Comparisons of Early Outcomes Between the Superior Approach and Posterior Approach in Total Hip Arthroplasty for Patients With Osteonecrosis of the Femoral Head

Purpose This study aimed to compare the early clinical outcomes between the superior approach (SA) and posterior approach (PA) in total hip arthroplasty (THA) for patients with osteonecrosis of the femoral head (ONFH), hypothesizing that SA offers advantages in terms of blood loss, complications, and early clinical outcomes. Methods A retrospective cohort study was conducted on 58 THAs performed on patients with ONFH between 2016 and 2023, divided into SA (n = 33) and PA (n = 25) groups. Demographic data, surgical parameters, radiographic outcomes, early clinical outcomes (Merle d'Aubigné-Postel and Harris Hip Scores (HHS)), and perioperative complications were analyzed. Statistical analyses included the Mann-Whitney U test, chi-square test, and Fisher's exact test, with significance set at p < 0.05. Results The SA group demonstrated significantly lower intraoperative blood loss (251 ± 130.9 mL vs. 504 ± 631.5 mL; p < 0.01) and perioperative total blood loss (416.5 ± 264.5 mL vs. 694 ± 510.3 mL; p < 0.05) compared to that in the PA group. At 1.5 months, the SA group showed better ability to walk (Merle d'Aubigné-Postel score: 4.3 ± 1.4 vs. 3.4 ± 1.3; p < 0.05) compared to the PA group. While both groups exhibited significant postoperative improvements, no significant differences were observed in the HHS. Two cases of dislocation and one of nerve palsy were observed in the PA group, whereas no complications were reported in the SA group. Conclusion This SA offers a minimally invasive option with fewer complications and is particularly advantageous for patients with ONFH.