Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes

Abstract

Introduction: The direct anterior approach (DAA) has gained popularity in recent years for total hip arthroplasty (THA). Several authors reported significantly better early outcomes when compared to the posterior approach (PA). Nevertheless, controversy exists regarding longer-term benefits of the DAA. Methods: Data was prospectively collected and retrospectively reviewed for primary THAs conducted between July 2008 and July 2016. Patients who underwent DAA and PA with minimum 2-year follow-up for Harris Hip Score (HHS), Forgotten Joint Score-12 (FJS-12), Veteran RAND 12 Mental (VR-12 Mental), Veteran RAND 12 Physical (VR-12 Physical), 12-Item Short Form Survey Mental (SF-12 Mental), 12-Item Short Form Survey Physical (SF-12 Physical), visual analogue scale, and patient satisfaction were included. Propensity score matching was performed on the DAA and PA cohorts (1:1) based on the following variables: age, sex, body mass index, and laterality. Results: 205 DAA hips were satisfactorily matched to 205 PA hips. The DAA group had higher scores at final follow-up for VR-12 Mental ( p = 0.0145), VR-12 Physical ( p = 0.0236), SF-12 Mental ( p = 0.0393), and SF-12 Physical ( p = 0.0391). The DAA and PA groups had comparable HHS ( p = 0.0737) and FJS-12 ( p = 0.2900). Conclusions: Although the DAA and PA groups had different follow-up periods, both the DAA and PA groups reported favourable outcomes at minimum 2-year follow-up. While both groups achieved comparable scores for the majority of PROs including VAS and patient satisfaction, the DAA group achieved superior quality of life outcomes when compared with a propensity score matched group of PA surgeries.

General vs Neuraxial Anesthesia in Direct Anterior Approach Total Hip Arthroplasty: Effect on Length of Stay and Early Pain Control

“…Total hip arthroplasty (THA) is one of the most frequently performed procedures in the United States and its demand is expected to continuing increasing in upcoming years [ 1 ]. The direct anterior approach to THA has become increasingly popular and has resulted in significant improvements in quality of life outcomes for patients [ 2 ]. Although benefits to regional anesthesia have been reported [ 3 ] we sought to standardize the evaluation and eliminate possible confounding variables that may be introduced by including different approaches.…”

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

“…With the development of ERAS in recent years, DAA has received increasing attention, and the utilization of DAA THA has increased because of its short invasive incision, reduced intraoperative bleeding, and improved recovery time. Many hospitals have carried out DAA THA and obtained satisfactory postoperative results [14]. With the increase in the number of operations, however, various intraoperative or postoperative complications have emerged [15].…”

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

“…With the development of ERAS in recent years, DAA had been giving more and more attention, and the utilization of DAA THA has been increased because its shorter invasive incision, less intraoperative bleeding, and improved recovery time. Many hospitals have carried out DAA THA and obtained satisfactory postoperative results [14]. With the increase of operations, however, various intraoperative or postoperative complications have emerged [15].…”