontinence after anterior approach. 36 of 50 patients were cured or improved. The subgroups are small, but stress incontinence and mixed incontinence did best, but urge incontinence alone also seemed improved. (Okumura et al)

The anterior approach has a disadvantage with an increased risk of fracture in the leg – the common figure quoted being 1%. Given the results with our mini posterior approach having a 1% dislocation rate, and 70% of patients home the day after surgery, it seems that dislocation risk is swapped for fracture risk. None the less if there is an advantage for bladder function, perhaps it is worthwhile. David Mitchell & Shaun English are doing anterior hip replacements for select patients, without a traction table.

Refs:
1. Baba T; Homma Y; Takazawa N; Kobayashi H; Matsumoto M; Aritomi K; Yuasa T; Kaneko K. Is urinary incontinence the hidden secret complications after total hip arthroplasty? Eur J Orthop Surg Traumatol 2014 Dec;24(8):1455-60 (ISSN: 1633-8065)
2. Okumura K; Yamaguchi K; Tamaki T; Oinuma K; Tomoe H; Akita K, Prospective analyses of female urinary incontinence symptoms following total hip arthroplasty. Int Urogynecol J 2017 Apr;28(4):561-568
3. Tamaki T; Oinuma K; Shiratsuchi H; Akita K; Iida S. Hip dysfunction-related urinary incontinence: a prospective analysis of 189 female patients undergoing total hip arthroplasty. Int J Urol 2014 Jul;21(7):729-31

David Mitchell
Ballarat Orthopaedics & Sports Medicine