A Crossover Cohort of Direct Anterior vs Posterolateral Approach in Primary Total Hip Arthroplasty: What Does the Patient Prefer?

Abstract

Background: The utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) continues to markedly increase. Despite proposed advantages, there are limited data regarding outcomes of staged bilateral THA via 2 different approaches in the same patient. The purpose of this study was to elucidate patient perspective on the THA approach in a crossover cohort of patients who underwent consecutive THAs via the posterolateral approach (PLA) followed by a contralateral DAA. Methods: A retrospective chart review and telephone interview were performed on 37 patients who underwent both THA approaches by a single surgeon from 2009 to 2019. Perioperative outcomes, complications/reoperations, and the patient-preferred approach were collected. The mean clinical follow-up was 105 and 44 months after PLA and DAA, respectively. Results: After DAA THA, patients demonstrated lower postoperative day 1 visual analog scale pain scores (1.8 vs 2.9, P ¼ .016) and ambulation (239 feet vs 31 feet, P < .001). The length of stay was significantly less (P < .001) for the DAA (1.9 days) compared with the PLA (3.1 days). There were no major complications or reoperations in either cohort. Most patients (26/37, 70%) preferred the DAA and stated that it was easier to recover from (30/37, 81%). Conclusion: In the same patient direct comparison, the DAA for THA may lead to less pain and improved ambulation in the early postoperative period. Furthermore, most patients prefer the DAA and believe it is easier to recover from than the PLA.

Modified Direct Anterior Approach for Total Hip Arthroplasty in an Indonesian Population with Primary Standard Instruments of Total Hip Arthroplasty: Our Experiences and Short-term Follow-up

“…The most frequently used procedures for THA are the direct lateral and posterior approaches 2,3 . The posterior method is the most often utilized worldwide 4,5,6,7 . Minimally invasive surgical methods for primary THA with the direct anterior approach continue to be an extremely successful operation 5,8 .…”

“…The direct anterior approach (DAA) has received increased attention from orthopedic surgeons and patients throughout the world 1,2,7,9 and tissuesparing arthroplasty has led to a surge in the use of DAA for total hip arthroplasty 10 . The advantages of DAA include less bleeding, faster recovery after surgery, less pain, lower dislocation rate, and accurate prosthesis placement 1,5,11,12,13,14 .…”