Joint replacement (primary): hip, knee and shoulder

Recommendation ID: NG157/11
Question: Do the direct anterior, direct superior and supercapsular percutaneously assisted (SuperPATH) approaches to hip replacement improve patient-recorded outcome measures and reduce length of hospital stays, revision rates, neurological complications and surgical site infections compared with the posterior and anterolateral approaches?
Any explanatory notes (if applicable): Full details of the research recommendation are in evidence review M: hip replacement approach.

Why the committee made the recommendation

The committee looked at evidence on 5 surgical approaches for hip replacement: posterior, anterolateral, direct anterior, direct superior and supercapsular percutaneously assisted (SuperPATH). The evidence did not indicate that any of these approaches was more beneficial than any other. The National Joint Registry for 2017 reported that 97% of hip replacements were done using the posterior or anterolateral approach. They concluded that either of these 2 established approaches could be considered, with the choice of approach based on the knowledge and experience of the surgeon and individual patient characteristics.

There was limited evidence on the newer approaches (direct anterior, direct superior and SuperPATH) and the committee made a recommendation for research to investigate these approaches.

How the recommendation might affect practice

The recommendation reflects most current practice and is not expected to lead to substantial changes.

Source guidance details

Comes from guidance: Joint replacement (primary): hip, knee and shoulder
Number: NG157
Date issued: June 2020

Other details

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	01/06/2020