Complications after direct anterior versus Watson-Jones approach in total hip arthroplasty: results from a matched pair analysis on 1408 patients

Abstract

Background The direct anterior approach (DAA) has gained popularity in total hip arthroplasty (THA) over the past decade. A large number of studies have compared the DAA to other approaches with inclusion of a learning curve phase. The aim of this study was to compare the complication rate and bleeding between the DAA and the anterolateral approach after the learning curve phase. Methods For this retrospective, single-institutional study, propensity score matching was performed, from an initial cohort of 1408 patients receiving an elective THA. Two matching groups were created, comprising of 396 patients each. After matching, both groups were similar in age, gender, body mass index, anesthesiologist’s score and surgeon’s experience. Results Average age in the matched groups was 68.7 ± 10.3 years. The total blood loss was similar in both groups, 450 vs 469 mL ( p = 0.400), whereas the transfusion rate (14.1 vs 5.8%, p < 0.001) and the overall complication rate (17.6 vs 12.1%, p = 0.018) were lower in the DAA group. The overall fracture rate was comparable, 1.5 vs 1% ( p = 0.376), as well as the early infection rate, 0.3 vs 1% ( p = 0.162). The dislocation rate was significantly increased in the DAA group, 2.2 vs 0.5% ( p = 0.032). Conclusions The direct anterior approach has comparable short-term surgical complications with reduced transfusion and general complication rates. Level of evidence Level III retrospective study.

Prospective Short-Term and Return-to-Sports Results of a Novel Uncemented Short-Stem Hip Prosthesis with Metaphyseal Anchorage

“…This is consistent with findings in the literature, especially in contrast to posterior approaches [33,34]. Inconsistent data exist when comparing that approach to the anterolateral one [35]. In our series, however, we were able to reach an overall complication rate comparable to the posterior approach.…”

Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position Versus Supine Position: A Random Clinical Trial

“…Zhao Wang et al researched a meta-analysis about 184 cases of DAA and 175 cases of PA, demonstrated that the average incision length of DAA for THA was 3.51cm less than posterior approach [13]. Klasan et al compared DAA with anterolateral approach, demonstrated that the blood transfusion rate was statistically decreased in DAA group, with 5.8% of 14.1% lower compared to anterolateral approach [14]. Whereas, DAA could be performed in lateral decubitus position or supine position, and there were few studies conducted on comparison these two different positions of DAA for THA.…”

Determination of Complications of Patients Undergoing Total Hip Replacement after Discharge

“…Taburculuk sırasında verilen yetersiz eğitimin hemşirenin verdiği eğitimden kaynaklandığı saptanmıştır (Tablo 7). (Higuera et el., 2011;Wright et el., 2012;Foster et al, 2015;Mclawborn et el., 2017;Deakin et al, 2018;Klasan et al, 2019). Eğitim düzenin artması bireylere verilecek olan hemşirelik eğitimin daha kolay anlaşılmasını ve uygulanmasını sağlar.…”