Direct Anterior Versus Anterolateral and Posterior Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Abstract

BackgroundDifferent surgical approaches used in total hip arthroplasty (THA) include a direct anterior approach (DAA), anterolateral approach (AL), and posterolateral approach (PL). However, the acetabular cup position varies according to surgical view, surgical table, and patient position for each approach. This study is aimed to compare acetabular cup position in THA under different approaches, including surgical time, blood loss, and postoperative complications.MethodsBetween Jan 2017 and Dec 2018, 231 patients who underwent THA (64 DAA, 96 AL, and 71 PL THAs) were analyzed retrospectively. Intraoperative blood loss, operation time, preoperative and postoperative WOMAC score, cup anteversion, inclination angle, and postoperative complications were analyzed.ResultsDAA showed longer operation time and more blood loss, but shorter hospital stays. The cup was found in the safe zone for 97% of DAA patients, 74% of AL patients, and 56% of PL patients. PL showed the highest complication rate (9.9%), followed by DAA (3.1%) and AL (1%). There was no statistically significant difference in preoperative and postoperative WOMAC scores. ConclusionTHA by DAA using a special table is a more reliable procedure to achieve safe cup position. Although DAA showed fewer outliers in cup position, it resulted in longer operation time and greater blood loss compared to other groups.Trial registration: Retrospective study