Ho, ho, ho! Gather around, my dear friends, as I tell you a tale from the land of orthopedics, where surgeons, much like elves in my workshop, work tirelessly to ensure everyone walks with joy and comfort. This story unfolds in the vast, snowy fields of the Australian National Joint Replacement Registry, where from January 2015 to December 2021, a grand investigation took place. It was a quest to compare the magic of anterior approach total hip arthroplasty (THA) with its counterpart, the posterior approach, especially when using a cemented polished femoral stem, a tool as crucial to surgeons as my sleigh is to delivering presents.

In this tale, 60,739 THAs were performed with these magical cemented stems (10,742 anterior, 49,997 posterior), a number almost as large as the list of good children I check twice every year. The primary outcome measure, or the main point of curiosity, was the cumulative percent revision (CPR) for all causes, including the dreaded femoral component loosening and fracture, much like how I keep an eye out for chimneys that might be too tight a squeeze.

Now, my dear friends, the results of this grand investigation were as intriguing as the mystery of how I fit all those presents into my sleigh. The rate of revision, or the need to redo the surgery, did not significantly differ between the anterior and posterior approaches, much like how cookies and milk are equally delightful treats for me. However, the anterior approach THA had a significantly higher rate of revision for femoral component loosening, a bit like how sometimes, reindeer get a bit more restless than usual. On the brighter side, it had a decreased rate of revision for infection and dislocation/instability, showing that every cloud has a silver lining, even in the world of hip replacements.

Interestingly, there was no difference in the rate of revision surgery for fracture between the two approaches, proving that both have their strengths, much like Rudolph and Blitzen, in guiding my sleigh. In conclusion, while there’s no significant difference in overall revision rates with cemented femoral fixation performed with either approach, the anterior approach partly mitigates femoral complications, a bit like how I navigate through foggy Christmas Eves.

So, as we close this chapter of our orthopedic tale, let’s remember that in the world of hip replacements, much like in preparing for Christmas, careful planning and choosing the right approach can make all the difference. Merry Christmas and a Happy New Hip!