Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period

Abstract

Purpose: Direct anterior approach total hip arthroplasty (DA THA) has been reported to improve early outcomes compared to posterior approach THA up to 6 weeks postoperatively. Limited weekly outcomes data are available prior to 6 weeks. We evaluate outcomes including when patients first drive a car, leave home, and discontinue their assist device. Methods: Patients undergoing THA for primary osteoarthritis were prospectively enrolled. Outcomes data were collected preoperatively and postoperatively at weekly intervals for 6 weeks. Results: 111 patients (55 DA and 56 posterior approach) were enrolled. There was no significant difference ( p > 0.05) in pre-surgical Patient-Reported Outcomes Measurement Information System (PROMIS) scores or modified Harris Hip Score (mHHS). Postoperatively, the DA THA group had decreased length of stay ( p = 0.0002) and increased distance walked on postoperative day 1 and 2 ( p = 0.011, p = 0.0004). The DA group had lower pain scores ( p < 0.05) and required less day 1 and total narcotics ( p = 0.029, p = 0.01). The DA cohort had improved PROMIS Physical Function scores and mHHS up to 5 weeks postoperatively. DA patients discontinued their assistive device 8 days earlier ( p = 0.01), left home 3 days earlier ( p = 0.001), and drove a car 5 days earlier ( p = 0.01). Conclusions: Patients undergoing DA THA discontinued their assistive device, left their home, and drove a car sooner than posterior approach patients. We found improvement in physical function with DA, and it persisted up to 5 weeks postoperatively. Furthermore, DA patients had significantly shorter length of stay, improved mobilisation, decreased narcotic requirements and improved inpatient pain scores compared to posterior approach THA. Future randomised controlled study should be performed to minimise the biases inherent in this study methodology and confirm the results.

Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis

“…Some studies show that compared with the PA, the DAA leads to less blood loss, low transfusion rates, shorter surgery times, a shorter length of hospital stay (LOS), low postoperative complication rates and better functional recovery [10][11][12][13][14][15][16][17]. Other studies have shown that DAA is associated with higher postoperative complication rates than is PA [18,19], especially regarding neuropraxia in the lateral cutaneous nerve of the thigh [18,20].…”

Measures of Hip Function and Symptoms

“…However, more recent studies have begun to use PROMIS instruments in assessment of outcomes related to surgical intervention for different hip pathologies. Clinical studies on outcomes after THA have used PROMIS scores for assessment of both functional outcomes and pain improvement postoperatively . PROMIS instruments have been used in clinical trials assessing baseline disability and functional performance in patients with femoroacetabular impingement (FAI) .…”

“…Further evaluation of the psychometric properties of PROMIS instruments, specifically for hip pathology, would be beneficial; however, PROMIS instruments have been used in several clinical trials involving THA, FAI, and hip dysplasia . Investigators should take note of the previously reported high floor effects in THA populations .…”

Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

“…On one hand, the direct anterior approach (DAA) is seen as a kind of true minimally invasive approach because of less muscle damage, which enters the operation area of the hip joint by muscle gap [7,8] .On the other hand, the conventional posterior approach (PA) is the most frequently used surgical approach for THA [9] . Some studies show DAA is inclined to less blood loss, low transfusion rates, shorter surgery times, shorter length of hospital stay (LOS), low postoperative complication rates and better functional recovery [10][11][12][13][14][15][16][17] . Some other studies find higher postoperative complication rates in the DAA group compared with PA group [18,19] , especially the lateral cutaneous nerve of thigh neuropraxia [18,20] .…”