Total Hip Arthroplasty in Patients Younger than 35 Is Effective Regardless of Surgical Approach

Abstract

Despite the increasing frequency of younger patients undergoing total hip arthroplasty (THA), very few, if any, studies report on postoperative outcomes that specifically compare the two most commonly used approaches in this age group. The purpose of our study is to assess whether surgical approach affects postoperative outcomes in THA patients younger than 35 years. A retrospective analysis of 115 patients younger than 35 years that underwent primary unilateral THA between January 2013 and April 2018 was conducted. Patients were divided into two cohorts: (1) patients that underwent THA utilizing the anterior approach and (2) patients that underwent THA utilizing the posterior approach. Subanalysis controlling for surgical case complexity and use of robotic assistance was performed. Radiographic analysis included measurement of perioperative leg length discrepancies. Of the total 115 patients, 37 were in the anterior THA cohort, and 78 were in the posterior THA cohort. All baseline patient characteristics were similar among both cohorts. Patients in the anterior THA cohort had shorter mean operative times (95 vs. 121 minutes; p < 0.01) and shorter mean hospital length of stay or LOS (1.9 vs. 2.8 days; p < 0.01). Leg length discrepancies, dislocation, revision, and all-cause postoperative complication rates were similar between both cohorts. When excluding complex cases and use of robotic assistance (anterior n = 36, posterior n = 39), there was no difference in operative time, LOS, or postoperative outcomes. Our study suggests that surgically complex patients were more likely to undergo posterior rather than anterior THA. When controlling for surgical complexity and use of robotic assistance, no difference between approach with respect to operative time, hospital LOS, dislocation, revision, and all-cause postoperative surgical complication rates in THA recipients under 35 years of age was found. The results suggest that the anterior and posterior approaches can be equally effective for the majority of young THA patients.